Diabetic Association of Bangladesh

Background: Type 2 diabetes mellitus (T2DM) is commonly associated with obesity and insulin resistance; however, a substantial proportion of South Asians develop diabetes at low body mass index (BMI), indicating metabolic heterogeneity beyond obesity-driven mechanisms. Objective: To describe the sociodemographic, clinical, and metabolic characteristics of lean T2DM individuals in rural Bangladesh and compare them with those of normal-weight and overweight/obese T2DM individuals. Materials and Methods: A community-based cross-sectional study was conducted among 2293 adults in rural Bangladesh. Of these, 181 individuals with T2DM underwent detailed metabolic assessment. Participants were categorized as lean (<21 kg/m2), normal weight (21–<23 kg/m2), and overweight/obese (≥23 kg/m2) using Asian-specific BMI cutoffs. Standardized anthropometric and biochemical measurements were performed. Insulin resistance and β-cell function were assessed using the Homeostatic Model Assessment indices for insulin resistance (HOMA-IR) and β-cell function (HOMA-β), respectively. Statistical analyses included analysis of variance, chi-square tests, and multinomial logistic regression. Results: Among individuals with T2DM, 17.7% were classified as lean. Lean individuals had lower socioeconomic status and dietary energy intake and exhibited reduced β-cell function and lower insulin resistance compared with overweight/obese individuals, who showed higher blood pressure, adverse lipid profiles, and greater prevalence of insulin resistance and dyslipidemia. Glycemic indices were lower in lean individuals, suggesting early-stage or newly diagnosed diabetes. However, when applying the conventional BMI cutoff for lean T2DM (i.e., BMI < 18.5 kg/m2), only 5% met the standard definition of lean T2DM. Conclusion: Two T2DM phenotypes coexist: a β-cell-deficient lean form and an insulin-resistant overweight/obese form. Conventional lean T2DM represents a small subgroup, highlighting the need for context-specific BMI thresholds in South Asian populations.

Introduction Bangladesh has a high burden of type two diabetes mellitus (T2DM) and hypertension. To better target non-communicable disease (NCD) programmes, populations with unmet care needs must be identified. We describe the unmet care needs for people living with T2DM and hypertension in rural Bangladesh at a subregional level.Methods We conducted a secondary analysis of cross-sectional surveys conducted in 2021 and 2022 in Alfadanga Upazila, Faridpur District. Surveys were conducted among random samples of non-pregnant adults aged >30 years, including questions about demographics, NCD diagnoses, care-seeking and treatment. Study staff conducted blood pressure measurements to determine hypertension and 2-hour oral glucose tolerance tests to determine T2DM status. We calculated the prevalence of T2DM and hypertension and the unmet need for care, defined as the prevalence minus the proportion screened (T2DM only), diagnosed, treated and controlled, following the cascade of care (COC). We present the COC for 12 subregional geographical clusters and sex.Results 1982 participants (62.9% women) were analysed. The prevalence of T2DM was 19.0%, and the unmet need for care was 90.7%. The prevalence of hypertension was 37.9%, and the unmet need for care was 81.4%. For both T2DM and hypertension, women had a higher prevalence of disease, but there was a wider gap in the COC for hypertension, with 22.4% of women achieving good control compared with 10.9% of men. At the subregional level, the prevalence of T2DM ranged from 12.4% to 26.5%, and the unmet need for care from 85.0% to 95.6%. Variations in the prevalence and unmet need for care were also seen for hypertension but with different subregional distribution patterns.Conclusions In this rural Bangladesh setting, the unmet care need was high for T2DM and hypertension, with subregional and sex differences. Understanding hyper-local factors driving NCD risks and access to care could support more effective programme delivery.

Objectives To assess knowledge regarding gestational diabetes mellitus (GDM) among pregnant women attending antenatal care facilities in Bangladesh and identify sociodemographic factors independently associated with good knowledge. Design Nationwide facility-based cross-sectional study. Setting Seventy diabetes screening centres and affiliated antenatal care facilities of the Diabetic Association of Bangladesh (BADAS) across urban and rural Bangladesh. Participants Of 6631 women retained in the parent-study analytical cohort, 6120 women aged 18-45 years with an observed knowledge outcome were included in the present analysis. Participants were recruited consecutively during routine antenatal care visits between November 2019 and October 2020. Primary outcome measures Knowledge regarding GDM was assessed using an interviewer-administered questionnaire comprising six pregnancy-specific domains adapted from a previously validated Bangladeshi instrument (Cronbach's alpha=0.72). Responses were scored from 0 to 6, and good knowledge (score>5) was analysed using population-averaged generalised estimating equations (GEEs) with centre as the clustering unit. Results Among 6120 women with an observed knowledge outcome, 23.2% had poor knowledge, 66.9% had average knowledge and 9.9% demonstrated good knowledge regarding GDM. In centre-clustered multivariable GEE analysis, middle household expenditure (adjusted OR 1.25, 95% CI 1.02 to 1.54), urban residence (adjusted OR 1.77, 95% CI 1.02 to 3.07), family history of diabetes (adjusted OR 1.22, 95% CI 1.02 to 1.45), receipt of preconception care (adjusted OR 1.26, 95% CI 1.02 to 1.55) and absence of previous pregnancy complications (adjusted OR 1.26, 95% CI 1.02 to 1.55) were independently associated with good knowledge. Maternal age, educational attainment and occupation were not independently associated with good knowledge. Conclusions Knowledge regarding GDM among pregnant women attending BADAS-affiliated antenatal care facilities in Bangladesh was suboptimal, with significant socioeconomic and urban-rural disparities. Strengthening structured GDM counselling within routine antenatal and preconception care may improve maternal health education and support earlier detection and management of GDM.

Abstract Introduction Population-based data on paediatric type-1 diabetes (T1D) remain limited in low-and middle-income countries. In Bangladesh, the absence of a national registry may contribute to under-ascertainment. Objectives The aim of this study was to estimate nationwide incidence and describe temporal, demographic, and geographic variations. Methods We conducted a nationwide, multicentre, population-based study leveraging data from 109 diabetes centres across all administrative divisions of Bangladesh from 2010 to 2024. Incident cases were defined as individuals aged 0–19 years diagnosed with T1D and requiring insulin at presentation. Incidence rates per 100,000 population were estimated using age-specific census denominators. Temporal trends in incidence were analysed using Poisson regression models. Results A total of 6,667 paediatric T1D cases were identified (2010–2024). Overall incidence increased modestly 0.63 to 0.70 per 100,000). However, the pattern was not uniform, with a steady decline through 2020, followed by a marked increase from 2021 to 2024 (IRR 1.09, 95% CI 1.04–1.13; p<0.001). Incidence highest among aged 10–14 years and was lowest among children aged 0–5 years. Females predominated (male-to-female ratio 1:1.54). Marked geographic heterogeneity was observed, with the highest incidence in Dhaka Division (3.46 per 100,000) and the lowest in Sylhet Division (0.23 per 100,000). Conclusions Paediatric T1D incidence in Bangladesh remains low in the global context but demonstrates a recent increasing trend and marked regional disparities. These findings highlight an evolving epidemiological pattern and underscore the urgent need for robust national surveillance and targeted public health interventions.