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Morkrid K.,University of Oslo | Ali L.,Bangladesh Institute of Research and Rehabilitation in Diabetes | Hussain A.,University of Oslo
International Journal of Diabetes in Developing Countries | Year: 2010

Aims/Hypothesis: The purpose of the study is to estimate the prevalence and risk factors for diabetic peripheral neuropathy (DPN) in type 2 diabetic outpatients at the BIRDEM hospital, Bangladesh. Materials and Methods: Type 2 diabetic outpatients, diagnosed 5-11 years prior to the investigation were randomly selected for the study. DPN was assessed using the Neuropathy Symptom Score (NSS) and Neuropathy Disability Score (NDS). Data about demographics, blood pressure, height, weight, waist and hip circumference, and random blood and urine samples were collected. Results: Two hundred and ninety four (139 men, 155 women) type 2 diabetic outpatients were studied. The overall DPN prevalence was 19.7 %; male (20.9%), female (18.7 %). The prevalence increased with age (from 11.1% in the 23-40 year-old group to 32.3% in the 60-80 year-old group) and duration of diabetes (from 14.1% in patients with five years to 29.2% in patients with 9-11 years duration). Age > 60 years (OR 4.2, 95% CI 1.4-12.3), low/normal WHR (OR 3.8, 95% CI 1.6-9.3), income < 800 TK (OR 3.1, 95% CI 1.1-9.3) and insulin treatment (OR 2.0, 95% CI 1.0-4.0) were independent, significant risk factors. Longer duration of diabetes (OR1.2 95% CI 1.0-1.4), and higher HbA1c (OR1.1, 95% CI 1.0-1.3) were marginally independent, significant risk factors for DPN. Conclusions/Interpretations: We observed a DPN prevalence of 19.7%. Higher age, low socioeconomic status, treatment with insulin, longer duration of diabetes and poor glycemic control were risk factors for DPN.


Bhowmik B.,University of Oslo | Munir S.B.,University of Oslo | Diep L.M.,University of Oslo | Diep L.M.,Executive Diabetes Care Center | And 4 more authors.
Journal of Diabetes Investigation | Year: 2013

Aims/Introduction: The aim of the present study was to evaluate the predictive ability of body mass index (BMI), waist circumference (WC), waist-to-hip ratio (WHR), waist-to-height ratio (WHtR) and body fat percentages (BF%) for the presence of cardiometabolic risk factors, namely type 2 diabetes (DM), hypertension (HTN), dyslipidemia and metabolic syndrome (MS). Materials and Methods: A total of 2293 subjects aged ≥20 years from rural Bangladesh were randomly selected in a population-based, cross-sectional survey. The association of anthropometric indicators with cardiometabolic risk conditions was assessed by using receiver operating characteristic curve analysis and adjusted odds ratios (ORs) for DM, HTN, dyslipidemia and MS. Results: Area under the curve cut-off values showed that the association of WHR, BF% and WC was higher than that for other indices for DM, HTN and MS, respectively, for both sexes, and WHtR for men and WHR for women for dyslipidemia. The ORs were highest for WHR for DM and WC for MS for both sexes, and WHtR for men and WC for women for HTN and dyslipidemia, respectively. The optimal cut-off values for obesity for the present study in men and women showed BMIs of 22 and 22.8 kg/m2, WHRs of 0.93 and 0.87, WHtRs of 0.52 and 0.54, BF% of 21.4 and 32.4%, and WCs of 82 and 81 cm, except for MS, which were 90 for men and 80 for women. Conclusions: Compared with BMI, measures of central obesity, particularly WHR, WC, WHtR and BF%, showed a better association with obesity-related cardiometabolic risk factors for both sexes. © 2013 Asian Association for the Study of Diabetes and Wiley Publishing Asia Pty Ltd.


Biswas S.K.,Bangabandhu Sheikh Mujib Medical University | Biswas S.K.,University of Tennessee Health Science Center | Mudi S.R.,Bangladesh Institute of Research and Rehabilitation in Diabetes | Mollah F.H.,Bangabandhu Sheikh Mujib Medical University | And 2 more authors.
Diabetes and Vascular Disease Research | Year: 2013

This study was designed to explore the relationship between serum levels of soluble receptor for advanced glycation end products (sRAGE) and cigarette smoking in non-diabetic healthy subjects. A total of 98 non-diabetic, otherwise healthy male subjects were recruited. A fasting blood sample and medical history including detail history of cigarette smoking was collected. The serum sRAGE levels were found significantly higher (p=0.002) in cigarette smokers (1475±422 pg/ml, n=45) compared with non-smokers (1165±350 pg/ml, n=53). Moreover, among the cigarette smokers, serum sRAGE levels were found significantly correlated with number of cigarettes smoked per day (r=0.60, p<0.001). In bivariate analysis in the total population, sRAGE positively correlated with smoking habit (r=0.37, p=0.002) and negatively correlated with systolic (r=-0.32, p=0.01) and diastolic blood pressure (r=-0.36, p=0.003). However, in stepwise multivariate linear regression model, sRAGE showed a significant independent association with smoking habit (b=0.32, p=0.007, R2=0.23). In conclusion, this study for the first time shows a significant elevation of serum sRAGE in cigarette smokers compared with non-smokers, a strong correlation between sRAGE and number of cigarettes smoked per day and an independent association of sRAGE with smoking habit in non-diabetic healthy subjects. © The Author(s) 2013.


Home P.,Northumbria University | Haddad J.,Prince Hamazah Hospital | Latif Z.A.,Bangladesh Institute of Research and Rehabilitation in Diabetes | Soewondo P.,University of Indonesia | And 5 more authors.
Diabetes Therapy | Year: 2013

Introduction: Development of higher standards for diabetes care is a core element of coping with the global diabetes epidemic. Diabetes guidelines are part of the approach to raising standards. The epidemic is greatest in countries with recent rises in income from a low base. The objective of the current study was to investigate the availability and nature of locally produced diabetes guidelines in such countries. Methods: Searches were conducted using Medline, Google, and health ministry and diabetes association websites. Results: Guidelines were identified in 33 of 75 countries outside North America, western Europe, and Australasia. In 25 of these 33 countries, management strategies for type 1 diabetes were included. National guidelines relied heavily on pre-existing national and international guidelines, with reference to American Diabetes Association standards of medical care and/or other consensus statements by 55%, International Diabetes Federation by 36%, European Association for the Study of Diabetes by 12%, and American Association of Clinical Endocrinologists by 9%. The identified guidelines were generally evidence-based, though there was some use of secondary evidence reviews, including other guidelines, rather than original literature reviews and evidence synthesis. In type 1 diabetes guidelines, the option of different insulin regimens (mostly meal-time? basal or premix regimens) was recommended depending on patient need. Type 2 diabetes guidelines either recommended a glycosylated hemoglobin target of \7.0% (\53 mmol/mol) (70% of guidelines) or\6.5% (\47 mmol/mol) (30% of guidelines) as the ideal glycemic target. Most guidelines recommended a target fasting plasma glucose that fell within the range of 3.8-7.2 mmol/L. Most guidelines also set a 2-h post-prandial glucose target value within the range of 4.0-8.3 mmol/L. Conclusion: While only a first step in achieving a high quality of disease management, national guidelines of quality and with fair consistency of recommendations are becoming prevalent globally. A further challenge is implementation of guidelines, by integration into local care processes. © The Author(s) 2013.


Home P.D.,Northumbria University | Shen C.,Novo Nordisk AS | Hasan M.I.,Diabetic Institute Pakistan | Latif Z.A.,Bangladesh Institute of Research and Rehabilitation in Diabetes | And 2 more authors.
Diabetes Care | Year: 2014

OBJECTIVE: Individualization of therapy choices requires the prediction of likely response. Predictor and explanatory factors of change in HbA1c were studied using data from a large observational study of starting insulin analog therapy (the A1chieve study). RESEARCH DESIGN AND METHODS: Univariate analyses were performed for insulin-naive people and prior insulin users in the A1chieve study. Statistically significant factors were carried forward to baseline factor-only multivariate analyses ("predictor" analysis), and separately using all significant factors ("explanatory" analysis). Power was considered in terms of the variance explained. RESULTS: Geographical region, baseline HbA1c level, lipid levels, and baseline insulin dose were the most powerful predictors of HbA1c change (mean change -2.1% [-23 mmol/mol]) observed in the univariate analysis (r2 > 0.010, P < 0.001). However, although the predictor and explanatory multivariate models explained 62-82% of the variance in HbA1c change, this was mainly associated with baseline HbA1c (r2 = 0.544-0.701) and region (r2 = 0.014-0.037). Other factors were statistically significant but had low predictive power (r2 < 0.010); in the explanatory analysis, this included end-of-study hypoglycemia (insulin-naive group), insulin dose, and health-related quality of life (r2 < 0.001-0.006, P ≤ 0.007). CONCLUSIONS: Many factors can guide clinicians in predicting the response to starting therapy with insulin analogs, but many are interdependent and thus of poor utility. The factor explaining most of the variance in HbA1c change is baseline HbA1c level, with each increase of 1.0%-units (11mmol/mol) providing a 0.7-0.8%-units (8-9mmol/mol) greater fall. Other factors do not explain much of the remaining variance, even when including all end-of-trial measures. © 2014 by the American Diabetes Association.


Tasnim F.,Bangladesh Institute of Research and Rehabilitation in Diabetes | Faruque M.O.,Bangladesh University | Hassan Z.,Bangladesh University | Ali L.,Bangladesh University
Journal of Taibah University Medical Sciences | Year: 2015

Abstract Objectives The present study aimed to explore the relationship of circulating vaspin levels with insulin sensitivity and anthropometric factors. Methods This study was conducted with 65 newly diagnosed type 2 diabetes mellitus (T2DM) patients with age-matched 65 healthy controls. Serum glucose was measured using glucose-oxidase method, lipid profiles by enzymatic end-point methods, and fasting insulin and vaspin levels were assessed with ELISA techniques. Homeostasis model assessment for insulin sensitivity (HOMA%S) and insulin secretory capacity (HOMA%B) were estimated from the fasting glucose and insulin levels using HOMA-CIGMA software. Results Fasting serum insulin (μU/ml) was higher in the diabetic group than controls (16.0 ± 7.9 vs. 10.9 ±3.3, respectively, p =0.0001). The mean (±SD) HOMA%S of the diabetics was significantly lower than that of the controls (48 ±31 vs. 76±55, respectively, p = 0.001). The HOMA%B of the T2DM group was nearly 50% of that of the controls (71± 40 vs. 131 ±46, respectively, p = 0.001). The T2DM group exhibited significantly lower serum vaspin (ng/ml) levels than the controls (0.62 ±0.26 vs. 0.83± 0.28, respectively, p =0.001). Vaspin levels were negatively correlated with waist circumference (r =0.17, p =0.043) and positively correlated with HOMA%S (r =0.243, p =0.007) among all of the participants. The association of serum vaspin with diabetes remained highly significant (p =0.008) in binary logistic regression analysis performed after adjusting for the effects of confounders. Conclusions Serum vaspin level is positively associated with insulin sensitivity and negatively correlated with serum glucose, BMI and waist-height ratio. © 2015 The Authors.


Chowdhury S.,Central Hospital Ltd | Banu L.A.,Laboratory AID Specialized Hospital | Chowdhury T.A.,Bangladesh Institute of Research and Rehabilitation in Diabetes | Rubayet S.,Save the Children United States | Khatoon S.,Bangladesh Medical College
BJOG: An International Journal of Obstetrics and Gynaecology | Year: 2011

Bangladesh has made commendable progress in achieving Millennium Development Goals (MDGs) 4 and 5. Since 1990, there has been a remarkable reduction in maternal and child mortality, with an estimated 57% reduction in child mortality and 66% in maternal mortality. This review highlights that, whereas Bangladesh is on track for achieving MDG 4 and 5A, progress in universal access to reproductive health (5B) is not yet at the required pace to achieve the targets set for 2015. In addition, Bangladesh needs to further enhance activities to improve newborn health and promote skilled attendance at birth. © 2011 RCOG.


Afsana F.,Bangladesh Institute of Research and Rehabilitation in Diabetes | Latif Z.A.,Bangladesh Institute of Research and Rehabilitation in Diabetes | Maksumul Haq M.,Ibrahim Cardiac Hospital and Research Institute ICHRI
International Journal of Diabetes Mellitus | Year: 2010

Aims: This study was undertaken to identify the parameters of metabolic syndrome which can predict cardiovascular and peripheral vascular disease. Subject: A total of 260 subjects were selected from Ibrahim Cardiac Hospital and Research Institute (ICHRI), who reported for coronary angiogram as per advice of a cardiologist. Method: Each subject undergoing angiogram was interviewed with a preset structured questionnaire. The study subjects were screened for PVD (peripheral vascular disease) by examining peripheral pulses and ankle brachial index measured. Subjects with absent pulse or non-recordable ankle brachial index was considered as ankle brachial index <0.9. Positive angiographic finding was defined by presence of mild to severe degree of coronary vascular narrowing of one or multiple of three coronary arteries. Result: Among the study subjects 64.6% had metabolic syndrome, 79.2% had positive and 20.8% had normal angiographic finding. Among the CAG positive subjects 38.8% had single vessel disease, 30.0% had double vessel disease and 31.08% had triple vessel disease. CAG positive subjects are mostly 40-60 years of age, 78.6% male, 54.8% smoker, 62.1% had waist circumference above normal, and about 90% have dyslipidemia and dysglycemia (DM/IGT/IFG). In this study subjects 83.9% of diabetic and 69.7% of non-diabetic had positive angiographic finding. Among the CAG positive subjects 16.6% had low ABI (<0.9). Conclusions: This study reveals that hypertriglyceridemia, waist circumference and hypertension are significantly related with angiographic positivity. Peripheral vascular disease was not significantly higher among CAG positive subjects and no association was observed between metabolic syndrome and PVD. © 2010 International Journal of Diabetes Mellitus. Published by Elsevier Ltd. All rights reserved.


Mohsin F.,Bangladesh Institute of Research and Rehabilitation in Diabetes
Mymensingh medical journal : MMJ | Year: 2012

The study was undertaken to see the prevalence of impaired glucose tolerance among children and adolescents with obesity, attending the Paediatric Endocrine OPD, Bangladesh Institute of Research and Rehabilitation in Diabetes, Endocrine and Metabolic disorders (BIRDEM), Dhaka, Bangladesh. A cross sectional study from January 2006 to December 2008 was conducted among obese children and adolescents (6-18 years). Children with any other endocrine disorder, dysmorphism/syndrome were excluded. Obesity was defined as BMI ≥ 95th percentile for age and sex using CDC growth chart. Children underwent two hours oral glucose tolerance test with 1.75 gm/kg or 75 gm of glucose, anthropometric and blood pressure measurement. Fasting serum insulin and lipid profile were measured. Impaired glucose tolerance (IGT) was defined as fasting plasma glucose (FPG) <7 mmol/L and 2 hours post glucose load ≥ 7.8 mmol/L to <11.1 mmol/L. Diabetes mellitus (DM) was defined as FPG ≥ 7 mmol/L or 2 hours post glucose load ≥ 11.1 mmol/L. Homeostasis model assessment was used to estimate insulin resistance. A total of 161 children presented with obesity. Male to female ratio was 1.3:1. Mean age was 10.3 ± 2 .5 years. Mean BMI was 27.86 ± 4.1 kg/m2. IGT was found in 16.9% of children and adolescents. In children aged 6-10 years IGT was detected in 16.1% and in adolescents aged 11-18 years IGT was detected in 20%. Diabetes mellitus was detected in 2.1% of subjects, all were adolescents. Serum fasting insulin and hip circumference were significantly higher among children and adolescents with IGT compared to that of normal glucose tolerance. The high rate of IGT among obese children and adolescents is of concern. Factors contributing towards obesity needs to be identified and strategies should be planned for prevention and management of this health problem.


Hossain S.M.F.,Robi Axiata Ltd | Gulshan J.,University of Dhaka | Khanam P.A.,Bangladesh Institute of Research and Rehabilitation in Diabetes
International Journal of Diabetes in Developing Countries | Year: 2016

This study aims at determining the impact of different background factors on type 2 diabetes. During the year 2007–2008, 12,112 registered diabetic patients of Bangladesh Institute of Research and Rehabilitation in Diabetes, Endocrine and Metabolic Disorders (BIRDEM) have been selected as the sample for this study. The variables age, sex, body mass index, marital status, place where spent three fourth of the life, educational level, occupation, economic status, smoking habit, and family history of diabetes have been considered as potential risk factors for diabetes. The dependent variable chosen was the fasting blood glucose level. Chi-square test of independence diagnosed age, place where spent at least three fourth of lifetime, body mass index, education, economic status, sibling’s having diabetes, occupation, father having diabetes, smoking habit, and sex to be significantly associated with the fasting blood glucose level. Ordinal logistic regression model was applied to detect the impact of risk factors on blood glucose level and age, body mass index (BMI), education, economic status, occupation and place where spent three fourth of the lifetime were found to be significant. © 2015, Research Society for Study of Diabetes in India.

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