Diabetes Mellitus is a leading cause of death in
present world. This study was carried out to evaluate the management, control,
complication profile and treatment strategies in patients with diabetes and to
determine what extent management of
diabetes in a tertiary-care diabetic hospital in Bangladesh adhered to current
guidelines. Total 140 diabetic pa- tients (type-1 = 3, type-2 = 137) were
randomly selected from outpatient department of a tertiary care diabetic hospital
in the Rajshahi city, Bangladesh, during the month of August to September. A
standard questionnaire was constructed in local language and interview was
administrated. The result was expressed as mean ± SD and the age was 53.2 ± 10.5 yr,
duration of diabetes was 6.3 ± 5.6 yr and age at the onset of diabetes was 46.9 ± 9.9 yr. The
study group comprised of about 43% male and 57% female with varying risk
factors including family history (49%), smoking (11%) and both smoking and
family history (4%). Results showed deteriorating glycemic control with mean FBG (fasting blood glucose) and
PPG (postprandial blood glucose) level was 8.9 ± 3.6 mmol/L and 11.2 ± 4.7 mmol/L respectively. About 25% patients had FBG level < 6.1 mmol/L, 24% had FBG 6.1 - 7.8 mmol/L
and rest 51% had FBG > 7.8 mmol/L.
Of the 51% patients with hypertension, 94% were taking anti-hypertensive
medicine and 21% patients with dyslipidemia, 59% were treated with lipid
lowering agents. Micro-vascular and Macro-vascular complications were reported
in 49% and 11% patients respectively. The rates of diabetic complications were
cataract 19%, diabetic retinopathy 14%, neuropathy symptoms 35%, nephropathy
6%, MI 6%, cerebral stroke 4% and history of angina pectoris was 7%. Proportion
of patients on diet control alone, oral hypoglycemic
agent (OHA), insulin and combination of insulin & OHA was 10, 44, 25 and 21
percent respectively. Quality of life evaluation showed that about half of
patients have poor quality of life as well as 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.
References
[1]
R. A. DeFronzo, R. C. Bonadonna and E. Ferrannini, “Pathogenesis of NIDDM: A Balanced Overview,” Diabetes Care, Vol. 15, No. 3, 1992, pp. 318-368.
doi:10.2337/diacare.15.3.318
[2]
WHO, “Diabetes Action Now: An Initiative of the World Health Organization and the International Diabetic Federation,” WHO, Geneva, IDF, Brussels, 2004, pp. 1-20.
[3]
P. Lenzo, “One Adult in Ten will Have Diabetes by 2030,” IDF Diabetes Atlas, Brussels, 2011.
[4]
G. Roglic, “Estimates of the Global and Regional Burden of Diabetes,” 4th Edition, IDF Diabetes Atlas, Brussels, 2012.
[5]
R. E. Lamb and B. J. Goldstein, “Modulating an Oxidative-Inflammatory Cascade: Potential New Treatment Strategy for Improving Glucose Metabolism, Insulin Resistance, and Vascular Function,” International Journal of Clinical Practice, Vol. 62, No. 7, 2008, pp. 1087-1095.
doi:10.1111/j.1742-1241.2008.01789.x
[6]
J. S. Johansen, A. K. Harris, D. J. Rychly and A. Ergul, “Oxidative Stress and the Use of Antioxidants in Diabetes: Linking Basic Science to Clinical Practice,” Cardiovascular Diabetology, Vol. 4, No. 1, 2005, p. 5.
doi:10.1186/1475-2840-4-5
[7]
T. Jaakko, “Reducing Coronary Heart Disease Associated with Type 2 Diabetes: Lifestyle Intervention and Treatment of Dyslipidaemia,” Diabetes Research and Clinical Practice, Vol. 61, Supplement 1, 2003, pp. S27-S34.
doi:10.1016/S0168-8227(03)00125-6
[8]
C. Rafael, “Type 2 Diabetes, Dyslipidemia, and Vascular Risk: Rationale and Evidence for Correcting the Lipid Imbalance,” American Heart Journal, Vol. 150, No. 5, 2005, pp. 859-870. doi:10.1016/j.ahj.2005.04.027
[9]
M. H. Davidson. “Statin/Fibrate Combination in Patients with Metabolic Syndrome or Diabetes: Evaluating the Risks of Pharmacokinetic Drug Interactions,” Expert Opinion on Drug Safety, Vol. 5, No. 1, 2006, pp. 145-156. doi:10.1517/14740338.5.1.145
[10]
M. P. Solano and R. B. Goldberg. “Lipid Management in Type 2 Diabetes,” Clinical Diabetes, Vol. 24, No. 1, 2006, pp. 27-32.
[11]
R. Balasubramanian, et al., “Assessment of the Efficacy and Tolerability of a Fixed Dose Combination of Atorvastatin 10 mg + Metformin SR 500 mg in Diabetic Dyslipidaemia in Adult Indian Patients,” Journal of the Indian Medical Association, Vol. 106, No. 7, 2008, pp. 464467.
[12]
S. M. Haffner, et al., “Mortality from Coronary Heart Disease in Subjects with Type 2 Diabetes and in NonDiabetic Subjects with and without Prior Myocardial Infarction,” The New England Journal of Medicine, Vol. 339, No. 4, 1998, pp. 229-234.
doi:10.1056/NEJM199807233390404
[13]
H. Miettinem, et al. and the FINMONICA Myocardial Infarction Register Study Group, “Impact of Diabetes on Mortality after the First Myocardial Infarction,” Diabetes Care, Vol. 21, No. 1, 1998, pp. 69-75.
doi:10.2337/diacare.21.1.69
[14]
J. W. Baynes and S. R. Thorpe, “Role of Oxidative Stress in Diabetic Complications: A New Perspective on an Old Paradigm,” Diabetes, Vol. 48, No. 1, 1999, pp. 1-9.
doi:10.2337/diabetes.48.1.1
[15]
J. W. Baynes, “Role of Oxidative Stress in Development of Complications in Diabetes,” Diabetes, Vol. 40, No. 4, 1991, pp. 405-412. doi:10.2337/diabetes.40.4.405
[16]
Z. A. Latif, A. Jain and M. M. Rahman, “Evaluation of Management, Control, Complications and Psychosocial Aspect of Diabetes in Bangladesh: DiabCare Bangladesh 2008,” Bangladesh Medical Research Council Bulletin, Vol. 37, No. 1, 2011, pp. 11-16.
[17]
S. Ghosh, A. Collier, M. Hair, I. Malik and T. Elhadd, “Metabolic Syndrome in Type 1 Diabetes,” International Journal of Diabetes Mellitus, Vol. 2, No. 1, 2010, pp. 38-42. doi:10.1016/j.ijdm.2009.10.005
[18]
K. Kasim, M. Amar, A. A. El Sadek and S. A. Gawad, “Peripheral Neuropathy in Type 2 Diabetic Patients Attending Diabetic Clinics in Al-Azhar University Hospitals, Egypt,” International Journal of Diabetes Mellitus, Vol. 2, No. 1, 2010, pp. 20-23. doi:10.1016/j.ijdm.2009.10.002
[19]
S. M. Kim, J. S. Lee, J. Lee, J. K. Na, J. H. Han, D. K. Yoon, S. H. Baik, D. S. Choi and K. M. Chi, “Prevalence of Diabetes and Impaired Fasting in Korea,” Diabetes Care, Vol. 29, No. 2, 2006, pp. 226-232.
doi:10.2337/diacare.29.02.06.dc05-0481
[20]
A. Bener, M. Zirie and A. Al-Rakabi, “Genetics, Obesity and Environmental Risk Factors Associated with Type 2 Diabetes,” Croatian Medical Journal, Vol. 46, No. 2, 2005, pp. 302-307.
[21]
A. Gupta, R. Gupta, M. Sarna, S. Rastogi, V. P. Gupta and K. Kothari, “Prevalence of Diabetes, Impaired Fasting Glucose and Insulin Resistance Syndrome in an Indian Population,” Diabetes Research and Clinical Practice, Vol. 61, No. , 2003, pp. 69-76.
doi:10.1016/S0168-8227(03)00085-8
[22]
M. G. Kibriya and H. Mahtab, “Micro-Vascular Complications in Type 2 Diabetes in Bangladesh: The Diabcare-Asia, Bangladesh Project,” Diabetes Research Clinical Practice, Vol. 50, Supplement 1, 2000, pp. 135-136.
[23]
H. Mahtab and M. G. Kibriya, “The Diabcare-Asia, Bangladesh Project: Management of Diabetes in Bangladesh,” Diabetes Research Clinical Practice, Vol. 50, Supplement 1, 2000, p. 55.
[24]
W. Patrick, E. H. M. Sullivan, G. Vahram, H. R. Wyatt and J. O. Hill, “Obesity, Inactivity, and the Prevalence of Diabetes and Diabetes Related Cardiovascular Co Morbidities in the US, 2000-2002,” Diabetes Care, Vol. Vol. 28, No. 7, 2005, pp. 1599-1603.
doi:10.2337/diacare.28.7.1599
[25]
S. G. Wannamethee and A. G. Shaper, “Weight Change and Duration of Overweight and Obesity in the Incidence of Type 2 Diabetes,” Diabetes Care, Vol. 22, No. 8, 1999, pp. 1266-1272. doi:10.2337/diacare.22.8.1266
[26]
A. K. Azad, M. A. Kabir, P. K. Roy, A. Raihan, M. T. Rahman and M. Hasan, “Diabetes Mellitus with MultiSystemic Complications,” Bangladesh Journal of Medicine, Vol. 10, 1999, pp. 53-55.
[27]
A. B. Anjuman, A. K. Azad, M. A. Alim and E. Saifuddin, “Nutritional Status of Diabetic Patients Attending to a District Level Diabetic Center,” The Journal of Teachers Association RMC, Vol. 17, No. 2, 2004, pp. 89-92.
[28]
H. Jorgensen, H. Nakayama, H. O. Raaschou and T. S. Olsen, “Stroke in Patients with Diabetes: The Copenhagen Stroke Study,” Vol. 25, No. 10, 1994, pp. 1977-1984.
doi:10.1161/01.STR.25.10.1977
[29]
D. M. Nathan, J. Lachin, P. A. Cleary and J. Y. Backlund, “Intensive Diabetes Therapy and Carotid Intima-Media Thickness in Type 1 Diabetes Mellitus,” NEJM, Vol. 348, No. 23, 2003, pp. 2294-303.
doi:10.1056/NEJMoa022314
[30]
H. Sone, S. Mizuno, Y. Ohashi, et al., “Prevention and Therapeutic Strategy of Metabolic Syndrome-Implications from the Interim Results of Japan Diabetes Complications Study (JDCS),” Nippon Rinsho, Vol. 62, No. 6, 2004, pp. 1150-1157.
