High prevalence of type 2 diabetes among the urban middle class in Bangladesh
1 Stanford University School of Medicine, Stanford Prevention Research Center (SPRC), Stanford University, Stanford, USA
2 Centre for Control of Chronic Diseases, International Center on Diarrheal Diseases and Research (ICDDR, B), Dhaka, Bangladesh
3 Centre for Clinical Epidemiology and Biostatistics, University of Newcastle, Newcastle upon Tyne, Australia
4 Stanford University School of Medicine, Division of Nephrology, Stanford University, Stanford, USA
5 Stanford University School of Medicine, Global Health, Stanford University, Stanford, USA
6 Centre for Nutrition and Food Security, International Center on Diarrheal Diseases and Research (ICDDR, B), Dhaka, Bangladesh
7 Stanford University School of Medicine, General Medical Disciplines, Stanford University, Stanford, CA, USA
BMC Public Health 2013, 13:1032 doi:10.1186/1471-2458-13-1032Published: 31 October 2013
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.
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).
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.
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.