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High prevalence of type 2 diabetes among the urban middle class in Bangladesh.

Saquib N, Khanam MA, Saquib J, Anand S, Chertow GM, Barry M, Ahmed T, Cullen MR - BMC Public Health (2013)

Bottom Line: Older age, female sex, overweight or obese, high wealth index and positive family history of diabetes were significantly associated with insulin resistance.Participants with type-2 diabetes or insulin resistance had significantly poorer physical health only if they had associated cardiovascular disease.Screening services should be implemented while researchers focus on strategies to lessen the incidence and morbidity associated with these conditions.

View Article: PubMed Central - HTML - PubMed

Affiliation: Stanford University School of Medicine, General Medical Disciplines, Stanford University, Stanford, CA, USA. mrcullen@stanford.edu.

ABSTRACT

Background: The prevalence of type-2 diabetes and metabolic syndrome are increasing in the developing world; we assessed their prevalence among the urban middle class in Bangladesh.

Methods: In this cross-sectional survey (n = 402), we randomly selected consenting adults (≥ 30 years) from a middle-income neighborhood in Dhaka. We assessed demography, lifestyle, and health status, measured physical indices and blood pressure and obtained blood samples. We evaluated two primary outcomes: (1) type-2 diabetes (fasting blood glucose ≥ 7.0 mmol/L or hemoglobin A1C ≥ 6.5% (48 mmol/mol) or diabetes medication use) and (2) insulin resistance (type-2 diabetes or metabolic syndrome using International Diabetes Federation criteria).

Results: Mean age and Quételet's (body mass) index were 49.4 ± 12.6 years and 27.0 ± 5.1 kg/m²; 83% were married, 41% had ≥12 years of education, 47% were employed, 47% had a family history of diabetes. Thirty-five percent had type-2 diabetes and 45% had metabolic syndrome. In multivariate models older age and family history of diabetes were significantly associated with type-2 diabetes. Older age, female sex, overweight or obese, high wealth index and positive family history of diabetes were significantly associated with insulin resistance. Participants with type-2 diabetes or insulin resistance had significantly poorer physical health only if they had associated cardiovascular disease.

Conclusions: The prevalence of type-2 diabetes and metabolic syndrome among the middle class in Dhaka is alarmingly high. Screening services should be implemented while researchers focus on strategies to lessen the incidence and morbidity associated with these conditions.

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Prevalence of individual components of Metabolic Syndrome by sex. Components included: centripetal obesity: (waist circumference ≥90 cm for men and ≥80 cm for women) plus any two of the following: (1) elevated triglycerides: triglycerides >150 mg/dL (1.7 mmol/L), (2) Low HDL: high-density lipoprotein <40 mg/dL (1.03 mmol/L) in men or <50 mg/dL (1.29 mmol/L) in women, (3) Hypertension: systolic blood pressure >130 mmHg, diastolic blood pressure >85 mmHg, or treatment for hypertension, and (4) Elevated plasma glucose: fasting plasma glucose >100 mg/dL (5.6 mmol/L) or previously diagnosed diabetes mellitus.
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Figure 2: Prevalence of individual components of Metabolic Syndrome by sex. Components included: centripetal obesity: (waist circumference ≥90 cm for men and ≥80 cm for women) plus any two of the following: (1) elevated triglycerides: triglycerides >150 mg/dL (1.7 mmol/L), (2) Low HDL: high-density lipoprotein <40 mg/dL (1.03 mmol/L) in men or <50 mg/dL (1.29 mmol/L) in women, (3) Hypertension: systolic blood pressure >130 mmHg, diastolic blood pressure >85 mmHg, or treatment for hypertension, and (4) Elevated plasma glucose: fasting plasma glucose >100 mg/dL (5.6 mmol/L) or previously diagnosed diabetes mellitus.

Mentions: The prevalence of centripetal obesity, elevated triglycerides, and elevated blood pressure was higher among women than men whereas the prevalence of low HDL cholesterol and high plasma glucose was comparable between the sexes (Figure 2). A total of 35% (142/402) of participants had type-2 diabetes (elevated plasma glucose = 19%, elevated HbA1c = 35%, both elevated plasma glucose and elevated HbA1c = 18%, medication use for type-2 diabetes = 22%); and 45% (160/357) had metabolic syndrome. Further, 15% (52/357) had type-2 diabetes without metabolic syndrome, 21% (74/357) had metabolic syndrome without type-2 diabetes and 24% (86/357) had both conditions. The prevalence of type-2 diabetes and metabolic syndrome was generally higher among participants who were female, older, overweight/obese, and scored higher in the wealth index (Figure 3). More than half of all participants (54%) had insulin resistance.


High prevalence of type 2 diabetes among the urban middle class in Bangladesh.

Saquib N, Khanam MA, Saquib J, Anand S, Chertow GM, Barry M, Ahmed T, Cullen MR - BMC Public Health (2013)

Prevalence of individual components of Metabolic Syndrome by sex. Components included: centripetal obesity: (waist circumference ≥90 cm for men and ≥80 cm for women) plus any two of the following: (1) elevated triglycerides: triglycerides >150 mg/dL (1.7 mmol/L), (2) Low HDL: high-density lipoprotein <40 mg/dL (1.03 mmol/L) in men or <50 mg/dL (1.29 mmol/L) in women, (3) Hypertension: systolic blood pressure >130 mmHg, diastolic blood pressure >85 mmHg, or treatment for hypertension, and (4) Elevated plasma glucose: fasting plasma glucose >100 mg/dL (5.6 mmol/L) or previously diagnosed diabetes mellitus.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3924340&req=5

Figure 2: Prevalence of individual components of Metabolic Syndrome by sex. Components included: centripetal obesity: (waist circumference ≥90 cm for men and ≥80 cm for women) plus any two of the following: (1) elevated triglycerides: triglycerides >150 mg/dL (1.7 mmol/L), (2) Low HDL: high-density lipoprotein <40 mg/dL (1.03 mmol/L) in men or <50 mg/dL (1.29 mmol/L) in women, (3) Hypertension: systolic blood pressure >130 mmHg, diastolic blood pressure >85 mmHg, or treatment for hypertension, and (4) Elevated plasma glucose: fasting plasma glucose >100 mg/dL (5.6 mmol/L) or previously diagnosed diabetes mellitus.
Mentions: The prevalence of centripetal obesity, elevated triglycerides, and elevated blood pressure was higher among women than men whereas the prevalence of low HDL cholesterol and high plasma glucose was comparable between the sexes (Figure 2). A total of 35% (142/402) of participants had type-2 diabetes (elevated plasma glucose = 19%, elevated HbA1c = 35%, both elevated plasma glucose and elevated HbA1c = 18%, medication use for type-2 diabetes = 22%); and 45% (160/357) had metabolic syndrome. Further, 15% (52/357) had type-2 diabetes without metabolic syndrome, 21% (74/357) had metabolic syndrome without type-2 diabetes and 24% (86/357) had both conditions. The prevalence of type-2 diabetes and metabolic syndrome was generally higher among participants who were female, older, overweight/obese, and scored higher in the wealth index (Figure 3). More than half of all participants (54%) had insulin resistance.

Bottom Line: Older age, female sex, overweight or obese, high wealth index and positive family history of diabetes were significantly associated with insulin resistance.Participants with type-2 diabetes or insulin resistance had significantly poorer physical health only if they had associated cardiovascular disease.Screening services should be implemented while researchers focus on strategies to lessen the incidence and morbidity associated with these conditions.

View Article: PubMed Central - HTML - PubMed

Affiliation: Stanford University School of Medicine, General Medical Disciplines, Stanford University, Stanford, CA, USA. mrcullen@stanford.edu.

ABSTRACT

Background: The prevalence of type-2 diabetes and metabolic syndrome are increasing in the developing world; we assessed their prevalence among the urban middle class in Bangladesh.

Methods: In this cross-sectional survey (n = 402), we randomly selected consenting adults (≥ 30 years) from a middle-income neighborhood in Dhaka. We assessed demography, lifestyle, and health status, measured physical indices and blood pressure and obtained blood samples. We evaluated two primary outcomes: (1) type-2 diabetes (fasting blood glucose ≥ 7.0 mmol/L or hemoglobin A1C ≥ 6.5% (48 mmol/mol) or diabetes medication use) and (2) insulin resistance (type-2 diabetes or metabolic syndrome using International Diabetes Federation criteria).

Results: Mean age and Quételet's (body mass) index were 49.4 ± 12.6 years and 27.0 ± 5.1 kg/m²; 83% were married, 41% had ≥12 years of education, 47% were employed, 47% had a family history of diabetes. Thirty-five percent had type-2 diabetes and 45% had metabolic syndrome. In multivariate models older age and family history of diabetes were significantly associated with type-2 diabetes. Older age, female sex, overweight or obese, high wealth index and positive family history of diabetes were significantly associated with insulin resistance. Participants with type-2 diabetes or insulin resistance had significantly poorer physical health only if they had associated cardiovascular disease.

Conclusions: The prevalence of type-2 diabetes and metabolic syndrome among the middle class in Dhaka is alarmingly high. Screening services should be implemented while researchers focus on strategies to lessen the incidence and morbidity associated with these conditions.

Show MeSH
Related in: MedlinePlus