Rising prevalence of type 2 diabetes in rural Bangladesh: A population based study

doi:10.1016/j.diabres.2006.11.010

Diabetes Research and Clinical Practice

Volume 77, Issue 2, August 2007, Pages 300-305

https://doi.org/10.1016/j.diabres.2006.11.010 Get rights and content

Abstract

The aim of the study was to determine the temporal changes in the prevalence of type 2 diabetes mellitus and its associated risk factors in a rural population of Bangladesh. A total of 4757 subjects age ≥20 years both male and female were enrolled randomly in a cross-sectional study in 1999. The same area and population was reinvestigated in 2004 following the same selection procedure, on a sample of 3981 individuals. Structural and economical changes were noted for the last 5 years in the locality. An increased prevalence of diabetes was found with 6.8% in the present survey compared with 2.3% in the earlier survey (p < 0.05). Age, BMI and systolic blood pressure were found to be significant risk factors following both for FBG and for OGTT. WHR was found to be a significant risk factor for men only. A substantial agreement was observed between FBG and OGTT (kappa 0.63) compared to the previous investigation in 1999 (kappa 0.40). Differences in the indices of obesity, that is BMI, WHR and waist girth, may in part explain the increased prevalence, which in turn may explain due to fast-expanded urbanization. The state of affairs warrants immediate measures necessary to prevent the epidemic particularly in the localities that are in the transition phase from rural to semi-urban facilities.

Introduction

Diabetes mellitus has a high prevalence worldwide in both developed and developing countries [1]. Recent epidemiological studies have shown an increased prevalence of diabetes in India (12.1%), Pakistan (11.1%), and China (6.1%) [2], [3], [4]. This increase has also been observed among Asian Americans, and was suggested to be due to ageing of the population, urbanization and increasing prevalence of obesity and physical inactivity [5].

Bangladesh is a developing country that has recently been facing rapid urbanization [6]. The country is also in a stage of demographic transition with an increasing proportion of older population. Urbanization has been found to be associated with a sedentary lifestyle, higher calorie food intake and stressful life conditions, which may be contributing to the increasing prevalence of diabetes mellitus [1], [7].

A few population-based studies conducted in Bangladesh at different times have revealed an increasing trend of diabetes prevalence in rural and urban populations [8], [9], [10]. Previously, a four-fold increase in the prevalence of type 2 diabetes was shown in urban migrants compare to their source (rural) population [10]. The studies conducted to observe the increased prevalence of type 2 diabetes in Bangladesh were largely based on unplanned coincidental investigations. As a consequence, these studies generally suffer from valid comparisons as they were performed at different times in different populations with varied sample sizes and applied different procedures for both blood glucose estimation and other biophysical measures. Previously, low concordance between fasting blood glucose (FBG) and oral glucose tolerance test (OGTT) were reported from Bangladesh [10]. To the best of our knowledge there has yet to be, a well-designed study conducted to observe the temporal changes in the prevalence of type 2 diabetes.

The purpose of this study was, therefore, to observe the temporal changes in the prevalence of type 2 diabetes in a rural population of Bangladesh. Moreover, agreement between FBG and OGTT for blood glucose estimation was also examined and the risk estimates are provided following both procedures.

Section snippets

Study area and population

The rural population was selected from a rural community 35 miles north of Dhaka city called “Chandra”. A cross-sectional study was conducted in 1999 approximately 35 miles north of Dhaka city called “Chandra”. Ten villages were randomly selected from five areas with a population of approximately 20,000 aged ≥20 years. All the individuals were given an identification number including a household number. Among those, 5000 subjects were selected following a simple random procedure. Of these 4757

Structural changes occurred in 1999–2004 in the study area

In 1999, the area was defined as rural, without urban facilities. The region can now be considered as semi-urban as the dwellers have partial access to some basic urban facilities such as sanitation, safe water supply, electricity (60% households have electric supply in 2004 compared to none in 1999) and brick road communication. Substantial number of new small industries and garments factories (37 in 2004 compared to 20 in 1999), poultry farm (32 in 2004 compared to 13 in 1999) and fisheries

Prevalence of diabetes and IFG

A significant increase in the prevalence of type 2 diabetes (T2D) among study subjects was observed over the last 5 years. A three-fold increase in prevalence, from 2.3% to 6.8%, is higher than found in the previous rural studies of Bangladesh [8], [9]. It was moderately higher than the prevalence found in rural China (5.6%), but more comparable to that of India (6.3%) [4], [12]. However, the observed prevalence rate of diabetes in this report is lower than that of rural populations in Turkey

Acknowledgements

We acknowledge the contribution of our survey team members, the village leaders and volunteers for their continuous effort in the collection of data. We express our appreciation to the authority of BIRDEM for providing us with local logistic support. We are also grateful to all participants in the study for their active co-operation.

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Rising prevalence of type 2 diabetes in rural Bangladesh: A population based study

Abstract

Introduction

Section snippets

Study area and population

Structural changes occurred in 1999–2004 in the study area

Prevalence of diabetes and IFG

Acknowledgements

Diab. Res. Clin. Pract.

Diab. Res. Clin. Pract.

J. Clin. Epidemiol.

Global prevalence of diabetes. Estimates for the year 2000 and projections for 2030

Diab. Care

High prevalence of diabetes and impaired glucose tolerance in India: national urban diabetes survey

Diabetologia

Pakistan National Diabetes Survey prevalence of glucose intolerance and associated factors in North West at Frontier Province (NWFP) of Pakistan

J. Pak. Med. Assoc.

Prevalence of type 2 diabetes in urban and rural Chinese population in Qingdao, China

Diab. Med.

Type 2 diabetes prevalence in Asian Americans

Diab. Care

Urbanization in Bangladesh: some contemporary observations

Bangladesh Dev. Stud.

Effect of socioeconomic risk factors on difference between rural and urban in the prevalence of diabetes in Bangladesh

Diab. Care

Diabetes and impaired fasting glycaemia in rural population of Bangladesh

Diab. Care

Type 2 diabetes in rural and urban population: diverse prevalence and associated risk factors in Bangladesh

Diab. Med.