A Competing Risk Hazard Model for Complications of Diabetes Mellitus

Diabetes mellitus is a major public health problem globally. It is the cause of serious and sometimes life-threatening complications leading to death. It is one of the most common non communicable diseases and leading cause of death in most developed countries including Bangladesh. It is associated with the increased risk of microvascular (nephropathy and retinopathy), macrovascular (cardiovascular diseases, stroke) and other mixed (cataract, pulmonary tuberculosis, foot ulcer etc.) complications. The aim of this study was to determine the risk factors related to diabetes complications and to propose competing risk models for analyzing complications of diabetes mellitus. We study 2887 diabetic patients from the BIRDEM registry record books for the period from 1984 to 1997 who have at least two follow-up visits and who are free from complications at the first visit. The data on variables such as 2-hBG, age, sex, family history of diabetes, area of residence, educational level, BMI, SBP, DBP and treatment status are obtained. Also, the time from the diagnosis of type 2 diabetes mellitus (T2DM) to the occurrence of complications was recorded. We use the competing risk hazard model and examined the potential risk factors for determining the development of such complications. This study reveals that increase in blood pressure is a potential risk factor for CHD and nephropathy in T2DM. We also found that male and illiterate patients are more affected by nephropathy. In our study, we also revealed that female and illiterate patients are also more influenced by cataract.

Childhood diabetes in a Bangladeshi population

Backgrounds and Aims: Several epidemiological investigations revealed that the prevalence of Type 2 Diabetes Mellitus (T2DM) has been increasing in the adult population of Bangladesh. But the prevalence of diabetes among the children and adolescents in Bangladesh has not been reported. This study addressed the prevalence of diabetes among the younger people in Bangladesh. Subjects and Methods: We investigated school children of age group 10 - 18 years in rural, suburban and urban communities. Investigations included socio-demographic information, height, weight, mid-upper-arm circumference (MUAC), blood pressure (SBP, DBP) and fasting plasma glucose (FPG). We used WHO criteria (1999) for impaired fasting glucose (IFG) and diabetes mellitus (T2DM). Results: A total of 2152 students (boys/girls: 1064/1088) volunteered the study. Their mean (SD) age was 13.3 (2.0) y, BMI was 18.5 (3.1) and MUAC was 21.2 (3.4) cm. The mean (SD) of FPG was 4.6 (0.87) mmol/l. The prevalence of IFG (95% CI) was 3.4% (2.63 - 4.17) and T2DM was 1.8% (1.23 - 2.37). BMI showed no association with FPG in either sex. In assessing risk for hyperglycemia (FPG > = 5.6mmol/l), logistic regression showed [odds ratio (OR) with 95% CI] that compared with lower age (16 y) higher age had excess risk (OR 5.2, 2.92 - 9.23). Compared with the rural the urban children had higher risk (OR 14.7, 6.41 - 33.78). Higher family income was also found to have higher risk (BDT 8000: OR 2.03, 1.30 - 3.18);whereas, higher BMI and MUAC were proved to be not significant. Conclusions: The prevalence of IFG and T2DM in Bangladeshi children and adolescents appears to be high. The urban children from the higher family income are the most vulnerable for developing diabetes, obesity and hypertension. A prospective cohort including other variables like physical activities, waist-girth, insulin or macro-/micronutrients may explain which risk factors are significant for developing diabetes among children and adolescents in Bangladesh.

Diabetes and Hypertension in a Santhal Tribe in Bangladesh: A Population Based Study

BACKGROUND: Santhal (Santals) tribe is one of the oldest and largest aboriginal pre Aryan populations in India and Bangladesh. There was no published report on the prevalence of diabetes and hypertension. OBJECTIVE: To determine the prevalence of type 2 diabetes mellitus (T2DM) and hypertension in a Santhal tribe of Bangladesh. RESEARCH DESIGN AND METHODS: Eight villages inhabited largely by Santhal tribe were purposively selected. All Santhals aged 20 years or more were considered eligible and enlisted for the study. Investigations included socio-demographic information (age, sex, education, income), clinical history (general illness), anthropometry (height, weight, waist-girth, hip-girth) and blood pressure. Body mass index (BMI) and waist-to-hip ration (WHR) were calculated. Blood samples were collected for fasting plasma glucose (FPG), total cholesterol (Chol), triglycerides (TG), urea and creatinine. RESULTS: Thirteen hundred eligible Santhals were enlisted. Of them, 1049 (80.7%) participated in the study. The male and female participants were 40% and 60%, respectively. The prevalence of T2DM was 0.6% and hyperglycemia (FPG > 5.5 mmol/l) was 10.0%. The prevalence of systolic hypertension (sHTN) was 24.4% and diastolic hypertension (dHTN) was 24.6%. Compared with the males the females had significantly higher prevalence of sHTN (OR, 2.20 with 95% CI, 1.62 - 3.02) and dHTN (OR, 1.81 with CI, 1.34 - 2.0);whereas, the prevalence of T2DM and IFG did not differ. Regarding obesity 45% of the participants had BMI 23.1. Logistic regression estimated that the increasing age, female sex, higher FPG (>5.5 mmol/l) and higher Chol (>160 mg/dl) had independent risk for sHTN and dHTN. CONCLUSIONS: The Santhals had less risk for diabetes but increased risk for hypertension. The Santhal females had excess risk of hypertension. Advancing age, female sex, hyperglycemia and hypercholesterolemia were found to have significant risk for hypertension. Obesity had no effect on diabetes or hypertension. High dietary salt intake among Santhals might have contributed to the development of hypertension. Further study may confirm the study findings and to understand why this tribe is less susceptible to diabetes and more to hypertension.