BIRDEM

Dhaka, Bangladesh
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Hoque S.,Khwaja Yunus Ali Medical College and Hospital | Muttalib M.A.,BIRDEM | Islam M.I.,Khwaja Yunus Ali Medical College and Hospital | Happy A.T.,Khwaja Yunus Ali Medical College and Hospital
Bangladesh Medical Research Council Bulletin | Year: 2016

This cross sectional study was carried out in the outpatient department of Bangladesh Institute of Research and Rehabilitation in Diabetes, Endocrine and Metabolic Disorders, Bangladesh (BIRDEM) General Hospital, Dhaka, to explore the factors influencing or related to the development of the diabetic peripheral neuropathy (DPN) with specific concern to the HbA1c levels. A total of 400 patients with type 2 diabetic were selected to collect information on sociodemographic, blood pressure, anthropometry and lipid profile. Glycaemic status was assessed by HbA1c and plasma glucose levels. Prevalence of DPN was 16.8%, with male 10.8% and female 20.9%. Increased HbA1c categories above 7.0% were significantly associated with increased prevalence of DPN (9.2 Vs. 10.5 Vs 26.5%; ?2 = 19.446, p = .000). Logistic regression models showed that the risk of DPN was strongly increased at the HbA1c categories >8% (OR = 3.57; 95% CI: 1.75-7.26). Advanced age (OR = 1.97; 95% CI: 1.12-3.47), longer duration of diabetes (OR = 1.81; 95% CI: 1.02-3.19), lacking of physical exercise (OR = 2.60; 95% CI: 1.47-4.58), female gender (OR = 2.17; 95% CI: 1.21-3.89), fasting blood glucose (OR = 1.153; 95% CI: 1.058-1.255) and blood glucose 2 hours after breakfast (OR = 1.096; 95% CI: 1.029-1.168) were significant risk factors of DPN. However, there is need of a large scale community based prospective study to validate the results.


Khan N.Z.,BIRDEM | Muttalib M.A.,BIRDEM | Sultana G.S.,BIRDEM
Bangladesh Medical Research Council Bulletin | Year: 2016

Type 2 diabetes mellitus (T2DM) and thyroid disorders (TD) are the two most common endocrine disorders in clinical practice. They show mutually influence on each other. Unrecognized thyroid disorders may adversely affect the metabolic control and add more risk to an already predisposing type 2 diabetes mellitus. The objective of this study was to find out the association of thyroid hormone levels in patients with type 2 diabetes mellitus. This cross sectional study was conducted in the department of Biochemistry and outpatient department of Endocrinology of Bangladesh Institute of Research and Rehabilitation in Diabetes, Endocrine and Metabolic Disorders, Dhaka, Bangladesh (BIRDEM) General Hospital, Bangladesh from July 2014 to June 2015. A Total of 200 patients were selected by applying inclusion and exclusion criteria. Of them, 115 were type 2 diabetic subjects and 85 were non diabetic. Diabetic patients were diagnosed according to WHO criteria from their previous medical records. All patients were underwent thyroid function tests; free thyroxine (FT4), free tri-iodothyronine (FT3) and serum TSH (thyroid stimulating hormone). Presence of TD in T2DM and non-DM patients were estimated. Comparison of all demographic characteristics and biochemical parameters were done among the groups. The percentage of TD in type 2 diabetic patients was 23.5% and in non diabetic subjects was 12%. Serum FT3 and serum FT4 did not show any significant difference among the groups. Type 2 diabetic patients with thyroid disorders had more elevated level of serum TSH level than those who were non diabetic subjects with TD. Thyroid disorders were significantly higher in female, overweight and obese subjects. Patients with TD had strong association with family history of TD. This study showed that the presence of TD in type 2 diabetes mellitus was very high. Regular screening for thyroid disorders in type 2 diabetic patients specially serum TSH level is recommended.


Tsai S.-T.,Taipei Veterans General Hospital | Pathan F.,Birdem | Ji L.,Peking University | Yeung V.T.F.,Our Lady of Maryknoll Hospital | And 7 more authors.
Journal of Diabetes | Year: 2011

Background: The First Basal Insulin Evaluation (FINE) Asia study is a multinational, prospective, observational study of insulin-naïve Type 2 diabetes mellitus (T2DM) patients in Asia, uncontrolled (A1c≥8%) on oral hypoglycemic agents, designed to evaluate the impact of basal insulin initiation. Methods: Basal insulin was initiated with or without concomitant oral therapy and doses were adjusted individually. All treatment choices, including the decision to initiate insulin, were at the physician's discretion to reflect real-life practice. Results: Patients (n=2679) from 11 Asian countries were enrolled (mean [±SD] duration of diabetes 9.3±6.5years; weight 68.1±12.7kg; A1c 9.8±1.6%). After 6months of basal insulin (NPH insulin, insulin glargine, or insulin detemir), A1c decreased to 7.7±1.4%; 33.7% patients reached A1c <7%. Fasting blood glucose (FBG) decreased from 11.7±3.6 to 7.2±2.5mmol/L and 36.8% of patients reached FBG <6.1mmol/L. The mean daily insulin dose prescribed increased marginally from 0.18 to 0.23U/kg per day at baseline to 0.22-0.24U/kg per day at Month 6. Mean changes in body weight and reported rates of hypoglycemia were low over the duration of the study. Conclusions: Initiation of insulin therapy is still being delayed by approximately 9years, resulting in many Asian patients developing severe hyperglycemia. Initiating insulin treatment with basal insulin was effective and safe in Asian T2DM patients in a real-world setting, but insulin needs may differ from those in Western countries. © 2011 Ruijin Hospital, Shanghai Jiaotong University School of Medicine and Blackwell Publishing Asia Pty Ltd.


PubMed | Post Graduate Medical Institute Hayatabad Medical Complex, Kathmandu University, National Hospital, Bharti Hospital and BRIDE and 18 more.
Type: Journal Article | Journal: Indian journal of endocrinology and metabolism | Year: 2015

Since their introduction in clinical practice in the 1950s, Sulfonylureas (SUs) have remained the main-stay of pharmacotherapy in the management of type 2 diabetes. Despite their well-established benefits, their place in therapy is inappropriately being overshadowed by newer therapies. Many of the clinical issues associated with the use of SUs are agent-specific, and do not pertain to the class as such. Modern SUs (glimepiride, gliclazide MR) are backed by a large body of evidence, experience, and most importantly, outcome data, which supports their role in managing patients with diabetes. Person-centred care, i.e., careful choice of SU, appropriate dosage, timing of administration, and adequate patient counseling, will ensure that deserving patients are not deprived of the advantages of this well-established class of anti-diabetic agents. Considering their efficacy, safety, pleiotropic benefits, and low cost of therapy, SUs should be considered as recommended therapy for the treatment of diabetes in South Asia. This initiative by SAFES aims to encourage rational, safe and smart prescription of SUs, and includes appropriate medication counseling.


Akhter M.,Bangabandhu Sheikh Mujib Medical University | Ali L.,Bangladesh Institute of Health Science | Hassan Z.,BIRDEM | Khan I.,BIRDEM
Journal of Health, Population and Nutrition | Year: 2013

Oral squamous cell carcinoma is the sixth most common malignancy worldwide. In Bangladesh, it comprises 20% of the whole body malignancies. Several studies found that 15% to 25% of oropharyngeal cancer cases are associated with human papilloma virus (HPV). This study is done to find the association of human papilloma virus subtypes, particularly HPV type 16 and HPV type 18, with the oral squamous cell carcinoma in Bangladeshi patients. In total, 34 diagnosed patients of oral squamous cell carcinoma were included in the study. Extracted DNA from the cancerous tissues was checked for PCR reaction to detect the subtypes of human papilloma virus. Data of the present study suggest that oral squamous cell carcinoma are almost absent in Bangladeshi patients with human papilloma virus, particularly HPV 16 and 18. © INTERNATIONAL CENTRE FOR DIARRHOEAL DISEASE RESEARCH, BANGLADESH.


Latif Z.A.,BIRDEM | Jain A.,Novo Nordisk AS | Rahman M.M.,Novo Nordisk AS
Bangladesh Medical Research Council Bulletin | Year: 2011

DiabCare Bangladesh 2008 evaluated the current status of diabetes care in Bangladesh as a continuation of similar cross-sectional study conducted previously in 1998. The current study recruited 1952 patients from general hospitals, diabetes clinics and referral clinics to study current scenario of diabetes management from 01 March 2009 to 31 March 2009. We report the results of type 2 diabetic population who constituted 95.3% (n=1860). Results showed deteriorating glycaemic control with mean HbA1c of 8.6±2.0% with only 23.1% of the patients achieving American Diabetes Association (ADA) target of <7%. 896 (47.0%) patients were hypertensive and 850 (94.9%) were on antihypertensive medication. 70.8% of patients had LDL levels >2.6 mmol/L; 43.8% had triglycerides >2.2 mmol/L; 44.1% had HDL<1 mmol/L despite 48% of the patients being on lipid lowering agents. Microvascular, macrovascular and severe late complications were reported in 39.2%, 9.9% and 12.1% patients respectively. The rates of diabetic complications were cataract 12.9%, microalbuminuria 15.7%, neuropathy symptoms 31.7%, leg amputation 1.2% and history of angina pectoris was 6.6%. Quality of life evaluation showed that about half of patients have poor quality of life. Also, there was poor adherence to diet, exercise and self testing of blood glucose. In conclusion, majority of the patients were still not satisfactorily controlled. There is an urgent need for effective remedial measures to increase adherence to practice guidelines and to educate both patients and healthcare personnel on importance of achieving clinical targets for metabolic control.


PubMed | BIRDEM, BSMMU, Health Economics Unit, Bangladesh Medical College and 2 more.
Type: Journal Article | Journal: Journal of gynecological endoscopy and surgery | Year: 2015

The study was undertaken to compare the efficiency and outcome of Laparoscopic Assisted Vaginal Hysterectomy (LAVH) and Vaginal Hysterectomy (VH) in terms of operative time, cost, estimated blood loss, hospital stay, quantity of analgesia use, intra- and postoperative complication rates and patients recovery.A total of 500 diabetic patients were prospectively collected in the study period from January 2005 through January 2009. The performance of LAVH was compared with that of VH, in a tertiary care hospital. The procedures were performed by the same surgeon.There was no significant difference in terms of age, parity, body weight or uterine weight. The mean estimated blood loss in LAVH was significantly lower when compared with the VH group (126.539.8 ml and 10032.8 ml), respectively. As to postoperative pain, less diclofenac was required in the LAVH group compared to the VH group (70.3813.45 mg and 75.1816.45 mg), respectively.LAVH, is clinically and economically comparable to VH, with patient benefits of less estimated blood loss, lower quantity of analgesia use, lower rate of intra- and postoperative complications, less postoperative pain, rapid patient recovery, and shorter hospital stay.


Hossain S.J.,Khulna University | Basar M.H.,Khulna University | Rokeya B.,BIRDEM | Arif K.M.T.,Khulna University | And 3 more authors.
Oriental Pharmacy and Experimental Medicine | Year: 2013

The mangrove fruit Sonneratia apetala Buch.-Ham. is extensively consumed by the people of coastal Bangladesh especially adjacent to the Sundarbans' forest. Seeds consist of very high content of polyphenols (300 ± 8.2 mg GAE/g extract), flavonoids (30.6 ± 0.7 CE/g extract), anthocyanins (2.3 ± 0.03 μmol/g extract) and vitamin C (4.0 ± 0.08 mg/g extract). The IC50 values for DPPH and NO free radical scavenging were 4.3 and 49.4 μg/mL for seed extract and that for pericarp extract were 59.8 and 751.6 μg/mL respectively. Seed extract also showed very high reducing power (O. D. 1.14 at 50 μg/mL extract) and total antioxidant capacity (280.8 GAE or 310.24 AAE/g extract). In streptozotocin (STZ) induced type 2 diabetes rats, seed extract treated group showed serum glucose decreased from 13.75 ± 2.21 mmol/L (at 30 min) to 10.3 ± 1.75 mmol/L (at 135 min) and in the pericarp treated group from 14.36 ± 2.16 to 11.32 ± 1.74 mmol/L. The area under the glucose curve was more profoundly decreased in the seed treated group than the pericarp treated group. Susceptibility test showed that seed extract inhibited the growth of both gram-positive and gram-negative pathogenic bacteria. Therefore, fruits of S. apetala, especially its seeds are functionally rich with phenolics, flavonoids, antioxidant, antidiabetic and antibacterial compounds. © 2012 Institute of Oriental Medicine, Kyung Hee University.


Jahan S.,BIRDEM | Ahmed C.M.,BSMMU | Zinnat R.,BIRDEM | Hasan Z.,BIRDEM | And 3 more authors.
Diabetes and Metabolic Syndrome: Clinical Research and Reviews | Year: 2011

Introduction: Leptin is now known to be an important hormone affecting intrauterine fetal growth. Since growth of fetus is also affected by the glycemic status of the mother. Serum leptin of infant is influenced by the maternal diabetic state. Investigation of cord blood leptin in babies of DM (Diabetes Mellitus) and GDM (Gestational Diabetes Mellitus) mothers (controlled blood glucose levels) may provide some indication about involvement of genetic factor in the development of leptin abnormalities in fetus. Aim: The study was taken to investigate whether cord blood insulin, c-peptide and leptin levels correlate with birth weight in offspring of DM mother. Methods: Blood was drawn from umbilical cord of 30 babies from GDM mothers (GDM-babies), 45 babies from Type 2 DM Mothers (DM-babies), and 30 babies from ND (Nondiabetic) mothers (ND-babies) of term pregnancy. Weight, blood glucose, placenta, serum leptin and c-peptide of the babies were measured. Results: Birth weight of GDM and DM babies were significantly higher compared to ND-babies. Glucose level in GDM babies was significantly higher than ND and DM babies. Leptin levels in GDM babies were significantly higher than that of ND and DM babies. Serum c-peptide in GDM babies was significantly higher than DM and ND babies. However, there was no significant difference in leptin-glucose ratio among the three groups. Irrespective of degree of hyperglycemia leptin is a major determinant of fetal growth. Conclusions: DM mother produces different insulinemic and leptinemic responses in the fetus indicating a possible genetic involvement. © 2010 Diabetes India. Published by Elsevier Ltd. All rights reserved.


Habib S.H.,Health Economics Unit | Biswas K.B.,BIRDEM | Akter S.,BIRDEM | Saha S.,Health Economics Unit | Ali L.,Health Economics Unit
Journal of Diabetes and its Complications | Year: 2010

The economic burden resulting from diabetic foot consumes a major portion of resources. The study was undertaken to assess the cost-effectiveness of medical intervention in patients with diabetic foot. At baseline 906 patients were analyzed. Then 200 patients with diabetic foot were purposively selected from a tertiary diabetes care hospital. Of these, 100 were late in detection and poorly managed (late diabetic foot or LDF) and 100 were detected early and properly managed (early diabetic foot or EDF). Among 906 patients, 2.8% (25 patients) were found to develop diabetic foot. Total cost of treatment was US$13,308.16 with an average of US$443.60 per patient. Comparing the cost of patients who underwent amputation with the patients who are not yet amputated, cost difference was US$6657.74. The result showed that cost of amputation was 5.54 times higher than the usual treatment. The average cost of care was US$134 per patient. Among the average annual cost, LDF consumed US$18,918. Fifty percent of the costs were attributable to drugs for both groups of which 77% was for LDF and 29% to hospitalizations. The regression equation showed that medical cost is significantly related to complications. Proper management can substantially reduce the cost of care of patients with diabetic foot. © 2010 Elsevier Inc.

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