Clinical characteristics and complications of patients with type 2 diabetes attending an urban hospital in Bangladesh

Abstract

Aims

To investigate the clinical features of patients with type 2 diabetes on oral medication and determine the complications and risk factors in these patients.

Methods

A cross-sectional was conducted among 515 patients with type 2 diabetes at the outpatient clinics of Bangladesh Institute of Health Science (BIHS) hospital from September to December 2013. We collected data on socio-economic characteristics, clinical status, risk factors, complications, anthropometric measurements and blood tests. Univariate and multivariate logistic regression was performed to identify risk factors associated with diabetes complications.

Results

The mean(±SD) age of the participants was 50.0(±10.1) years and 15.3% were less than 40 years. The mean HbA1c was 8.3(±2.1). Only 28.7% of the participants achieved targets for HbA1c. The overall prevalence of hypertension, obesity and dyslipidemia was 57.5%, 62.6% and 72.7%, respectively. Eye problems were the most common complication (68.9%) followed by chronic kidney diseases (21.3%) and cardiovascular diseases (11.8%). There were significant associations between the complications and age, duration of diabetes and duration of hypertension. In the multivariate analysis adjusting for other confounding variables, only systolic blood pressure was found to be significantly associated with complications [OR 0.809, 95% CI 0.666–0.981 (p-value 0.031)].

Conclusion

Results of the study confirm that even under best clinical settings a great majority Bangladeshi adults with type 2 diabetes have uncontrolled diabetes and a high prevalence of risk factors that might contribute to early development of complications. Early screening of high risk groups and proper management of diabetes is recommended to avoid early complications.

Introduction

Diabetes is a growing problem worldwide, particularly in developing countries where rates have skyrocketed. According to the International Diabetes Federation (IDF), of the 382 million people with diabetes (a number expected to be almost double by 2035), a staggering 80% live in developing countries, which are least equipped to deal with this emerging crisis [1], [2]. The region most likely to experience the main brunt of the epidemic is South East Asia, where diabetes is expected to increase by 71% within the next 25 years. Bangladesh is among the top ten countries globally in terms of diabetes burden with increasing prevalence of diabetes in both urban and rural areas [2], [3].

In South Asia the overwhelming majority of diabetes cases are type 2 diabetes (T2D). The South Asian population presents with a number of diverse risk factors for T2D due to a combination of several genetic and environmental factors [4]. A recent survey showed that diabetes has become epidemic among the adult Bangladeshi population and the prevalence of diabetes and prediabetes was 10% and 23% respectively [5]. The prevalence of diabetes was almost double in urban compared to rural areas (15.2% and 8.3%, respectively); diabetes patients were older, had significantly more hypertension and obesity compared to those without [5]. In Bangladesh, as in other countries, T2D is associated with high body mass index (BMI), waist circumference (WC) and waist hip ratio (WHR), i.e. central obesity, which is a risk factor for both cardiovascular diseases (CVD) and diabetes [6], [7].

The CVD risk that can be attributed to diabetes is even more prominent among South Asians than in other populations [8]. In particular hypertension and diabetes aggravate one another and in combination can dramatically increase the rate of complications [9]. Previous studies have shown that diabetes can increase the prevalence of dyslipidemia by at least two fold also leading to CVD [10]. Secondary complications of diabetes start early and progress rapidly among South Asians that can be reduced significantly through early detection and adequate management [11]. To the best of our knowledge, factors determining the clinical status and complications of patients with diabetes in Bangladesh have not been studied in detail. To address these issues we conducted a cross-sectional study at a tertiary diabetes hospital in Dhaka, Bangladesh. We focused on subjects with T2D on oral therapy and with a time since diagnosis of less than 10 years. In general this is the subgroup of T2D patients with the lowest rate of complications and which most easily reaches treatment targets. Data from this cohort allow to address the questions of whether diabetes is diagnosed early enough, whether care adequately reaches the patients and whether the escalation from oral therapy to insulin treatment occurs in a timely manner. The results of this study will help clinicians and policy makers to further develop management plans for diabetes in Bangladesh and other developing countries.