Socioeconomic disparities in diabetes prevalence and management among the adult population in Bangladesh

Prevalence and regional disparities of undiagnosed diabetes mellitus in Bangladesh: Results from the Bangladesh Demographic and Health Survey data

BACKGROUND

While undiagnosed diabetes mellitus (DM) presents a substantial global concern, there is a dearth of research examining its prevalence and characteristics specifically within the regional context of Bangladesh. The study focused on assessing the prevalence of undiagnosed diabetes mellitus in Bangladesh and examining regional disparities.

METHODS

The study analyzed data from the Bangladesh Demographic and Health Survey conducted between 2017 and 2018. The analysis focused on 11,911 participants aged 18 and above. Prevalence rates of both diagnosed and undiagnosed DM were calculated across various demographic and regional factors. To understand the impact of socio-demographic and regional variables on diagnosed and undiagnosed DM, the study employed multinomial regression analysis.

RESULTS

The study encompassed 11,911 participants with an average age of 39, of whom 57% were females. Among them, 333 individuals (2.8%) were diagnosed with diabetes mellitus (DM), while 667 participants (5.6%) had undiagnosed DM. The prevalence of both diagnosed and undiagnosed DM was notably higher in elderly, hypertensive, overweight or obese, and rural residents. Regression analysis indicated that individuals aged 70 and above faced 2.14 times more likely of diagnosed diabetes compared to those aged 30-39 (RRR = 2.20; 95% CI = 1.35-3.58). Regarding residential regions, individuals from the city exhibited significantly higher prevalence rates for both diagnosed DM (RRR: 1.83; 95% CI = 1.31-2.57) and undiagnosed DM (RRR: 1.52; 95% CI = 1.18-1.95) compared to those from the rural of Bangladesh.

CONCLUSION

The high prevalence of undiagnosed DM in city areas suggests potential shortcomings in routine diabetes screening practices. Prioritizing screening, particularly for high-risk groups like older adults, individuals with elevated BMI, hypertension, and urban residents from the central region of the country, is crucial. These groups have elevated diabetes risk and face higher complications without timely detection and treatment. To address this issue, collaborative efforts among the Bangladeshi government, healthcare providers, and community organizations are imperative.

The pattern of diabetic care and glycemic control among the ambulatory diabetic patients in tertiary care settings in Bangladesh

Diabetes mellitus is a major public health concern in Bangladesh. The pattern of diabetic care and control of blood sugar among diabetic patients are not well described. We assessed the pattern of diabetic care among ambulatory diabetic patients attending tertiary care hospitals in Bangladesh, and explored the relationship of glycemic control with behavioral and metabolic risks. Any patient 18 years and older attending the medicine outpatient department (OPD) at randomly selected three government tertiary hospitals in three divisions in Bangladesh were examined by hospital doctors. If a patient who was diagnosed as having diabetes and produced any medical document to support the diagnosis was recruited following an informed consent. Data on socio-demographic characteristics, diabetic care plan and behavioral risks, including tobacco use, physical activity, healthy diet (daily fruits and vegetable consumption) and salt intake were obtained from study participants by recall. Three milliliters of venous blood were tested to determine uncontrolled diabetes by measuring glycated hemoglobin (HbA1C > 7.0), and hyperlipidemia by measuring total cholesterol (> 200 mg/dL), high density lipoprotein/HDL (< 40 Mg/dL, low density lipoprotein/ LDL (> 200 mg/dL), and Triglyceride (> 160 mg/dL). A Total of 465 patients were enrolled. The Mean age was 49 years (SD:11) and 58% were women. Sixty percent patients were on a treatment plan of anti-diabetic drugs (drug), healthy diet (diet) and physical activity (PA), 13.3% diet and drug, 9.7% on drug only, 6.4%  on diet and PA, 3.9% on PA and drug, 1.3% on PA only and 0.9% on diet only. Two- third of the patients (68.6%) had uncontrolled diabetes, which was three times higher, if a patient had diabetes for more than five years than otherwise (OR: 3.31, 95% CI 2.06-5.33), two times higher if a patient did not consume fruits  (OR: 2.28, 1.34-3.87), or three times higher, if a patient did not consume vegetables (OR: 3.70, 95% CI 1.80-7.59) than otherwise, 78% higher, if a patient had taken extra salt in meal than otherwise (OR: 1.78, 95% CI 1.13-2.80) and nine times higher, if a patient had a raised total cholesterol level (> 200 mg/dL) than otherwise (OR: 9.60, 95% CI 2.60-35.40) and three times higher, if a patient had a raised LDL level compared than otherwise (OR: 3.33, 95% CI: 1.93-5.70). Diabetic patients seeking care at tertiary hospitals in Bangladesh follow diverse diabetic care plans and the majority of them do not have diabetes under control. Unhealthy dietary practice and hyperlipidemia among diabetic patients contribute to uncontrolled diabetes. Routine monitoring of blood glucose and enforcing lifestyle modifications could promote effective control of diabetes among diabetic patients in Bangladesh.

Socioeconomic inequalities in the prevalence, non-awareness, non-treatment, and non-control of diabetes among South Korean adults in 2021

The purpose of this study was to investigate socioeconomic inequalities in diabetes prevalence, non-awareness, non-treatment, and non-control among South Korean adults in 2021. This cross-sectional study used data from the 2021 Korean National Health and Nutrition Examination Survey. Relative concentration indices (RCIs) and relative concentration curves stratified by sex and age were used to investigate socioeconomic inequalities in the prevalence, non-awareness, non-treatment, and non-control of diabetes. The prevalence, non-awareness, lack of treatment, and non-control rates in adults aged 30 years and older in 2021 were 15.9%, 29.5%, 33.3%, and 76.1%, respectively. Diabetes was more prevalent in participants under the age of 65 years than those aged 65 years and older for both men (RCI: -0.081, RCI: -0.158, respectively) and women (RCI: -0.203, RCI: -0.292, respectively). The larger the absolute value of the RCI in non-awareness and non-treatment of diabetes in women, the greater the level of socioeconomic inequalities (RCI: 0.182, RCI: 0.154). Socioeconomic inequalities existed in the prevalence of diabetes among both men and women aged under 65 years. In women, socioeconomic inequalities of non-awareness and non-treatment of diabetes were greater than those in men. Thus, preventive care and monitoring are required, particularly among women and individuals under the age of 65 years.

Stagnation of maternal mortality decline in Bangladesh between 2010 and 2016 in spite of an increase in health services utilisation: Examining data from three large cross-sectional surveys

Background

After a 40% reduction in maternal mortality ratio (MMR) during 2001-2010 in Bangladesh, the MMR level stagnated between 2010 and 2016 despite a steady increase in maternal health services use and improvements in overall socioeconomic status. We revisited the factors that contributed to MMR decline during 2001-2010 and examined the changes in these factors between 2010 and 2016 to explain the MMR stagnation in Bangladesh.

Methods

We used data from the 2001, 2010, and 2016 Bangladesh Maternal Mortality Surveys, which sampled 566 115 households in total, to estimate the changes in the risk of dying of maternal causes associated with a pregnancy or birth between 2001-2010 and 2010-2016. We carried out Poisson regression analyses with random effects at the sub-district level to explore the relationship between the change in risk of maternal death from 2001 to 2016 and a range of demographic, socioeconomic, and health care factors.

Results

Between 2001 and 2016, the proportion of high-risk pregnancies decreased, except for teenage pregnancies. Meanwhile, there were notable improvements in socioeconomic status, access to health services, and the utilisation of maternal health services. A comparison of factors affecting the risk of maternal death between 2001-2010 and 2010-2016 indicated that first pregnancies continued to offer significant protection against maternal deaths. However, subsequent pregnancies among girls under 20 years became a significant risk factor during 2010-2016, increasing the risk of maternal deaths by nearly 3-fold. Among the key maternal health services, only skilled birth attendants (SBA) were identified as a key contributor to MMR reduction during 2001-2010. However, SBA is no longer significantly associated with reducing mortality risk during 2010-2016.

Conclusions

Despite continued improvements in the overall socioeconomic status and access to maternal health services in Bangladesh, the stagnation of MMR decline between 2010 and 2016 is associated with multiple teenage pregnancies and the lack of capacity in health facilities to provide quality delivery services, as SBA has been primarily driven by facility delivery. The findings provide a strong rationale for targeting at-risk mothers and strengthening reproductive health services, including family planning, to further reduce maternal mortality in Bangladesh.

Potential Association of The Pathogenic Kruppel-like Factor 14 (KLF14) and Adiponectin (ADIPOQ) SNVs with Susceptibility to T2DM

AIM

To evaluate the associations of the pathogenic variants in Kruppel-like Factor 14 (KLF 14) and Adiponectin (ADIPOQ) with susceptibility to type 2 diabetes mellitus (T2DM).

BACKGROUND

Type 2 diabetes mellitus (T2DM) is a pandemic metabolic disease characterized by increased blood sugar and caused by resistance to insulin in peripheral tissues and damage to pancreatic beta cells. Kruppel-like Factor 14 (KLF-14) is proposed to be a regulator of metabolic diseases, such as diabetes mellitus (DM) and obesity. Adiponectin (ADIPOQ) is an adipocytokine produced by the adipocytes and other tissues and was reported to be involved in T2DM.

OBJECTIVES

To study the possible association of the KLF-14 rs972283 and ADIPOQ-rs266729 with the risk of T2DM in the Saudi population.

METHODS

We have evaluated the association of KLF-14 rs972283 C>T and ADIPOQ-rs266729 C>G SNV with the risk to T2D in the Saudi population using the Amplification Refractory Mutation System PCR (ARMS-PCR), and blood biochemistry analysis. For the KLF-14 rs972283 C>T SNV we included 115 cases and 116 healthy controls, and ADIPOQ-rs266729 C>G SNV, 103 cases and 104 healthy controls were included.

RESULTS

Results indicated that the KLF-14 rs972283 GA genotype and A allele were associated with T2D risk with OR=2.14, p-value= 0.014 and OR=1.99, p-value=0.0003, respectively. Results also ADIPOQ-rs266729 CG genotype and C allele were associated with an elevated T2D risk with an OR=2.53, p=0.003 and OR=1.66, p-value =0.012, respectively.

CONCLUSION

We conclude that SNVs in KLF-14 and ADIPOQ are potential loci for T2D risk. Future large-scale studies to verify these findings are recommended. These results need further verifications in protein functional and large-scale case control studies before being introduced for genetic testing.

Diabetes care cascade and their predictors in young and middle-aged population in India: evidence from the National Family Health Survey (2019-21)

PURPOSE

Weak care cascade of diabetes from the time of screening, diagnosis, treatment initiation and attainment of optimal glycemic control is a public health challenge particularly in resource limited settings. We aimed to assess the diabetes care cascade in India and its determinants in the 15-49 age group.

METHODS

We conducted a secondary data analysis of the National Family Health Survey (NFHS-5, 2019-2021), a nationally representative cross-sectional survey, including a total of 724,115 women and 101,839 men with mean (SD) age 30.6 (9.9) years.

RESULTS

The prevalence of self-reported Diabetes Mellitus (DM) in the sample was 2.14% (n = 14,116, 95% CI: 2.06, 2.21) of which 55.13% (n = 6990, 95% CI: 53.37, 56.88) were currently undergoing anti-diabetes therapy. The net prevalence of DM including both old and new cases detected on screening was 2.9%. Poor glycemic control was observed in 52.43% (n = 3506, 95% CI: 50.69, 54.16) of patients with DM on anti-diabetes therapy. Patients from the richest wealth quintile (aOR = 5.17, 95% CI: 1.93, 13.84) had significantly higher odds of accessing private health facilities, while female patients with DM were less likely to be on anti-diabetes therapy.

CONCLUSION

The prevalence of self-reported DM in India has increased from 1.7% (NFHS-4, 2015-16) to 2.1% (NFHS-5, 2019-21) while more than half of existing patients continue to remain undiagnosed. Consequently, diabetes care cascade have major lacunae at every stage from screening to diagnosis, initiation of effective treatment, and achievement of safe blood glucose levels.

SUPPLEMENTARY INFORMATION

The online version contains supplementary material available at 10.1007/s40200-023-01263-9.

Contrasting socioeconomic inequality with noncommunicable diseases: Insights from a population-based survey using the concentration index in Kong cohort study

Background

Noncommunicable diseases (NCDs) are the major causes of mortality across the globe, which impose a substantial burden on health care systems, particularly in low- and middle-income countries. The present study aimed to determine socioeconomic inequality in the prevalence of NCDs using the concentration index (CI).

Methods

This cross-sectional study was conducted on the baseline data of the Bandar Kong cohort. The principal component analysis was used to determine people's socioeconomic status (SES). The CI and Lorenz Curve were used for the assessment of socioeconomic inequality. Multivariate logistic regression was used to assess the relationship between SES and the prevalence of NCDs. A p Value less than 0.05 is considered significant.

Results

Frequency and prevalence of diabetes was 653 (16.22%), hypertension 848 (21.06%), chronic lung diseases 161 (4%), epilepsy 70 (1.74%), mental disorders 191 (4.74%), stillbirth 299 (13.94%), thyroid disorders 391 (9.71%) and depression 146 (3.63%). CI for the prevalence of diabetes was [-0.107, %95 CI: -0.146 to -0.068], hypertension [-0.122, %95 CI: -0.155 to -0.088], chronic lung disease [-0.116, %95 CI: -0.202 to -0.03], psychiatric disorders [-0.230, %95 CI: -0.304 to -0.155], depression [-0.132, %95 CI: -0.220 to-0.043] and stillbirth [-0.162, %95 CI: -0.220 to -0.105]. The Gini index was negative for all these diseases, indicating that these are significantly concentrated in people of poor SES.

Conclusions

The findings suggest that selected NCDs were concentrated among the poor and the low-income. Particular attention may be necessary to address the problem of NCDs among these groups.

Prevalence and determinants of hypertension among older adults: A comparative analysis of the 6th and 8th national health surveys of Bangladesh

BACKGROUND

Hypertension is a major public health concern in low-and middle-income countries. A nationwide Health, Population, and Nutrition Sector Development Program in Bangladesh has been shown to be effective in resource-poor settings. This article aims to investigate whether the prevalence and determinants of adult hypertension changed from 2011 to 2018.

METHODS

The determinants of adult hypertension were assessed in 2011 and 2018 data of Bangladesh Demographic and Health surveys. These two surveys included both men and women over the age of 34 years and measured their blood pressure, weight, height, and other covariates. For both surveys, we estimated the age-standard prevalence of hypertension and relative, attributable and mediated risk of determinants of hypertension using hierarchical mixed-effects sequential Poisson regression models.

RESULTS

The prevalence of adult hypertension increased by 10.9% from 29.5% in 2011 to 40.4% in 2018. The nationwide awareness program on the Health, Population and Nutrition Sector changed the risks associated with hypertension determinants over the years. During 2011, Socio-economic status (SES) was a major distal determinant of adult hypertension, explaining 21% of population-attributable risk (ART). However, other factors accounted for 90% of risk, mainly by excessive body weight (51%) and awareness of hypertension (39%). In contrast, SES only explained 16% of ART risk, with 97% of the risk mediated by excessive body weight (55%) and awareness of hypertension (41%).

CONCLUSION

The study results highlight that hypertension among older adult was significantly increased over the six-year period. Specially, the socio-economic status, awareness of hypertension and excessive body weight were the significant determinants. Being awareness of hypertension and excessive body weight changed the causal pathways of socio-economic status. The results also highlight the value of studying the effect of non-communicable disease awareness programs to enhance our comprehension of factors influencing health.

Cascade of diabetes care in Bangladesh, Bhutan and Nepal: identifying gaps in the screening, diagnosis, treatment and control continuum

Diabetes has become a major cause of morbidity and mortality in South Asia. Using the data from the three STEPwise approach to Surveillance (STEPS) surveys conducted in Bangladesh, Bhutan, and Nepal during 2018-2019, this study tried to quantify the gaps in diabetes screening, awareness, treatment, and control in these three South Asian countries. Diabetes care cascade was constructed by decomposing the population with diabetes (diabetes prevalence) in each country into five mutually exclusive and exhaustive categories: (1) unscreened and undiagnosed, (2) screened but undiagnosed, (3) diagnosed but untreated, (4) treated but uncontrolled, (5) treated and controlled. In Bangladesh, Bhutan, and Nepal, among the participants with diabetes, 14.7%, 35.7%, and 4.9% of the participants were treated and controlled, suggesting that 85.3%, 64.3%, and 95.1% of the diabetic population had unmet need for care, respectively. Multivariable logistic regression models were used to explore factors associated with awareness of the diabetes diagnosis. Common influencing factors for awareness of the diabetes diagnosis for Bangladesh and Nepal were living in urban areas [Bangladesh-adjusted odd ratio (AOR):2.1; confidence interval (CI):1.2, 3.6, Nepal-AOR:6.2; CI:1.9, 19.9].

Religious disparities in health in Bangladesh-the case of hypertension and diabetes: evidence from two nationally representative cross-sectional surveys

OBJECTIVES

Religious affiliation, beliefs, and practices shape lifestyles and disease risks. This study examined Hindu-Muslim differences in the prevalence and management of hypertension and diabetes in Bangladesh, a religiously plural country with 91% Muslims and 8% Hindus.

DESIGN, SETTINGS AND PARTICIPANTS

We used the nationally representative 2011 Bangladesh Demographic and Health Survey (BDHS) and 2017-2018 BDHS data. The 2011 BDHS collected blood pressure (BP) data with an 89% response rate (RR) and fasting blood glucose (FBG) data (RR 85%) from household members aged 35 years and above. The 2017-2018 BDHS collected BP and FBG data from household members aged 18 years and above with 89% and 84% RRs, respectively. We analysed 6628 participants for hypertension and 6370 participants for diabetes from the 2011 BDHS, 11 449 for hypertension and 10 744 for diabetes from the 2017-2018 BDHS.

METHODS

We followed the WHO guidelines to define hypertension and diabetes. We used descriptive statistics and multiple logistic regression to examine the Hindu-Muslim differences in hypertension and diabetes, and estimated predicted probabilities to examine the changes in hypertension and diabetes risk over time.

RESULTS

Nine in 10 of the sample were Muslims. About 31% of Hindus and 24% of Muslims were hypertensive; 10% of both Hindus and Muslims were diabetic in 2017-2018. The odds of being hypertensive were 45% higher among Hindus than Muslims (adjusted OR: 1.45; 95% CI: 1.23 to 1.71; p<0.001). The levels of awareness, medication and control of hypertension were similar between the religious groups. Between the 2011 and 2017-2018 BDHS, the Hindu-Muslim difference in the prevalence of hypertension increased non-significantly, by 3 percentage points.

CONCLUSIONS

Further studies on religious-based lifestyles, Hindu-Muslim differences in diet, physical activity, stress, and other risk factors of hypertension and diabetes are needed to understand Hindus' higher likelihood of being hypertensive, in contrast, not diabetic compared with Muslims.