Sri Lanka Journal of Diabetes Endocrinology and Metabolism, Nov 23, 2021
Original Article Background: Diabetes mellitus (DM) patients have an increased risk of developing... more Original Article Background: Diabetes mellitus (DM) patients have an increased risk of developing several serious health problems in comparison with patients without DM. Depression is one of the more common co-morbid conditions found among diabetic patients. It is associated with poorer glycaemic control, reduced compliance with treatment, and increased complications, which can lead to impaired quality of life. Objective: This study was designed to assess the prevalence of depression and to recognize its associated factors among patients with type 2 diabetes mellitus attending a tertiary care hospital in Dhaka, Bangladesh. Methods: This cross-sectional study was conducted from July 2019 to February 2020. We recruited 318 types 2 diabetics (T2DM) patients who attended an outpatient diabetic clinic at a tertiary care hospital in Dhaka, Bangladesh. We used Patient Health Questionnaire-9 (PHQ-9) to assess depression among the subjects. A semi-structured questionnaire was used to collect demographic, clinical, and diabetes-related information after informed written consent was taken from the patients. Results: Among study subjects, the mean duration of diabetes was 7.51 ±6.18 (±SD) years. About one-third of the patients (34.9%) had been suffering from diabetes for more than 10 years. The prevalence of depressive illness using the PHQ-9 (score≥5) was found higher among female patients than male patients (46.2% vs.17.9%); (P=0.98). The calculated mean depression score was 6.89±6.08 (±SD). On the other hand, the prevalence of moderate to severe depressive illness using the PHQ-9 (score≥10) was 33.6% (male vs. female: 7.2% vs. 26.4%); (P=0.06). Mild depression (PHQ-9 score: 5-9) had been found among 30.8% of subjects. Moderate depression (PHQ-9 score: 10-14) and moderately severe depression (PHQ-9 score: 15-19) were found among 18.9% and 11.6% diabetic subjects respectively. The prevalence of severe depression (PHQ-9 score: 20-27) was only 3.1%; (p=0.12). Among demographic variables older age, urban residency, housewife, widow, lower education level, and low income were significantly associated with depression; (p<0.05). On the other hand, the clinical variables i.e. patients for a longer duration of diabetes (≥10 years), those with a co-morbid disease, or diabetes-related complications, and higher BMI, were significantly associated with a substantial risk for moderate to severe depression; (p<0.05). Poor glycaemic control (HbA1c >8.0%), was detected as a strong forecaster for depression; (p<0.001). Conclusions: The prevalence of depression specifically moderate to severe is very high among the study population. The high prevalence of depression in diabetic individuals suggests that patients with diabetes mellitus should be inquired for depression or mental disorders. Since depression could significantly impede a patient's adherence to treatment; mental health care needs to be incorporated into the management of diabetes for early diagnosis and treatment.
The study was aimed to describe the patterns of single anti-diabetic agents used by type 2 diabet... more The study was aimed to describe the patterns of single anti-diabetic agents used by type 2 diabetic patients and their glycemic status during hospital admission. Study design and methods: This cross-sectional study was carried out in BIRDEM among hospitalized type 2 adult diabetic patients of different ages and both sexes. Data were collected during admission that included detailed history, medical records review, clinical examination and laboratory investigations. Results: Subjects (n=253; 174 female, 79 male) had age (years) as mean ± SD: 55.28 ±13.45 (15-90 years), BMI (kg/m 2) as mean ±SD: 24.67±4.97 and HbA1c (%) as mean ±SD: 10.56±2.98. Use of pre-mixed insulin 90 (35.57%) and split-mixed insulin 70 (27.66%) were more common than other drugs. Glycaemic control was poor in all age groups as evidenced by raised HbA1c, significantly higher in patients <40 years age group. Blood glucose profiles were also high among the all age groups. HbA1c and blood glucose profiles both were high irrespective of type of anti-diabetic agents used during admission. It was also found that patients with increasing age groups were using insulin more frequently. BMI categorization had no significance within treatment groups. (p=0.453). Conclusion: There was no significant difference in blood glucose control among the different single anti-diabetic drug users, that might be due to treatment of diabetes includes medical nutrition therapy with judicious and individualized dietary plan, lifestyle modification, effective exercise plan, and individualized target oriented use of anti-diabetic agents. Along with proper selection of anti-diabetic agents, patient's self-management education and disease-specific awareness is essential to achieve good glycemic control.
Background: This study was designed to assess the effectiveness of use of the fracture risk asses... more Background: This study was designed to assess the effectiveness of use of the fracture risk assessment system (FRAX) as risk assessment tool for osteoporosis risk score scale in Bangladeshi subjects and to assess how the results of the tools correlate with each other.
Journal of Bangladesh College of Physicians and Surgeons, Jun 5, 2016
Tuberculosis may affect many of the endocrine glands including the hypothalamus, pituitary, thyro... more Tuberculosis may affect many of the endocrine glands including the hypothalamus, pituitary, thyroid with adrenal gland being the commonest. We describe a patient presented with recurrent spontaneous hypoglycemia, hypotension, fever, weight loss and cough. Along with this clinical picture, high ACTH in the face of low cortisol was compatible with diagnosis of Addison's disease. Rapid ACTH stimulation test affirmed the diagnosis. Disseminated TB affecting adrenal glands was supported by CXR, USG, CT Abdomen and FNAC. Adrenal Crisis was led by add-on bacterial pneumonia. Patient made good recovery with treatment for adrenal crisis and subsequently with standard antitubercular regimen and steroid replacement therapy. Tuberculosis, although uncommon but potentially devastating cause of adrenal failure, merits consideration when fever, weight loss, gastrointestinal symptoms, hyponatremia, hyperkalemia are observed in patients with features of active tuberculosis or past history of tuberculosis.
International Journal of Diabetes Mellitus, Aug 1, 2010
Aims: This study was undertaken to identify the parameters of metabolic syndrome which can predic... more 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.
International Journal of Diabetes and Endocrinology, 2021
Background: Metabolic syndrome (MetS) is a cluster of metabolic abnormalities characterized by ce... more Background: Metabolic syndrome (MetS) is a cluster of metabolic abnormalities characterized by central obesity, hyperglycemia plus insulin resistance, hypertriglyceridaemia plus low high density lipoprotein (HDL) cholesterol and hypertension. This cluster of metabolic syndrome is associated with some of the endocrine disorders prominently thyroid dysfunction. Thyroid dysfunction and metabolic syndrome are both associated with cardiovascular disease risk conversely increasing both morbidity and mortality. Objectives: This study was carried out to evaluate thyroid function in patients with metabolic syndrome and to assess its relationship with the components of metabolic syndrome in a tertiary care hospital. Methods: A cross sectional study was carried out among metabolic syndrome patients attending Hormone and Diabetes clinic in a tertiary care hospital, Dhaka, Bangladesh during June 2019 to March 2020. We included 346 patients who fulfilled National Cholesterol Education Program-Adu...
Bangladesh Medical Research Council Bulletin, 1970
DiabCare Bangladesh 2008 evaluated the current status of diabetes care in Bangladesh as a continu... more 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.
Benign prostatic hyperplasia (BPH) is one of the most common genitourinary complications in men o... more Benign prostatic hyperplasia (BPH) is one of the most common genitourinary complications in men over 50 years of age and typically presents with lower urinary tract symptoms (LUTS) and may need medical and occasionally surgical interventions. Few of them may only need advice on behavioral modification like less water intake after sunset, avoid tea, coffee after evening, avoid alcohol and less use of diuretics. The symptoms related to BPH or LUTS without any prostatic enlargement are incomplete voiding, frequency, intermittency, urgency, weak stream, straining and nocturia. For most patients with mild to moderate symptoms of BPH [International Prostate Symptom Score (IPSS) <8 or 8-19 respectively] monotherapy with an á-1-adrenergic antagonist remains initial treatment. The choice of specific á-adrenergic antagonist agent is generally based on cost and side effect profile. Other classes of medications include 5á-reductase inhibitors and phosphodiesterase (PDE) 5 inhibitors. In men who have mild to moderate symptoms of BPH and concomitant erectile dysfunction (ED), PDE-5 inhibitors are reasonable alternative. Now a days á-1-adrenoceptor blockers and 5á-reductase inhibitors are often combined to give a synergistic effect. A review of the current literature identified several adverse sexual side effects, including ED, decreased libido, orgasmic disorders and ejaculatory disorders. It is important to know the extent of these side effects, as the clinician and patient will need to decide the cost of improved voiding symptoms. The prime adverse effect is ejaculatory disorders including the absence of ejaculation. Clinical consideration for BPH/LUTS should include the elements of male sexual function, patient's age and the characteristics and comprehensive effects of each group of drugs. Methodological bias in clinical studies, such as the subjective evaluation of the sexual side effect makes it difficult to determine the ideal drug for treatment. Men without ED or irritant symptoms who desire medical therapy but cannot tolerate á-1-adrenergic antagonists and do not have predominately irritant symptoms or concomitant ED, treatment with a 5á-reductase inhibitor is a reasonable. Treatment for 6 to 12 months is generally needed before prostate size is sufficiently reduced to improve symptoms. Symptoms are usually reversible, so drugs may need to be continued for long time or indefinitely under supervision of specialist.
Background: Chikungunya is an emerging viral infection in Bangladesh. This self-limiting febrile ... more Background: Chikungunya is an emerging viral infection in Bangladesh. This self-limiting febrile illness may have acute life-threating features including cardiomyopathy and encephalitis. Acute kidney injury (AKI) is less well described complication of chikungunya. This study was designed to evaluate risk factors for AKI among patients with chikungunya virus infection. Methods: This case-control study was done in 3 different centers in Dhaka, Bangladesh from July to October 2017. Adult patients (>18 years) with confirmed diagnosis of chikungunya were included in this study. AKI was diagnosed as per Kidney Disease: Improving Global Outcomes (KDIGO) Clinical Practice Guideline for Acute Kidney Injury. Patients suffering from chikungunya complicated by AKI were cases and those without AKI were controls. Results: Total patients were 107 (male 61) with a mean age of 35.6 (range 19-84) years. Common comorbidities were diabetes mellitus (DM) (20.6%), hypertension (17.8%) and chronic kidney disease (CKD) (12.1%). Common presentations included fever (86.9%) or recent history of fever (13.1%), joint pain (88.8%), rash (23.4%), pruritus (15.9%), gastro-intestinal (GI) features like diarrhea and/or vomiting (28%), lymphadenopathy (12.1%), gum swelling/oral ulcer (4.1%) and oedema (8.4%). Fourteen (13.1%) patients required hospitalization. Eleven (10.3%) cases were complicated by AKI.
Background: Diabetic retinopathy (DR) and nephropathy are two major complications of diabetes mel... more Background: Diabetic retinopathy (DR) and nephropathy are two major complications of diabetes mellitus carrying significant morbidity and mortality. In this study DR was investigated in different stages of chronic kidney disease (CKD) to find out possible association of these two devastating complications. Methods: This cross-sectional study was conducted in 150 diabetic patients having CKD in BIRDEM. CKD was defined as estimated glomerular filtration rate (eGFR) of <60ml/min/1.73m 2 and/or urinary albumin excretion rate (UAER) >30 mg/day in at least two occasions in 3 months apart. Retinopathy was assessed by direct fundoscopic examination and confirmed by color fundus photography. Severe DR (SDR) included proliferative diabetic retinopathy, severe non-proliferative DR and maculopathy; whereas microaneurysm regarded as non-severe retinopathy. Results: Majority (68%) of the respondents had some form of retinopathy (38.35% SDR and 29.65% nonsevere). There was strong association between different levels of albuminuria (UAER) and DR (p<0.0001). On the contrary DR did not correspond with stages of CKD (P=0.349). Hypertension (79.5%) and dyslipidaemia (59%) were common co-morbidities. Conclusion: This study concluded that DR prevalence was more in nephropathy along with significant association with UAER. Whereas different stages of CKD was not associated with stages of DR. This finding focused the necessity of regular retinal examination irrespective of the stage of renal involvement.
Background: Type 2 diabetes mellitus (T2DM) is a progressive disease which needs prolonged manage... more Background: Type 2 diabetes mellitus (T2DM) is a progressive disease which needs prolonged management with anti-diabetic drugs. The purpose of the present study was to assess effectiveness, safety and tolerability of treatment by vildagliptin alone or with the combination of vildagliptin and metformin in T2DM patients in a real-world setting. Methods: This non-interventional, prospective, multi-center study was conducted in several hospitals in Bangladesh from 15 th September 2010 to 12 th June 2012. Both male and female patients, aged ≥18 years with an established diagnosis of T2DM, who had been prescribed vildagliptin or vildagliptin added to metformin free-dose or single-pill combination according to local prescribing information and who consented to data collection, were eligible for inclusion in the study. During the observational period of 24±6 weeks, data from three routine clinic visits were recorded; i.e. the baseline visit (Day 1), visit 2 (week 12±4 weeks) and a final visit (visit 3) at the end of the study (week 24±6 weeks). Result: A total number of 510 patients were enrolled in this study of which 468 patients were analyzed for the study and the remaining 42 patients were lost to follow up. Patients in vildagliptin group were treated with vildagliptin as monotherapy which was received by 101 patients; however, patients in vildagliptin/metformin group received the combination of vildagliptin and metformin which was in 367 cases. In vildagliptin group, the mean HbA1c was reduced from baseline (8.50±1.02 %) to 24 week (7.19±0.74%) (p<0.0001). Similarly, in vildagliptin group the mean HbA1c at week 12 (7.76±0.96 %) was lower vs. baseline (8.50±1.02 %) (p<0.0001). In vildagliptin and metformin combination group, the mean HbA1c at week 24 (7.02±0.66%) was lower vs. baseline (8.55±0.75%) (p<0.0001). There were no deaths and no serious adverse effects. None of the patients reported any hypoglycemic event. Conclusion: In conclusion vildagliptin treating T2DM patients with or without metformin is associated with a significant and clinically relevant improvement in glycaemic control. Furthermore, vildagliptin treatment is generally well tolerated.
Bangladesh Medical Research Council Bulletin, Sep 4, 2014
The aim of A 1 chieve was to remedy the deficit of data on the efficacy and safety of insulin ana... more The aim of A 1 chieve was to remedy the deficit of data on the efficacy and safety of insulin analogues in routine clinical care in less well-resourced developed countries. To present results from the Bangladesh cohort of the A 1 chieve study receiving BIAsp 30 ± oral anti diabetic drugs. A 1 chieve was a 6-month, observational study of 66,726 people with type 2 diabetes, started on insulin detemir, insulin aspart or biphasic insulin aspart (BIAsp 30) in 28 countries across four continents. A total of 1,093 subjects were recruited from 49 sites in Bangladesh and 580 subjects initiated on BIAsp 30 were studied. In the entire cohort, treatment with BIAsp 30 for 24 weeks significantly reduced mean HbA 1c (2.8%, p<0.001), fasting plasma glucose (4.0mmol/L, p<0.001) and post prandial plasma glucose (6.6mmol/L, p<0.001) levels from baseline. The rate of overall hypoglycaemic events in the entire cohort also reduced significantly at 24 weeks (1.86 to 0.02 events/person year, p<0.0001). BIAsp 30 can be considered as a safe and effective option for initiating as well as intensifying insulin therapy for type 2 diabetes.
Diabetes Research and Clinical Practice, Apr 1, 2013
To determine the safety and effectiveness of biphasic insulin aspart 30 (BIAsp 30) therapy in Ban... more To determine the safety and effectiveness of biphasic insulin aspart 30 (BIAsp 30) therapy in Bangladeshi type 2 diabetes (T2D) patients switched from biphasic human insulin (BHI) as a sub-analysis of the A₁chieve study. Bangladeshi patients switched from BHI to BIAsp 30 at the discretion of their physicians were included. The primary outcome was the incidence of serious adverse drug reactions (SADRs), including major hypoglycaemia. Secondary outcomes comprised changes from baseline to Week 24 in the number of hypoglycaemic events, glycated haemoglobin A1c (HbA1c), fasting plasma glucose (FPG), postprandial plasma glucose (PPPG), systolic blood pressure and body weight. Quality of life (QoL) was evaluated at baseline and Week 24 using the EQ-5D questionnaire. A total of 82 patients (mean age ± SD: 52.3 ± 12.2 years; body mass index: 25.6 ± 3.3 kg/m(2)) with a mean diabetes duration of 9.5 ± 5.5 years and mean duration on insulin of 2.5 ± 2.4 years were included. The mean BIAsp 30 dose was 0.49 ± 0.20 U/kg at baseline and 0.47 ± 0.17 U/kg at Week 24. No SADRs were reported. No events of hypoglycaemia (overall, major, minor or nocturnal) were reported at Week 24. Mean HbA1c, FPG and PPPG levels improved by -2.5 ± 1.3%, -65.0 ± 31.8 mg/dL and -119.3 ± 48.7 mg/dL, respectively, over 24 weeks. QoL also improved (mean change from baseline: +28.5 ± 12.9 points). Switching from BHI to BIAsp 30 therapy improved blood glucose control and was well-tolerated in this Bangladeshi subgroup.
Diabetes and Metabolic Syndrome: Clinical Research and Reviews, Mar 1, 2019
AIMS The aim was to see the frequency of CAN in type 2 diabetes mellitus patients with peripheral... more AIMS The aim was to see the frequency of CAN in type 2 diabetes mellitus patients with peripheral neuropathy, and its association with peripheral nerve conduction abnormalities. METHODS A cross-sectional study at BIRDEM was conducted in 62 patients with type 2 diabetes mellitus having electrophysiologically diagnosed peripheral neuropathy. CAN was detected by four clinical tests - heart rate response to deep breathing and valsalva maneuver, blood pressure response to standing and sustained handgrip. RESULT The study showed that all patients had CAN - 14.52% had early, 26.67% had definitive and 59.68% had severe CAN. Patients with severe CAN had significantly reduced nerve conduction velocity and amplitude of peripheral nerves (sural 4.36 ± 12.77 vs 9.65 ± 17.77 m/s, p = 0.009; 2.23 ± 1.89 vs 3.01 ± 2.76 mV, p = 0.001; peroneal 7 ± 4.23 vs 8.53 ± 5.99 mV, p = 0.047; tibial 0.008 ± 0.03 vs 0.026 ± 0.05 mV, p = 0.009) and higher serum triglyceride levels (221.17 ± 120.61 vs 197.76 ± 68.43 mg/dl, p = 0.033). CONCLUSION Diabetic patients with peripheral neuropathy have CAN, the severity of which increases with worsening neuropathy.
Indian Journal of Endocrinology and Metabolism, 2022
Insulin degludec/insulin aspart (IDegAsp) is a modern coformulation of ultra-long-acting basal in... more Insulin degludec/insulin aspart (IDegAsp) is a modern coformulation of ultra-long-acting basal insulin degludec, with rapid-acting insulin aspart. IDegAsp provides effective, safe, well-tolerated glycemic control, with a low risk of hypoglycemia while allowing flexibility in meal patterns and timing of administration. This consensus statement describes a pragmatic framework to identify patients who may benefit from IDegAsp therapy. It highlights the utility of IDegAsp in type 2 diabetic patients who are insulin-naive, suboptimally controlled on basal or premixed insulin, or dissatisfied with basal-bolus regimens. It also describes potential IDegAsp usage in type 1 diabetic patients.
Bangabandhu Sheikh Mujib Medical University Journal
Autonomic neuropathy is a troublesome complication of diabetes mellitus often is not addressed by... more Autonomic neuropathy is a troublesome complication of diabetes mellitus often is not addressed by the physicians. The aim was to see the accuracy of autonomic symptoms in the detection of severe cardiac autonomic neuropathy (CAN). This study was done in BIRDEM in 62 adult patients with type 2 diabetes mellitus and cardiac autonomic neuropathy. Cardiac autonomic neuropathy was detected clinically by heart rate and blood pressure change to maneuvers such as deep breathing, valsalva and standing. Eight symptoms of autonomic neuropathy, namely exercise intolerance, dizziness, dysphagia, abdominal bloating, constipa- tion, diarrhea, gustatory sweating and impotence were tested. In this study, impotence was the most common symptom (58%). There was no difference in the frequency of autonomic symptoms between severe and non-severe cardiac autonomic neuropathy. Taking clinical tests as gold standard, gustatory sweating had the highest specificity (96%) and constipation had the highest sensit...
Background and Aims Emphysematous pyelonephritis (EPN) is an uncommon, severe, necrotizing infect... more Background and Aims Emphysematous pyelonephritis (EPN) is an uncommon, severe, necrotizing infection of the renoureteral unit and is recognized by accumulation of gas within the collecting system, renal parenchyma and/or perinephric tissue. Common risk factors for EPN are diabetes mellitus, renal stone, obstructive uropathy and immunosuppression. Principles of treatment include resuscitative measures, antibiotics, strict glycaemic control and interventions in selected cases. This study aimed to describe clinical, laboratory and imaging characteristics of EPN patients with special emphasis on in-hospital outcome. Method This cross-sectional study included consecutive 22 EPN patients, managed in the Department of Internal Medicine and the Department of Nephrology of a tertiary care hospital in Dhaka, Bangladesh from January 2013 to December 2019. Patients’ selected socio-demographic, clinical and laboratory parameters and in-hospital treatment-outcome were recorded in case record form...
Sri Lanka Journal of Diabetes Endocrinology and Metabolism, 2016
Introduction: Despite the numerous advances achieved in diabetes control and evaluation, the mana... more Introduction: Despite the numerous advances achieved in diabetes control and evaluation, the management of this complex disease remains challenging. This study was conducted with the aim of determining the level of glycaemic control among adult patients with type 2 Diabetes mellitus. Method: The cross-sectional study was conducted in the diabetes care centers of the outpatient departments in Bangladesh. Adult patients with at least 2 years documented history of type 2 diabetes mellitus (T2DM) were recruited and data regarding the demographics, treatment they received and the level of glycaemic control was assessed. Result: A total of 5140 diabetic patients fulfilling the inclusions criteria were recruited for the study. 9.90% of the patients were below 40 years of age and the majority (64.05%) of the respondents were from urban communities. Based on HbA1c levels, only 18.8% of the patients had good glycaemic control. Gender, educational level and the income seem to have a relationship with the level of glycaemic control. Conclusion: Despite the medical advances in the management of diabetes, the glycaemic control of the majority (81.2%) of the T2DM patients are still very poor.
Sri Lanka Journal of Diabetes Endocrinology and Metabolism, Nov 23, 2021
Original Article Background: Diabetes mellitus (DM) patients have an increased risk of developing... more Original Article Background: Diabetes mellitus (DM) patients have an increased risk of developing several serious health problems in comparison with patients without DM. Depression is one of the more common co-morbid conditions found among diabetic patients. It is associated with poorer glycaemic control, reduced compliance with treatment, and increased complications, which can lead to impaired quality of life. Objective: This study was designed to assess the prevalence of depression and to recognize its associated factors among patients with type 2 diabetes mellitus attending a tertiary care hospital in Dhaka, Bangladesh. Methods: This cross-sectional study was conducted from July 2019 to February 2020. We recruited 318 types 2 diabetics (T2DM) patients who attended an outpatient diabetic clinic at a tertiary care hospital in Dhaka, Bangladesh. We used Patient Health Questionnaire-9 (PHQ-9) to assess depression among the subjects. A semi-structured questionnaire was used to collect demographic, clinical, and diabetes-related information after informed written consent was taken from the patients. Results: Among study subjects, the mean duration of diabetes was 7.51 ±6.18 (±SD) years. About one-third of the patients (34.9%) had been suffering from diabetes for more than 10 years. The prevalence of depressive illness using the PHQ-9 (score≥5) was found higher among female patients than male patients (46.2% vs.17.9%); (P=0.98). The calculated mean depression score was 6.89±6.08 (±SD). On the other hand, the prevalence of moderate to severe depressive illness using the PHQ-9 (score≥10) was 33.6% (male vs. female: 7.2% vs. 26.4%); (P=0.06). Mild depression (PHQ-9 score: 5-9) had been found among 30.8% of subjects. Moderate depression (PHQ-9 score: 10-14) and moderately severe depression (PHQ-9 score: 15-19) were found among 18.9% and 11.6% diabetic subjects respectively. The prevalence of severe depression (PHQ-9 score: 20-27) was only 3.1%; (p=0.12). Among demographic variables older age, urban residency, housewife, widow, lower education level, and low income were significantly associated with depression; (p<0.05). On the other hand, the clinical variables i.e. patients for a longer duration of diabetes (≥10 years), those with a co-morbid disease, or diabetes-related complications, and higher BMI, were significantly associated with a substantial risk for moderate to severe depression; (p<0.05). Poor glycaemic control (HbA1c >8.0%), was detected as a strong forecaster for depression; (p<0.001). Conclusions: The prevalence of depression specifically moderate to severe is very high among the study population. The high prevalence of depression in diabetic individuals suggests that patients with diabetes mellitus should be inquired for depression or mental disorders. Since depression could significantly impede a patient's adherence to treatment; mental health care needs to be incorporated into the management of diabetes for early diagnosis and treatment.
The study was aimed to describe the patterns of single anti-diabetic agents used by type 2 diabet... more The study was aimed to describe the patterns of single anti-diabetic agents used by type 2 diabetic patients and their glycemic status during hospital admission. Study design and methods: This cross-sectional study was carried out in BIRDEM among hospitalized type 2 adult diabetic patients of different ages and both sexes. Data were collected during admission that included detailed history, medical records review, clinical examination and laboratory investigations. Results: Subjects (n=253; 174 female, 79 male) had age (years) as mean ± SD: 55.28 ±13.45 (15-90 years), BMI (kg/m 2) as mean ±SD: 24.67±4.97 and HbA1c (%) as mean ±SD: 10.56±2.98. Use of pre-mixed insulin 90 (35.57%) and split-mixed insulin 70 (27.66%) were more common than other drugs. Glycaemic control was poor in all age groups as evidenced by raised HbA1c, significantly higher in patients <40 years age group. Blood glucose profiles were also high among the all age groups. HbA1c and blood glucose profiles both were high irrespective of type of anti-diabetic agents used during admission. It was also found that patients with increasing age groups were using insulin more frequently. BMI categorization had no significance within treatment groups. (p=0.453). Conclusion: There was no significant difference in blood glucose control among the different single anti-diabetic drug users, that might be due to treatment of diabetes includes medical nutrition therapy with judicious and individualized dietary plan, lifestyle modification, effective exercise plan, and individualized target oriented use of anti-diabetic agents. Along with proper selection of anti-diabetic agents, patient's self-management education and disease-specific awareness is essential to achieve good glycemic control.
Background: This study was designed to assess the effectiveness of use of the fracture risk asses... more Background: This study was designed to assess the effectiveness of use of the fracture risk assessment system (FRAX) as risk assessment tool for osteoporosis risk score scale in Bangladeshi subjects and to assess how the results of the tools correlate with each other.
Journal of Bangladesh College of Physicians and Surgeons, Jun 5, 2016
Tuberculosis may affect many of the endocrine glands including the hypothalamus, pituitary, thyro... more Tuberculosis may affect many of the endocrine glands including the hypothalamus, pituitary, thyroid with adrenal gland being the commonest. We describe a patient presented with recurrent spontaneous hypoglycemia, hypotension, fever, weight loss and cough. Along with this clinical picture, high ACTH in the face of low cortisol was compatible with diagnosis of Addison's disease. Rapid ACTH stimulation test affirmed the diagnosis. Disseminated TB affecting adrenal glands was supported by CXR, USG, CT Abdomen and FNAC. Adrenal Crisis was led by add-on bacterial pneumonia. Patient made good recovery with treatment for adrenal crisis and subsequently with standard antitubercular regimen and steroid replacement therapy. Tuberculosis, although uncommon but potentially devastating cause of adrenal failure, merits consideration when fever, weight loss, gastrointestinal symptoms, hyponatremia, hyperkalemia are observed in patients with features of active tuberculosis or past history of tuberculosis.
International Journal of Diabetes Mellitus, Aug 1, 2010
Aims: This study was undertaken to identify the parameters of metabolic syndrome which can predic... more 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.
International Journal of Diabetes and Endocrinology, 2021
Background: Metabolic syndrome (MetS) is a cluster of metabolic abnormalities characterized by ce... more Background: Metabolic syndrome (MetS) is a cluster of metabolic abnormalities characterized by central obesity, hyperglycemia plus insulin resistance, hypertriglyceridaemia plus low high density lipoprotein (HDL) cholesterol and hypertension. This cluster of metabolic syndrome is associated with some of the endocrine disorders prominently thyroid dysfunction. Thyroid dysfunction and metabolic syndrome are both associated with cardiovascular disease risk conversely increasing both morbidity and mortality. Objectives: This study was carried out to evaluate thyroid function in patients with metabolic syndrome and to assess its relationship with the components of metabolic syndrome in a tertiary care hospital. Methods: A cross sectional study was carried out among metabolic syndrome patients attending Hormone and Diabetes clinic in a tertiary care hospital, Dhaka, Bangladesh during June 2019 to March 2020. We included 346 patients who fulfilled National Cholesterol Education Program-Adu...
Bangladesh Medical Research Council Bulletin, 1970
DiabCare Bangladesh 2008 evaluated the current status of diabetes care in Bangladesh as a continu... more 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.
Benign prostatic hyperplasia (BPH) is one of the most common genitourinary complications in men o... more Benign prostatic hyperplasia (BPH) is one of the most common genitourinary complications in men over 50 years of age and typically presents with lower urinary tract symptoms (LUTS) and may need medical and occasionally surgical interventions. Few of them may only need advice on behavioral modification like less water intake after sunset, avoid tea, coffee after evening, avoid alcohol and less use of diuretics. The symptoms related to BPH or LUTS without any prostatic enlargement are incomplete voiding, frequency, intermittency, urgency, weak stream, straining and nocturia. For most patients with mild to moderate symptoms of BPH [International Prostate Symptom Score (IPSS) <8 or 8-19 respectively] monotherapy with an á-1-adrenergic antagonist remains initial treatment. The choice of specific á-adrenergic antagonist agent is generally based on cost and side effect profile. Other classes of medications include 5á-reductase inhibitors and phosphodiesterase (PDE) 5 inhibitors. In men who have mild to moderate symptoms of BPH and concomitant erectile dysfunction (ED), PDE-5 inhibitors are reasonable alternative. Now a days á-1-adrenoceptor blockers and 5á-reductase inhibitors are often combined to give a synergistic effect. A review of the current literature identified several adverse sexual side effects, including ED, decreased libido, orgasmic disorders and ejaculatory disorders. It is important to know the extent of these side effects, as the clinician and patient will need to decide the cost of improved voiding symptoms. The prime adverse effect is ejaculatory disorders including the absence of ejaculation. Clinical consideration for BPH/LUTS should include the elements of male sexual function, patient's age and the characteristics and comprehensive effects of each group of drugs. Methodological bias in clinical studies, such as the subjective evaluation of the sexual side effect makes it difficult to determine the ideal drug for treatment. Men without ED or irritant symptoms who desire medical therapy but cannot tolerate á-1-adrenergic antagonists and do not have predominately irritant symptoms or concomitant ED, treatment with a 5á-reductase inhibitor is a reasonable. Treatment for 6 to 12 months is generally needed before prostate size is sufficiently reduced to improve symptoms. Symptoms are usually reversible, so drugs may need to be continued for long time or indefinitely under supervision of specialist.
Background: Chikungunya is an emerging viral infection in Bangladesh. This self-limiting febrile ... more Background: Chikungunya is an emerging viral infection in Bangladesh. This self-limiting febrile illness may have acute life-threating features including cardiomyopathy and encephalitis. Acute kidney injury (AKI) is less well described complication of chikungunya. This study was designed to evaluate risk factors for AKI among patients with chikungunya virus infection. Methods: This case-control study was done in 3 different centers in Dhaka, Bangladesh from July to October 2017. Adult patients (>18 years) with confirmed diagnosis of chikungunya were included in this study. AKI was diagnosed as per Kidney Disease: Improving Global Outcomes (KDIGO) Clinical Practice Guideline for Acute Kidney Injury. Patients suffering from chikungunya complicated by AKI were cases and those without AKI were controls. Results: Total patients were 107 (male 61) with a mean age of 35.6 (range 19-84) years. Common comorbidities were diabetes mellitus (DM) (20.6%), hypertension (17.8%) and chronic kidney disease (CKD) (12.1%). Common presentations included fever (86.9%) or recent history of fever (13.1%), joint pain (88.8%), rash (23.4%), pruritus (15.9%), gastro-intestinal (GI) features like diarrhea and/or vomiting (28%), lymphadenopathy (12.1%), gum swelling/oral ulcer (4.1%) and oedema (8.4%). Fourteen (13.1%) patients required hospitalization. Eleven (10.3%) cases were complicated by AKI.
Background: Diabetic retinopathy (DR) and nephropathy are two major complications of diabetes mel... more Background: Diabetic retinopathy (DR) and nephropathy are two major complications of diabetes mellitus carrying significant morbidity and mortality. In this study DR was investigated in different stages of chronic kidney disease (CKD) to find out possible association of these two devastating complications. Methods: This cross-sectional study was conducted in 150 diabetic patients having CKD in BIRDEM. CKD was defined as estimated glomerular filtration rate (eGFR) of <60ml/min/1.73m 2 and/or urinary albumin excretion rate (UAER) >30 mg/day in at least two occasions in 3 months apart. Retinopathy was assessed by direct fundoscopic examination and confirmed by color fundus photography. Severe DR (SDR) included proliferative diabetic retinopathy, severe non-proliferative DR and maculopathy; whereas microaneurysm regarded as non-severe retinopathy. Results: Majority (68%) of the respondents had some form of retinopathy (38.35% SDR and 29.65% nonsevere). There was strong association between different levels of albuminuria (UAER) and DR (p<0.0001). On the contrary DR did not correspond with stages of CKD (P=0.349). Hypertension (79.5%) and dyslipidaemia (59%) were common co-morbidities. Conclusion: This study concluded that DR prevalence was more in nephropathy along with significant association with UAER. Whereas different stages of CKD was not associated with stages of DR. This finding focused the necessity of regular retinal examination irrespective of the stage of renal involvement.
Background: Type 2 diabetes mellitus (T2DM) is a progressive disease which needs prolonged manage... more Background: Type 2 diabetes mellitus (T2DM) is a progressive disease which needs prolonged management with anti-diabetic drugs. The purpose of the present study was to assess effectiveness, safety and tolerability of treatment by vildagliptin alone or with the combination of vildagliptin and metformin in T2DM patients in a real-world setting. Methods: This non-interventional, prospective, multi-center study was conducted in several hospitals in Bangladesh from 15 th September 2010 to 12 th June 2012. Both male and female patients, aged ≥18 years with an established diagnosis of T2DM, who had been prescribed vildagliptin or vildagliptin added to metformin free-dose or single-pill combination according to local prescribing information and who consented to data collection, were eligible for inclusion in the study. During the observational period of 24±6 weeks, data from three routine clinic visits were recorded; i.e. the baseline visit (Day 1), visit 2 (week 12±4 weeks) and a final visit (visit 3) at the end of the study (week 24±6 weeks). Result: A total number of 510 patients were enrolled in this study of which 468 patients were analyzed for the study and the remaining 42 patients were lost to follow up. Patients in vildagliptin group were treated with vildagliptin as monotherapy which was received by 101 patients; however, patients in vildagliptin/metformin group received the combination of vildagliptin and metformin which was in 367 cases. In vildagliptin group, the mean HbA1c was reduced from baseline (8.50±1.02 %) to 24 week (7.19±0.74%) (p<0.0001). Similarly, in vildagliptin group the mean HbA1c at week 12 (7.76±0.96 %) was lower vs. baseline (8.50±1.02 %) (p<0.0001). In vildagliptin and metformin combination group, the mean HbA1c at week 24 (7.02±0.66%) was lower vs. baseline (8.55±0.75%) (p<0.0001). There were no deaths and no serious adverse effects. None of the patients reported any hypoglycemic event. Conclusion: In conclusion vildagliptin treating T2DM patients with or without metformin is associated with a significant and clinically relevant improvement in glycaemic control. Furthermore, vildagliptin treatment is generally well tolerated.
Bangladesh Medical Research Council Bulletin, Sep 4, 2014
The aim of A 1 chieve was to remedy the deficit of data on the efficacy and safety of insulin ana... more The aim of A 1 chieve was to remedy the deficit of data on the efficacy and safety of insulin analogues in routine clinical care in less well-resourced developed countries. To present results from the Bangladesh cohort of the A 1 chieve study receiving BIAsp 30 ± oral anti diabetic drugs. A 1 chieve was a 6-month, observational study of 66,726 people with type 2 diabetes, started on insulin detemir, insulin aspart or biphasic insulin aspart (BIAsp 30) in 28 countries across four continents. A total of 1,093 subjects were recruited from 49 sites in Bangladesh and 580 subjects initiated on BIAsp 30 were studied. In the entire cohort, treatment with BIAsp 30 for 24 weeks significantly reduced mean HbA 1c (2.8%, p<0.001), fasting plasma glucose (4.0mmol/L, p<0.001) and post prandial plasma glucose (6.6mmol/L, p<0.001) levels from baseline. The rate of overall hypoglycaemic events in the entire cohort also reduced significantly at 24 weeks (1.86 to 0.02 events/person year, p<0.0001). BIAsp 30 can be considered as a safe and effective option for initiating as well as intensifying insulin therapy for type 2 diabetes.
Diabetes Research and Clinical Practice, Apr 1, 2013
To determine the safety and effectiveness of biphasic insulin aspart 30 (BIAsp 30) therapy in Ban... more To determine the safety and effectiveness of biphasic insulin aspart 30 (BIAsp 30) therapy in Bangladeshi type 2 diabetes (T2D) patients switched from biphasic human insulin (BHI) as a sub-analysis of the A₁chieve study. Bangladeshi patients switched from BHI to BIAsp 30 at the discretion of their physicians were included. The primary outcome was the incidence of serious adverse drug reactions (SADRs), including major hypoglycaemia. Secondary outcomes comprised changes from baseline to Week 24 in the number of hypoglycaemic events, glycated haemoglobin A1c (HbA1c), fasting plasma glucose (FPG), postprandial plasma glucose (PPPG), systolic blood pressure and body weight. Quality of life (QoL) was evaluated at baseline and Week 24 using the EQ-5D questionnaire. A total of 82 patients (mean age ± SD: 52.3 ± 12.2 years; body mass index: 25.6 ± 3.3 kg/m(2)) with a mean diabetes duration of 9.5 ± 5.5 years and mean duration on insulin of 2.5 ± 2.4 years were included. The mean BIAsp 30 dose was 0.49 ± 0.20 U/kg at baseline and 0.47 ± 0.17 U/kg at Week 24. No SADRs were reported. No events of hypoglycaemia (overall, major, minor or nocturnal) were reported at Week 24. Mean HbA1c, FPG and PPPG levels improved by -2.5 ± 1.3%, -65.0 ± 31.8 mg/dL and -119.3 ± 48.7 mg/dL, respectively, over 24 weeks. QoL also improved (mean change from baseline: +28.5 ± 12.9 points). Switching from BHI to BIAsp 30 therapy improved blood glucose control and was well-tolerated in this Bangladeshi subgroup.
Diabetes and Metabolic Syndrome: Clinical Research and Reviews, Mar 1, 2019
AIMS The aim was to see the frequency of CAN in type 2 diabetes mellitus patients with peripheral... more AIMS The aim was to see the frequency of CAN in type 2 diabetes mellitus patients with peripheral neuropathy, and its association with peripheral nerve conduction abnormalities. METHODS A cross-sectional study at BIRDEM was conducted in 62 patients with type 2 diabetes mellitus having electrophysiologically diagnosed peripheral neuropathy. CAN was detected by four clinical tests - heart rate response to deep breathing and valsalva maneuver, blood pressure response to standing and sustained handgrip. RESULT The study showed that all patients had CAN - 14.52% had early, 26.67% had definitive and 59.68% had severe CAN. Patients with severe CAN had significantly reduced nerve conduction velocity and amplitude of peripheral nerves (sural 4.36 ± 12.77 vs 9.65 ± 17.77 m/s, p = 0.009; 2.23 ± 1.89 vs 3.01 ± 2.76 mV, p = 0.001; peroneal 7 ± 4.23 vs 8.53 ± 5.99 mV, p = 0.047; tibial 0.008 ± 0.03 vs 0.026 ± 0.05 mV, p = 0.009) and higher serum triglyceride levels (221.17 ± 120.61 vs 197.76 ± 68.43 mg/dl, p = 0.033). CONCLUSION Diabetic patients with peripheral neuropathy have CAN, the severity of which increases with worsening neuropathy.
Indian Journal of Endocrinology and Metabolism, 2022
Insulin degludec/insulin aspart (IDegAsp) is a modern coformulation of ultra-long-acting basal in... more Insulin degludec/insulin aspart (IDegAsp) is a modern coformulation of ultra-long-acting basal insulin degludec, with rapid-acting insulin aspart. IDegAsp provides effective, safe, well-tolerated glycemic control, with a low risk of hypoglycemia while allowing flexibility in meal patterns and timing of administration. This consensus statement describes a pragmatic framework to identify patients who may benefit from IDegAsp therapy. It highlights the utility of IDegAsp in type 2 diabetic patients who are insulin-naive, suboptimally controlled on basal or premixed insulin, or dissatisfied with basal-bolus regimens. It also describes potential IDegAsp usage in type 1 diabetic patients.
Bangabandhu Sheikh Mujib Medical University Journal
Autonomic neuropathy is a troublesome complication of diabetes mellitus often is not addressed by... more Autonomic neuropathy is a troublesome complication of diabetes mellitus often is not addressed by the physicians. The aim was to see the accuracy of autonomic symptoms in the detection of severe cardiac autonomic neuropathy (CAN). This study was done in BIRDEM in 62 adult patients with type 2 diabetes mellitus and cardiac autonomic neuropathy. Cardiac autonomic neuropathy was detected clinically by heart rate and blood pressure change to maneuvers such as deep breathing, valsalva and standing. Eight symptoms of autonomic neuropathy, namely exercise intolerance, dizziness, dysphagia, abdominal bloating, constipa- tion, diarrhea, gustatory sweating and impotence were tested. In this study, impotence was the most common symptom (58%). There was no difference in the frequency of autonomic symptoms between severe and non-severe cardiac autonomic neuropathy. Taking clinical tests as gold standard, gustatory sweating had the highest specificity (96%) and constipation had the highest sensit...
Background and Aims Emphysematous pyelonephritis (EPN) is an uncommon, severe, necrotizing infect... more Background and Aims Emphysematous pyelonephritis (EPN) is an uncommon, severe, necrotizing infection of the renoureteral unit and is recognized by accumulation of gas within the collecting system, renal parenchyma and/or perinephric tissue. Common risk factors for EPN are diabetes mellitus, renal stone, obstructive uropathy and immunosuppression. Principles of treatment include resuscitative measures, antibiotics, strict glycaemic control and interventions in selected cases. This study aimed to describe clinical, laboratory and imaging characteristics of EPN patients with special emphasis on in-hospital outcome. Method This cross-sectional study included consecutive 22 EPN patients, managed in the Department of Internal Medicine and the Department of Nephrology of a tertiary care hospital in Dhaka, Bangladesh from January 2013 to December 2019. Patients’ selected socio-demographic, clinical and laboratory parameters and in-hospital treatment-outcome were recorded in case record form...
Sri Lanka Journal of Diabetes Endocrinology and Metabolism, 2016
Introduction: Despite the numerous advances achieved in diabetes control and evaluation, the mana... more Introduction: Despite the numerous advances achieved in diabetes control and evaluation, the management of this complex disease remains challenging. This study was conducted with the aim of determining the level of glycaemic control among adult patients with type 2 Diabetes mellitus. Method: The cross-sectional study was conducted in the diabetes care centers of the outpatient departments in Bangladesh. Adult patients with at least 2 years documented history of type 2 diabetes mellitus (T2DM) were recruited and data regarding the demographics, treatment they received and the level of glycaemic control was assessed. Result: A total of 5140 diabetic patients fulfilling the inclusions criteria were recruited for the study. 9.90% of the patients were below 40 years of age and the majority (64.05%) of the respondents were from urban communities. Based on HbA1c levels, only 18.8% of the patients had good glycaemic control. Gender, educational level and the income seem to have a relationship with the level of glycaemic control. Conclusion: Despite the medical advances in the management of diabetes, the glycaemic control of the majority (81.2%) of the T2DM patients are still very poor.
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