Theme 2:
Prevention of Diabetes in Bangladesh

List of Abstracts

  1. Drug, Diet And Physical Activities Management Of Bangladeshi Rural Diabetic Patient

  2. Comparison of Vitamin D Status Between Newly Detected Type 2 Diabetes Mellitus and Control

  3. Scaling Up Diabetic Retinopathy Services (SDRS) Phase-II: Reflects The Epidemic of Diabetic Retinopathy in Bangladesh

  4. Frequency of Thyroid Dysfunction in Newly Detected Adult Patients with Type 2 Diabetes Mellitus Attending Tertiary Care Hospital of Bangladesh

  5. Prevalence of diabetic retinopathy among ambulatory diabetic patients visiting tertiary hospitals in Bangladesh

  6. Outcome of Vitamin D Supplementation on Prediabetic Adults with Vitamin D Deficiency

  7. Diabetic Retinopathy in Youth-Onset Diabetes: Reports from A Screening Centre in Bangladesh

  8. Is There Any Relationship Between Vitamin D and Insulin Resistance among Adults with Prediabetes?

  9. Cost of Care for T2 Diabetes Management of Patients Attending The Tertiary Level Hospitals in Dhaka

  10. Frequency of Lower Lung Field Tuberculosis among Diabetic Patients Attending Bangabandhu Sheikh Mujib Medical University

  11. Digital Management of Diabetes by Using Smart Phone Technology

  12. Astrocyte Elevated Gene 1 Expression in Adults with Newly Diagnosed Type 2 Diabetes Mellitus

  13. Vitamin D Status and Its Relation with Tumour Necrosis Factor-Alpha and High Sensitivity C-Reactive Protein among Adults with Prediabetes

  14. Cardiovascular Risk  in Adults with Newly Diagnosed Prediabetes in Bangabandhu Sheikh Mujib Medical University

  15. Cardiovascular Risk in Adults with Newly Diagnosed Prediabetes in Bangabandhu Sheikh Mujib Medical University



 Drug, Diet And Physical Activities Management Of Bangladeshi Rural Diabetic Patient

Bilkis Banu1, 2, Liaquat Ali3, Rainer Sauerborn1, Volker Winkler1, Aurélia Souares1


1Heidelberg Institute of Global Health, Heidelberg University, Germany,  2Northern University Bangladesh, Dhaka, Bangladesh, 3Bangladesh University of Health Sciences, Dhaka, Bangladesh


Background: Drug usage, diet and physical activities are key concerns for the proper management of diabetes. Socio-economic status is impacting all of these dimensions of diabetes proper management. Few studies illustrate these issues in the rural area of Bangladesh. This study was designed to observe the pattern of drug usage, diet and physical activities in relation to socio-economic status. Method: A cross-sectional survey was conducted among 990 diabetics aged between 18-64 years residing in Thakurgaon district, rural part of Bangladesh. Data were collected by face to face interview and socio-economic status was derived from a principal component analysis (PCA) of household assets. Result: Among respondents of poorest quintile, the majority (66.7%) was not adherent to the prescription and skipped on average 2 drugs per day (Mean±SD, 3±2). Overall, adherence to non-diabetic (antibiotic, vitamin and others) was similar (53.3%) to diabetic drug (46.7%). The majority (68.9%) of the poorest quintile ate 4 meals/ day and even 97.1% skipped evening snacks. Low calorie as well as low carbohydrate, protein and fat intake (less intake than the recommended) were seen in 84.7%, 82.3%, 77.5% and 71.1% of the poorest quintile respectively. Only 28.6% of the patients of richest quintile were revealed with walking >150 minutes/week while an increasing proportion were found in case of walking included moderate activities >150 minutes/week. Seating duration 180 minutes/ day was observed amongst half (51.4%) of the respondents of richest quintile. Conclusion: An alarming high proportion of diabetics are found with poor practices in drug and dietary management under the poorest socio-economic quintile. While poor practices of physical activities are also picturized under the richest socio-economic quintile.











Comparison of Vitamin D Status Between Newly Detected Type 2 Diabetes Mellitus and Control

Hossain MF, Fariduddin M, Shahjada S, Haq T, Khan MA, Hasanat A


Department of Endocrinology, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh.


Background: An association between low vitamin D level and risk for type 2 diabetes mellitus (T2DM) is recently thought. Very limited data are available regarding vitamin D among adults with newly detected T2DM in Bangladesh. Objective: To see vitamin D level in newly detected T2DM. Materials and method: This cross-sectional study was carried out in 102 newly detected T2DM diagnosed on the basis of the ADA 2017 criteria [age: 42.95±10.68 yrs; BMI (kg/m²): 26.33±4.30; mean±SD; m/f: 44/58] and equal number of age and sex matched controls [age: 40.43±11.04 yrs; BMI (kg/m²): 25.52±4.32; mean±SD; m/f: 44/58] recruited consecutively from the Department of Endocrinology, BSMMU to see serum 25(OH)D which was measured by high performance liquid chromatography (HPLC) method. Result: About 96% had low vitamin D level. Vitamin D sufficiency, insufficiency and deficiency were present in 4.9%, 7.8%, and 87.3% in diabetics which were 3.9%, 21.6% and 74.5% in non-diabetic controls. Vitamin D deficiency was high frequency in both groups (diabetics vs. control: 87.3% vs 74.5%, p<0.022). The mean levels of 25(OH)D were significantly lower in the T2DM adults than that in controls (12.41±6.85 ng/ml vs. 15.74±6.25 ng/ml, mean±SD; p<0.001). Severe vitamin D deficiency was 71.4% in T2DM compared to 28.6% in controls and also higher mild to moderate deficiency in cases than controls (58.9% vs 41.1%, p<0.001). T2DM Patients with poor glycemic control (HbA1c ≥10%) had a low vitamin D level (11.23±6.60 ng/ml) and highest 90.9% vitamin D deficient. A significant inverse correlation was observed between vitamin D and HbA1c (r=-0.249, p=0.011) in T2DM. Conclusion: Frequency of hypovitaminosis D is high in newly detected T2DM as well as in control. However, T2DM has relatively much lower level. It inversely and significantly correlates with HbA1c. Early detection of vitamin D deficiency and supplementation may be helpful in the management and prevention of DM.








Scaling Up Diabetic Retinopathy Services (SDRS) Phase-II: Reflects The Epidemic of Diabetic Retinopathy in Bangladesh

Dipak Nag1, Afsana Habib2, Rinku Paul3, Arifur Rahman2, Pallab Sen4, Aminul Akanda5, Aminuzzaman Talukder2


1National Institute of Ophthalmology and Hospital, Dhaka, Bangladesh, 2Helen Keller International, Bangladesh, 3Lions Eye Institute and Hospital, Dhaka, Bangladesh, 4Shaheed Ziaur Rahman Medical College and Hospital, Bogra, Bangladesh, 5Mymensingh Medical College and Hospital, Mymensingh, Bangladesh


Introduction: To report the prevalence of DR by photographic screening service (Scaling up Diabetic Retinopathy Service, SDRS, Phase-II) at a tertiary level setting, assumption of the probable national scenario and burden of such morbidity in Bangladesh. Method: This prospective observational study used data from the visit of all patients presenting to the diabetes retinal screening service at three centers executed by Helen Keller International in collaboration with National Institute of Ophthalmology Hospital (NIOH), Mymensingh Medical College Hospital (MMCH) and Shaheed Ziaur Medical College Hospital (SZMCH) over 14-month period. Images taken by Topcon AFC-330 non-mydriatic fundus photography and graded during  acquisition in software according to the National Screening Committee, UK guidelines. Result: Total 13,424 patients were screened over the period (7966 in NIOH, 2561 in MMCH, 2897 in SZMCH). Of them, in NIOH males were predominant (58.1%) in contrast to other two (in MMCH 36.1% and in SZMCH 39.7%). Mean age (years) were 53.03±15.02 (NIOH), 49.45±11.82 (MMCH) and 48.55±11.54 (SZMCH). In MMCH, patients visited with low mean duration of diabetes (6.62 years) compare to NIOH (10.20 years) and SZMCH (10.90 years). DR prevalence was 29.0% with highest in NIOH (33.0%). Considering the classification of DR in NIOH, MMCH and SZMCH; background 67.7%, 83.4% and 63.3%; pre-proliferative 14.2%, 5.7%, and 24.7% and more severe proliferative retinopathy  28.1%, 10.9% and 12.0% respectively. Vision threatening maculopathy were found almost in similar distribution; 32.9% (NIOH), 25.4% (MMCH) and 25.5 %( SZMCH). Smoking and hypertension were found as an individual risk factor in NIOH (p=0.002, both). Hypertension was also noted as risk factor in MMCH (p<0.001). In three centers, Chronic Kidney disease was found as determinant for DR (p<0.001 in all). Conclusion: Population based national screening and great resource allocation in needed for combating DR is emphasized.






Frequency of Thyroid Dysfunction in Newly Detected Adult Patients with Type 2 Diabetes Mellitus Attending Tertiary Care Hospital of Bangladesh

Dhar A1, Selim S2, Marufa-Mustari2 , Haq T2,  Khan MA2, Rajib MH2, Hasanat MA2, Fariduddin M2

1Shaheed Suhrawardy Medical College and Hospital, Dhaka Bangladesh, 2Bangabandhu Sheikh Mujib Medical University, Dhaka Bangladesh

Background: Thyroid dysfunction (TD) and diabetes mellitus (DM) are the two common endocrinopathies that frequently coexists. Unrecognized TD may impair metabolic control in diabetic patient. Coexistence of these two conditions is important for management of both the disorders. Objective: To see the frequency of thyroid dysfunction in newly detected patients with type 2 DM. Materials and method: This cross-sectional study was carried out on newly detected type 2 DM patients [n=200, m/f: 81/119; age: 41.1±8.3; BMI (kg/m2): 26.0±4.2; mean±SD] recruited consecutively from department of Endocrinology, BSMMU. History and relevant clinical examination were recorded. Free thyroxine (FT4), thyroid stimulating hormone (TSH), anti-TPO and anti-TG antibody were tested by Chemiluminescence Immunoassay System (Germany). Thyroid dysfunction was classified as hypothyroidism if TSH > 5.0 mIU/L and FT4 < 9.5 pmol/L; Subclinical hypothyroidism if TSH >5.0 mIU/L and FT4 ranged from 9.5 to 25.5 pmol/L; Subclinical hyperthyroidism if TSH < 0.3mIU/L and FT4 in the normal range (9.5 to 25.5) pmol/L and hyperthyroidism if TSH < 0.3 mIU/L and FT4 >25.5 pmol/L. Autoimmunity was diagnosed when either of the antibody level was˃60 U/mL. Result: Thyroid dysfunction was observed in 13% subjects. Most of them had subclinical hypothyroidism (8.5%) followed by overt hypothyroidism (3%), subclinical thyrotoxicosis (1.0%)  and hyperthyroidism (0.5%). Only (11.5%) had family history of thyroid disorder among subjects having dysfunction. About 11% subjects were antithyroid antibody positive. Highest frequency for positive antithyroid antibody (87.5%) was observed in group having TSH ≥10 m IU/L followed by 66.7% in the group having TSH (5-10) m IU/L, while only 2.8% in the group having TSH <5 m IU/L (p<0.001). There was no significant difference either for level of FT4 (14.0±4.5 vs 14.1±2.2 vs 13.9±1.5; p=0.925) or for TSH (3.4±5.0 vs 3.7±9.7 vs 2.3±1.6; p=0.691) or for the antibody status (p=0.721) among different levels of HbA1c. No significant correlations of FPG, 2Hr75gPPG and HbA1c was found with any of FT4, TSH, anti-TPO and anti-TG antibodies (p=NS for all). Logistic regression revealed anti-TPO antibody as independent predictor for thyroid dysfunction in subjects with diabetes mellitus (p<0.001). Conclusion: The results of the present study suggest that thyroid dysfunction is not uncommon in newly diagnosed type-2 DM patients. Thyroid autoimmunity is one of the predictors for increased risk of thyroid dysfunction in them. Detection of abnormal thyroid hormone levels in the early stage of DM will help the patients to improve quality of life and reduce the morbidity rate.




Prevalence of diabetic retinopathy among ambulatory diabetic patients visiting tertiary hospitals in Bangladesh

Noshin Farzana1 , Md. Saimul Islam1, Dipak Nag2, Aliya Naheed1

1Initiative for Noncommunicable Diseases, Health Systems and Population Studies Division, International Centre for Diarrhoeal Disease search, Dhaka, Bangladesh;2Dept of Vitreo-retina, National Institute of Ophthalmology (NIO), Dhaka, Bangladesh


Background:Diabetic retinopathy (DR) is a major micro vascular complication in Diabetes mellitus (DM). We estimated prevalence of DR among ambulatory diabetic patients attended selected tertiary hospitals in Bangladesh.Methods: Patients ≥18 years of age attending the medicine outpatient departments (OPD) of three teaching hospitals located in Dhaka, Sylhet and Mymensingh were examined for DM by hospital physicians and referred to a DR clinic set by the research team near the OPD. A trained research physician obtained data on age, sex, socio economic status (SES), medical history, examined visual acuity using Snellen’s chart and took retinal images using a fundus camera following consent. Blood samples were processed for HbA1C and hyperglycemia was reported if HbA1C was >7.0.Results:Between January and June 2016, 465 DM patients went under ocular examinations, sixteen had cataract and 450 had a fundus photography taken (97%).  Mean(±SD) age of the study patients was 49.3(±11) years and 56% was female. Mean(±SD) duration of DM was 5(±11) years and 69% had hyperglycaemia.  Following eye examinations low vision was reported in 28% patients. DR was diagnosed in 23% patients; 92% had mild to moderate non proliferative diabetic retinopathy (NPDR), 2% had no perception of light, and no one was aware of the condition. Prevalence of DR was higher among patients who had low vision (36% vs. 17%, P<0.001), had DM for at least 5 years (35% vs. 10%, P<0.001) and had hyperglycemia (27% vs. 13%; P=0.001) than those who did not. After adjustment of age, sex and SES, prevalence of DR was high among those who had hyperglycaemia (OR 1.88; CI: 1.03-3.42), DM for ≥5 years (OR 3.69; CI: 2.11-6.46) and low vision (OR 2.15, CI: 1.27-3.63). Conclusion: The burden of DR among ambulatory diabetic patients is substantial, but patients had no knowledge about it. Patients living with DM for 5 years, or having hyperglycemia or low vision should go under fundus examination for early detection of diabetic retinopathy in Bangladesh.








Outcome of Vitamin D Supplementation on Prediabetic Adults with Vitamin D Deficiency

Ghani MH, Haq T, Selim S, Khan MA, Marufa-Mustari, Mostafahasan-Rajib, Yadav A, Faisal I, Shahed-Morshed, Anil-Shah, Hasanat MA, Fariduddin M


Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh


Background: Low vitamin D level is thought to be involved in diabetes either by increasing insulin resistance, decreasing β- cell function or both. So correcting the deficiency may prevent or halt the progression of diabetes. No published Bangladeshi data are available regarding vitamin D effect in prediabetes. Objective: To see the effect of vitamin D supplementation on insulin resistance, glycaemic status and inflammation of prediabetic adults with vitamin D deficiency. Materials and method: This double blind randomized placebo controlled trial was done on 27 newly detected prediabetes adults with vitamin D level less than 20 ng/ml for 6 months. Group 1 (n= 14) had taken 60,000 IU of vitamin D weekly for 8 weeks followed by monthly for next 4 months and group 2 (n= 13) taken placebo; along with lifestyle modification in both groups. Glycemic status (FBG and HbA1C), insulin resistance (HOMA-IR) and inflammatory marker (hs-CRP) were measured at baseline and after 6 months. Result: Mean age of the participants were 37.64±8.92 vs 38.54±7.95 in two groups with majority were female (78.6% vs 69.2%). Vitamin D level increased in both groups (12.16±5.85 vs 3.89±3.50 ng/ml, p <0.001) from baseline. Though BMI and waist circumference (WC) improved from baseline in both groups, there were no significant differences between the groups (BMI: 1.14±0.70 vs 1.30±1.83 kg/m2, p=0.78; WC: 4.71±4.98 vs 3.73±5.96 cm, p= 0.65) respectively. There were also no significant changes in HOMA-IR (0.29±1.59 vs 0.08±1.57, p= 0.74), hs-CRP (2.02±6.74 vs 2.10±5.64 mg/L, p= 0.10) and HbA1C (0.09±0.34 vs 0.19±0.33%, p= 0.42) respectively in vitamin D and placebo groups after intervention. Conclusion: Vitamin D supplementation has no positive outcome in prediabetic patients with vitamin D deficiency.







Diabetic Retinopathy in Youth-Onset Diabetes: Reports from A Screening Centre in Bangladesh

Dipak Nag1, Afsana Habib2, Arifur Rahman2, Rinku Paul3, Aminuzzaman Talukder2


1National Institute of Ophthalmology and Hospital, Dhaka, Bangladesh, 2Helen Keller International, Bangladesh, 3Lions Eye Institute and Hospital, Dhaka, Bangladesh


Introduction: To report the prevalence of Diabetic Retinopathy(DR) in young age (≤30 years) and to see the retinopathy pattern in this aged group of diabetic patients. Methodology: Data is usedfrom the visit of all diabetic patients presenting to the diabetic retinopathy screening service at a tertiary care hospital in Bangladesh from November 2014 to July 2018. Patients who were attended at the service underwent non-mydriatic color fundus photography. Images were analyzed and graded at the time of acquisition in optimize software according to the National Screening Committee (NSC), UK guidelines. Result: 16,385 diabetic patients enrolled in the service, 469 (2.86%) were aged ≤30 years. Age ranged from 9 to 30 years with 28 years median. In this study, 295 (62.8%) had type 1 DM and 174 (37.2%) had type 2 DM. Median duration of diabetes detection in young diabetic patients was 3 yrs with 3 yrs Inter Quartile Range (IQR) and that for retinopathy was 2 yrs with IQR 2 years. Among retinopathy patients, 71 (83.5%)  had less than 5 years duration of diabetes since detected. The overall prevalence of diabetic retinopathy was 18.3% (95% confidence interval[CI], 14.74% to 21.86%). Regarding retinopathy, 52 (60.6%) were in type 1 and 34 (39.4%) were in type 2 diabetic patient. Prevalence of developing diabetic retinopathy was significantly high in type 1 DM (p<00.001). Urban population significantly had more prevalence in developing retinopathy with the percentage of 65.1% (p=0.016). It was found that 44 (51.2%) had background retinopathy, 2(2.3%) had pre- proliferative and 40(46.5%) patients had proliferative retinopathy. Regarding maculopathy, 74 (86%%) had vision threatening maculopathy (visual acuity less than 6/18). Conclusion: Youths with both type 1 and type 2 DM showed a substantial risk of developing DR and should undergo regular check up and appropriate management for such ocular morbidity.




Is There Any Relationship Between Vitamin D and Insulin Resistance among Adults with Prediabetes?

Shahed-Morshed, Haq T, Selim S, Khan MA, Marufa-Mustari, Mostafahasan-Rajib, Yadav A, Faisal I, Ghani H, Anil-Shah, Hasanat MA,  Fariduddin M

Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh


Background: Both low vitamin D and prediabetes are common. Low vitamin D was observed in patients with prediabetes. So an inverse relationship between low vitamin D and insulin resistance is expected. But their  relationship in prediabetes is controversial and needs to be explored in our population. Objective: To determine the relationship between vitamin D and insulin resistance among adults with prediabetes. Materials and method: This cross-sectional study was carried out in 115 newly detected patients with prediabetes  according to ADA 2018 criteria and 75 age-group and sex-matched control were recruited consecutively from the department of Endocrinology, BSMMU to measure serum 25(OH)D which was measured by high performance liquid chromatography  method,  intact parathormone (iPTH) by chemiluminescent enzyme-labeled immunometric assay. Fasting insulin was measured by chemiluminescent microparticle immunoassay to calculate homeostasis model of insulin resistance (HOMA-IR). Result: The frequency of vitamin D deficiency was more in the control group than the prediabetic group (54.7%  vs 46.1%) which did not differ significantly. Among the different prediabetes category, vitamin D level and status were also not significantly different.There were no significant association between vitamin D status and iPTH status or their interaction with HOMA-IR in the prediabetic population. No significant correlation was found between vitamin D level (r= -0.07, p= 0.44) and iPTH level (r= 0.08, p= 0.37) with HOMA-IR. Conclusion: Vitamin D deficiency in prediabetes is as prevalent as in general population. There is no relationship between vitamin D and insulin resistance among adults with prediabetes.











Cost of Care for T2 Diabetes Management of Patients Attending The Tertiary Level Hospitals in Dhaka

Farhana Karim, Lal B Rawal, Nadia Alamgir, Kuhel Islam, Shaila Nazneen, Rubana Islam, Pradeep Adhikari, Manish Namendo, Punam Ganguly, Md. Kaoser Bin Siddique


International Centre for Diarrhoeal Disease and Research, Dhaka, Bangladesh


Background: Type 2 diabetes mellitus (T2DM) has now become a major public health problem worldwide. Patients with diabetes incur substantial amount of money for managing disease conditions. The low and middle income countries including Bangladesh are facing greater challenges of having financial burden caused by the disease. Due to lack of support mechanisms to manage the cost, the affected households adapt different coping mechanisms to manage regular treatment costs. Objective:  To assess the cost of type 2 diabetes care and the coping mechanisms among patients attending tertiary level hospitals in Dhaka, Bangladesh. Methodology: A cross sectional study design using purposive sampling was used to collect data from patients with T2DM in outpatient department of two tertiary level hospitals. A total 318 patients with history of diagnosed T2DM attending the hospitals were interviewed using a semi structured questionnaire. Questions related to direct and indirect costs and different coping mechanisms were asked. Result: In last 90 days duration mean direct cost of T2DM was BDT 6,010 per patient and mean indirect cost was BDT 1,000. Highest expenditure was incurred on medication (49.92%). The cost estimation suggests that 7% households had to incur catastrophic treatment expenditure each month. A total of 67% respondents families managed treatment cost within their monthly wages and 21.6% from their own savings. 35 patients were admitted in the hospitals in the past 6 months due to diabetes and related complications. The mean direct and indirect costs were BDT 20,000 and BDT 6,000 respectively. Conclusion: The patients with T2DM in Bangladesh are spending a significant share of their monthly family income to manage diabetes and related health conditions. There is a need for developing an effective strategy to help them reduce spending for the treatment cost and preventing them from encountering problem of catastrophic expenditure in the future.








Frequency of Lower Lung Field Tuberculosis among Diabetic Patients Attending Bangabandhu Sheikh Mujib Medical University

Raihan Kamal Galib

Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh


Background: Diabetic people are considered to be high risk patient for developing pulmonary tuberculosis (PTB). Usually PTB found predominantly in the upper lobes. Lower lung field tuberculosis occurs but it often misdiagnosed as pneumonia, carcinoma, and lung abscess. In a number of published comparative studies found chest X ray image from PTB with diabetes (DM) have been described as atypical because they frequently involve lower lung field often with cavities. Objective: The present study will be conducted with an objective to observe frequency of lower lung field TB in patients with co-existing TB DM and investigate correlation between lower lung fields TB in DM patients. Method: On this cross sectional observational study, we studied 59 patients with PTB proven by their sputum AFB, /Culture, /Gene Xpert MTB/Rif and DM which is proven by taking oral hypoglycemic drugs orreceiving insulin at the time of hospital admission or FPG ≥126 mg/dL (7.0 mmol/L). Fasting is defined as no caloric intake for at least 8 h.OR 2-h PG≥200mg/dL (11.1mmol/L) during OGTT. The test should be performed as described by the WHO, using a glucose load containing the equivalent of 75-g anhydrous glucose dissolved inwater.OR A1C ≥6.5% (48 mmol/L). The test should be performed in a laboratory using a method that is NGSP certified and standardized to the DCCT assay. OR in a patient with classic symptoms of hyperglycemia or hyperglycemic crisis, a random plasma glucose ≥200 mg/dL (11.1 mmol/L).In the absence of unequivocal hyperglycemia, results should be confirmed by repeat testing. Extra pulmonary TB without pulmonary involvement and seropositive HIV are excluded to allow better Data comparison. All patients will undergo chest x-ray to see frequency of lower lung field Tuberculosis among TB with coexisting diabetes (DM) patients. Result: A total of 117 TBDM patients of which frequency of lower lung field TB was 20.5%, majorityof them was belong to age 41-60 years.Male were predominant with male female ratio of 3:1.The comparison of frequency of lower lung field TB and other radiological forms among different age groups, smear positivity, ESR and HbA1c found statistically significant p value <0.05 and among duration of diabetes, smoking history, smoking duration, treatment profile MDR TB was not found statistically significant p value > 0.05. Conclusion: Frequency of lower lung field TB among TB DM patients are around 1/5 th so during investigation of DM patient, care must be taken no to miss this atypical radiological pattern of tuberculosis and treatment should be started as early as possible to reduce morbidity and mortality. Further studies areneeded to determine whether this is also true for other patients with secondary immunosuppression.




Digital Management of Diabetes by Using Smart Phone Technology

Bilkis Banu1, 2, Rainer Sauerborn1


1Heidelberg Institute of Global Health, Heidelberg University, Germany, 2Department of Public Health, Northern University Bangladesh, Dhaka, Bangladesh


Diabetes is a huge and costly chronic metabolic disease, spreading like spider net in Bangladesh. It is a growing problem with increasing prevalence (5.52% in 20131 and 7.4% in 20152) and escalating cost for complications (41 USD in 20131 and 51 USD in 20152) which can be prevented through early diagnosis and proper management of diabetes. Diabetes self-care management include diet, drug, physical exercise, follow-up visit, blood glucose test, risk behaviors and foot care act positive correlation to reduce complications, improve glycemic control and quality of life. There are several ways to educate and empower patients in diabetes management. In recent years, mobile phone plays an impressive role in educational or behavioral intervention and drive the world one step forward to the digitalization. Now a day, the uses of mobile phone communication technology for public health, is emerging, demanding, low cost and rapidly-evolving practices which could empower patients in diabetes management all over the world. It is the fastest growing sector of the communications industry in the developing country specially in a low resource country like Bangladesh where the current number of mobile phone subscribers are 129 million amongst the total population of 149 million. Different usage of mobile phone such as text messages, reminder by voice calling, smart phone applications have been revealed to be an effective tool for providing diabetes health education, clinic and appointment reminders, medication reminders, insulin injection, self-monitoring of blood glucose, diet, exercise and for building awareness about the disease. This may help patient to manage their diabetes more effectively, consistently, and enjoyably- a giant step in the direction to reduce the risk of non-communicable diseases.











Astrocyte Elevated Gene 1 Expression in Adults with Newly Diagnosed Type 2 Diabetes Mellitus

Shahjada Selim1, SK Mohammad Khorshed Alam2, Mohammad Shahnoor Hossain3, Sahadat Hossain Riyad4


1Assistant Professor, Department of Endocrinology, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh, 2Associate Professor, Department of Biochemistry, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh, 3Assistant Professor, Department of Genetic Engineering and Biotechnology, University of Dhaka, Dhaka, Bangladesh, 4Lecturer, Department of Biotechnology and Genetic Engineering, Noakhali Science and Technology University, Noakhali, Bangladesh


Background: Diabetes mellitus (T2DM) or more appropriately type 2 diabetes mellitus is the most heterogeneous form of diabetes which is caused by complex interactions between genetic and environmental factors. Although genome-wide analysis has found several single nucleotide polymorphisms (SNPs) in association with T2DM, their documented role is ambiguous and very few studies have reported about the correlation of particular gene expression with T2DM.  This study aimed to examine the correlation of AEG-1 gene expression in peripheral blood monocytes with type 2 diabetes. Method: This cross-sectional study includes 17 newly diagnosed T2DM patients and 16 healthy nonglycemic control subjects of Bangladeshi origin without any current treatment regimen.  Peripheral blood monocytes (PBMCs) were sorted from the whole blood and RNA was extracted followed by Q-RT PCR analysis to study the gene expression patterns. Result: Our study suggests that AEG-1 gene expression in peripheral blood monocytes of newly diagnosed patients with type 2 diabetes is significantly higher than control subjects. AEG-1 gene expression is positively correlated with BMI index and increased level was observed in patients with BMI index of 30 or more. Conclusion: Our study indicates that elevated expression of AEG-1 gene is a novel risk factors for type 2 diabetes.











Vitamin D Status and Its Relation with Tumour Necrosis Factor-Alpha and High Sensitivity C-Reactive Protein among Adults with Prediabetes

Faisal I, Haq T, Selim S, Khan M A, Marufa-Mustari, Mostofa hassan-Rajib, Shahed- Morshed, Ghani M H, Anil- Shah, Anil –Yadav, Hasant M A, Fariduddin M


Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh


Introduction: Progression of prediabetes to diabetes is very common. Recent studies support the role of inflammatory cytokines and proteins like tumour necrosis factor alpha (TNF-α) and high sensitivity C-reactive protein (hs-CRP) in the pathogenesis of diabetes. Vitamin D acts as an immune-modulator and interferes with systemic inflammation and thus may reduce the progression of prediabetes to diabetes. So, the role of vitamin D in prediabetes needs to be explored in our population. Objective: To determine the relation between vitamin D status and TNF-α and hs-CRP among adults with prediabetes. Materials and method: This cross-sectional study was carried out in 91 newly detected patients with prediabetes according to ADA 2018 criteria, were recruited consecutively from the department of Endocrinology, BSMMU to measure serum 25(OH)D which was measured by high performance liquid chromatography method, TNF-α was measured by ELISA and hs-CRP was measured by immunonephelometry technique. Result: About 74.7% had low vitamin D level. Vitamin D sufficiency, insufficiency and deficiency were present in 25.3%, 35.1%, and 39.6% respectively. Among the different prediabetes category, hs-CRP was elevated mostly in the IFG+IGT group which was statistically significant (p=0.049) but not with vitamin D and TNF-α .A negative correlation with hs-CRP and vitamin D was found (r= -.0246, p= 0.019) but it absent with TNF-α. Conclusion: A substantial proportion of the study population with prediabetes has hypovitaminosis D. There is a negative correlation of hs-CRP with vitamin D but not with TNF.





Cardiovascular Risk  in Adults with Newly Diagnosed Prediabetes in Bangabandhu Sheikh Mujib Medical University

Abedin M, Fariduddin M, Hasanat MA, Haq T, Selim S, Jahan S, Sultana N, Banu H, Khan MA, Nahar SB

Abdul Malek Ukil Medical College, Noakhali, Bangladesh, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh

Background: Cardiovascular complications start early in abnormal glucose tolerance. Prediabetesstate is an independent risk for cardiovascular problems. Objective: To assess cardiovascular risk factors (central obesity, hypertension, dyslipidemia, microalbuminuria, family history of diabetes and cardiovascular disease) in newly detected prediabetes. Materials and method: This cross-sectional study included 100 newly detected adults with prediabetes (M/F: 31/69; Age: 37.46±9.07 years; mean ± SD). Participants were divided into 4 groups: (i) Only IFG (ii) Only IGT (iii) Both IFG-IGT and (iv) Only HbA1c to see the cardiovascular risk factors [family history, body mass index (BMI kg/m2), blood pressure, lipid profile and urine microalbumin]. Lipid profile was measured by enzymatic method using commercial kit while urine for microalbumin was measured by immunoturbidimetric assay. Result: Among the cardiovascular risk factors, one-third of the subjects (33%) had family history of cardiovascular disease and 30% had hypertension. 54% were obese and 35% were overweight, whereas 90% had central obesity. Almost all subjects had dyslipidemia (98%), among which low HDL (83%) was the most common abnormality followed by high LDL (63%) level. More than half of the subjects (69%) had metabolic syndrome. Only 5% had microalbuminuria.  There was a significant difference in the frequency of family history of diabetes and cardiovascular disease among different categories of prediabetes (p=0.006 and0.009). Although only IFG group had highest frequency of central obesity (100%), dyslipidemia (100%), HTN (42.9%), metabolic syndrome (85.7%), there was no significant difference among different categories of prediabetes. Conclusion: Prediabetes is associated with high frequency of cardiovascular risk factors.








Cardiovascular Risk in Adults with Newly Diagnosed Prediabetes in Bangabandhu Sheikh Mujib Medical University

Mohaiminul Abedin


Background: Cardiovascular complications start early in abnormal glucose tolerance. Prediabetesstate is an independent risk for cardiovascular problems. Objective: To assess cardiovascular risk factors (central obesity, hypertension, dyslipidemia, microalbuminuria, family history of diabetes and cardiovascular disease) in newly detected prediabetes. Materials and method: This cross-sectional study included 100 newly detected adults with prediabetes (M/F: 31/69; Age: 37.46±9.07 years; mean ± SD). Participants were divided into 4 groups: (i) Only IFG (ii) Only IGT (iii) Both IFG-IGT and (iv) Only HbA1c to see the cardiovascular risk factors [family history, body mass index (BMI kg/m2), blood pressure, lipid profile and urine microalbumin]. Lipid profile was measured by enzymatic method using commercial kit while urine for microalbumin was measured by immunoturbidimetric assay. Result: Among the cardiovascular risk factors, one-third of the subjects (33%) had family history of cardiovascular disease and 30% had hypertension. 54% were obese and 35% were overweight, whereas 90% had central obesity. Almost all subjects had dyslipidemia (98%), among which low HDL (83%) was the most common abnormality followed by high LDL (63%) level. More than half of the subjects (69%) had metabolic syndrome. Only 5% had microalbuminuria.  There was a significant difference in the frequency of family history of diabetes and cardiovascular disease among different categories of prediabetes (p=0.006 and0.009). Although only IFG group had highest frequency of central obesity (100%), dyslipidemia (100%), HTN (42.9%), metabolic syndrome (85.7%), there was no significant difference among different categories of prediabetes. Conclusion: Prediabetes is associated with high frequency of cardiovascular risk factors.

 

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