Sexual dysfunction (SD) is a prevalent but frequently overlooked complication of Type 2 Diabetes Mellitus, with a particularly high burden in South Asia, a region experiencing a rapid rise in diabetes prevalence. Despite its significant effects on quality of life, interpersonal relationships, and psychological well-being, SD is often insufficiently addressed in routine clinical care. This gap is largely influenced by sociocultural barriers, limited openness in patient-physician communication, and inadequate access to specialized services. In men, erectile dysfunction (ED) represents the most common clinical manifestation and may occur before overt cardiovascular disease, reflecting underlying endothelial and vascular abnormalities. In contrast, sexual dysfunction in women is more heterogeneous, encompassing reduced sexual desire, impaired lubrication, difficulty achieving orgasm, and pain during intercourse. These issues often carry profound personal and relational implications within South Asian sociocultural settings. The underlying mechanisms are complex and multifaceted, involving vascular compromise, autonomic neuropathy, hormonal imbalance, as well as psychological and sociocultural influences. Comprehensive evaluation includes the use of validated assessment instruments, focused clinical examination, and appropriate laboratory investigations. Management requires a holistic and culturally appropriate strategy, integrating optimal glycaemic control, management of cardiovascular risk factors, psychosocial support, and involvement of partners when appropriate. In addition, condition-specific pharmacological and non-pharmacological interventions should be tailored to individual needs. This review consolidates current evidence with an emphasis on the South Asian context, identifies significant gaps in regional and gender-specific data, and explores the potential implications of emerging glucose-lowering therapies on sexual health outcomes.

Background: Bisphenol A (BPA) is a ubiquitous environmental endocrine-disrupting chemical (EDC) widely found in plastics and food packaging. Growing epidemiological and experimental evidence suggests BPA exposure may contribute to metabolic dysfunction, particularly diabetes mellitus. This study investigated the association between serum BPA levels and diabetes mellitus, examining whether elevated BPA concentrations correlate with increased diabetic risk and altered glycemic parameters. Methods: A cross-sectional study was conducted involving 240 participants (120 individuals with type 2 diabetes mellitus (T2DM) and 120 age- and sex-matched controls). Serum BPA levels were measured using high-performance liquid chromatography-tandem mass spectrometry (HPLC-MS/MS). Glycemic parameters, including fasting blood glucose, HbA1c, fasting insulin, and HOMA-IR, were assessed. Multiple logistic regression analysis was performed to evaluate the association between BPA exposure and diabetes prevalence, adjusting for potential confounders including age, sex, body mass index, physical activity, and dietary factors. Results: Median serum BPA levels were significantly higher in diabetic participants compared to controls (3.82 μg/L vs 1.64 μg/L, p<0.001). After adjusting for confounders, participants in the highest BPA quartile demonstrated 3.74-fold increased odds of diabetes (OR 3.74, 95% CI: 1.89-7.42) compared to the lowest quartile. Serum BPA concentrations showed positive correlations with fasting glucose (r=0.48, p<0.001), HbA1c (r=0.51, p<0.001), and HOMA-IR (r=0.44, p<0.001). Dose-response relationships were observed between BPA exposure and markers of insulin resistance. Conclusion: Elevated serum BPA levels are significantly associated with T2DM and impaired glycemic control. These findings support BPA's potential diabetogenic effects and highlight the need for public health interventions to reduce environmental BPA exposure. Further prospective studies are warranted to establish causality and elucidate underlying mechanisms. Bangladesh Medical Res Counc Bull 2026;52(1): 30-39

Empagliflozin, a member of the Sodium-Glucose Co-Transporter 2 (SGLT-2) inhibitor family, is a promising antidiabetic drug with proven benefits in heart failure (HF). However, its effects in heart failure patients in varying ejection fractions with and without diabetes, and its impact in a real-world clinical setting, remain underexplored. This multicenter observational study, conducted in a real-world setting, from November 2022 to October 2023 in four specialized and tertiary care hospitals in Bangladesh. The study included 797 patients diagnosed with heart failure, irrespective of ejection fraction, who received empagliflozin at a dose of 10 mg daily over six months. The primary aim was to evaluate the efficacy and safety of empagliflozin in enhancing clinical, biochemical, and echocardiographic parameters in patients with heart failure across ejection fraction types, with or without diabetes. Of the 797 enrolled patients, 460 (57.7

Objective Three major guidelines (Rotterdam, National Institutes of Health (NIH) and Androgen Excess Society (AES)) have been proposed to diagnose polycystic ovary syndrome (PCOS). The concordance of these guidelines, along with covariates of individual phenotypic features, has been explored among young Bangalee women.Methods This observational study included 158 PCOS (diagnosed by Modified Rotterdam Criteria 2003) and 127 non-PCOS women (PCOS, 55%; age 18–35 years). Phenotypic characteristics were collected following standard procedures/investigations. Ovarian folliculometry was done with ultrasonography and a 75 g oral glucose tolerance test was performed. Serum total testosterone, SHBG and C-peptide were measured by chemiluminescence immunoassay and Free Androgen Index (FAI) was computed. Subjects were recategorised following NIH and AES criteria, and concordance between the guidelines was assessed by kappa test. Associations between phenotypic features of PCOS and their covariates were explored.Results As compared with 55% of the Rotterdam criteria-based PCOS among overall subjects, the proportion was 43% with NIH and 51% with AES criteria (k=0.76 and k=0.90 as compared with Rotterdam, respectively). FAI correlated positively with fasting blood glucose (FBG) in all the criteria-based groups (p<0.45 to <0.001). Body mass index, waist-hip ratio, FBG and 2-hour-after blood glucose were the significant covariates independently associated with phenotypic features of clinical (anovulation/oligomenorrhoea) and biochemical (FAI) hyperandrogenism; however, there were overlapping and variations among different criteria regarding these associations.Conclusions NIH criteria may underdiagnose PCOS among Bangalee young women, and overweight/obesity as well as hyperglycaemia are major covariates underlying the phenotypic feature of hyperandrogenism in this group.

A bstract Background: Thyroid disorders are frequently encountered among women of reproductive age and are associated with adverse outcomes for both maternal well-being and fetal development. In Bangladesh, thyroid dysfunction continues to be common despite the overall iodine sufficiency. A nationwide survey of physicians revealed notable inconsistencies between international guideline recommendations and routine local clinical practice, underscoring the need for updated, context-specific, and evidence-based guidance. Materials and Methods: The Thyroid Task Force of the Bangladesh Endocrine Society (BES) formulated these updated recommendations by synthesizing international best practices—particularly those from the American Thyroid Association and the Endocrine Society—with locally generated evidence. The committee systematically reviewed the 2023 guidelines to identify areas requiring modification in light of the emerging clinical data and prevailing practice patterns in Bangladesh. Results: The 2026 BES updates offer detailed recommendations on universal screening strategies, trimester-specific interpretation of thyroid function tests, and the management of hypothyroidism, hyperthyroidism, thyroid nodules, and thyroid-related emergencies. Emphasis has been placed on pragmatic, resource-sensitive approaches aligned with the national healthcare infrastructure, with additional focus on postpartum thyroid care. Conclusion: The BES 2026 guidelines establish a unified and practical framework for improving the diagnosis and management of thyroid disorders in Bangladesh. By aligning global evidence with local healthcare realities, these recommendations aim to minimize preventable maternal and neonatal morbidity across diverse clinical settings.

A bstract Background: Thyroid dysfunction includes both hypothyroidism and hyperthyroidism, conditions that influence metabolic and biochemical processes, including blood glucose regulation and its long-term control. Objectives: Therefore, the aim of this study was to estimate the prevalence of undiagnosed thyroid dysfunction (overt and subclinical hypothyroidism and hyperthyroidism) among selected professional groups in Dhaka, Bangladesh, and metabolic markers and explore gender differences in the prevalence of thyroid disorders. Materials and Methods: This is a cross-sectional study including 401 patients. Data collection was done from 2023 to 2024 in Dhaka, Bangladesh. A stratified random sampling was used for selecting sample size such as corporate, education, healthcare, and government. Results: Most participants were euthyroid (85.5%), followed by those with hypothyroidism (13.2%) and hyperthyroidism (1.2%). Significant differences in thyroid-stimulating hormone (TSH) and free thyroxine (FT4) levels appeared for hyperthyroid and hypothyroid groups ( P < 0.05), with the hypothyroid group showing higher TSH and lower levels of FT4. Blood sugar is weakly though significantly positively correlated with FT4 ( r = 0.113, P < 0.024), and there was a strong correlation of blood sugar and glycated hemoglobin A1c ( r = 0.849, P < 0.001). Gender differences were noted, with males having predominantly subclinical hypothyroidism and females having overt hypothyroidism. Conclusion: This study found that while most participants were euthyroid, a notable proportion had previously undiagnosed thyroid dysfunction, predominantly subclinical hypothyroidism, among professional groups in Dhaka. Gender-specific patterns were observed, with overt hypothyroidism more common in females and subclinical hypothyroidism more frequent in males.

Background: Hypothyroidism is a widespread endocrinological disorder that affects millions of people worldwide. The thyroid gland fails to produce sufficient amounts of thyroid hormones, T4 and T3. Hormonal deficiency causes disturbance of metabolism in the organism and affects multiple organ systems. Objective: In this study, the objective was to establish a correlation between the demographic, clinical, and serological factors associated with hypothyroidism among patients with special emphasis on their menstrual problems, obstetric history, and thyroid autoimmunity. Methods: This was a cross-sectional study conducted with 154 patients. The data collection period was from January 2, 2015 to December 31, 2015. Statistical tests, such as Spearman’s correlation and multiple regression, were used to establish correlations. Results: Amenorrhoea was found in 22.7% of patients, while oligomenorrhoea was found in 11.7% of them. No problems during pregnancy were recorded in 50% of patients, while 16.2% suffered from spontaneous abortion, which was the most frequent complication among all other mentioned issues. There were no relations between anti-TPO and anti-Tg antibodies and TSH/FT4 concentrations; nonetheless, a significant association between these antibodies and grade 1 goitre (OR 11.7, p<0.001) was found. Weight gain was observed in 73.4% of antibody-positive patients (p<0.043). Conclusion: Hypothyroidism is accompanied by considerable menstrual and obstetric problems, while thyroid autoimmunity is related to morphological changes in the gland, including goitre and weight gain. The absence of any relation between antibodies and TSH/FT4 levels indicates complicated immune mechanisms.

A bstract The thyroid gland and nutritional status are bound in a profound, bidirectional relationship that spans from subcellular biochemistry to national public health policy. Adequate availability of key micronutrients—iodine, selenium, zinc, iron, vitamin D, and vitamin A—is indispensable for every phase of thyroid hormone biosynthesis, peripheral activation, and genomic signaling. Conversely, thyroid dysfunction itself disrupts macronutrient metabolism, energy homeostasis, and micronutrient absorption, creating a self-reinforcing cycle of metabolic deterioration. Dietary constituents, including goitrogens, processed foods, ultra-processed carbohydrates, and specific drug–nutrient interactions, further modulate thyroid function in both clinically apparent and subclinical ways. At the population level, iodine deficiency disorders remain the leading preventable cause of intellectual disability globally, while emerging data point to excessive iodine intake as an underappreciated driver of autoimmune thyroid disease. This review comprehensively examines the molecular and clinical evidence linking nutrition to thyroid health, the public health burden of micronutrient-related thyroid disorders, dietary and lifestyle strategies for optimizing thyroid function, and priority areas for future research, with particular attention to the contexts of South Asia and Bangladesh.

Background:This study assessed the real-world effectiveness and safety of imeglimin among Bangladeshi patients with type 2 diabetes mellitus (T2DM). Methods:This prospective, multi-center observational study was conducted across 15 specialized diabetes care centers in Bangladesh from January 2024 to December 2024. Adults with uncontrolled T2DM (HbA1c >7%) prescribed imeglimin (500-2000 mg daily) either as monotherapy or combination therapy were enrolled. A total of 898 subjects were assessed at baseline, 3 months, and 6 months. Primary outcomes were changes in HbA1c, fasting plasma glucose (FPG), and postprandial plasma glucose (PPPG). Secondary outcomes included body mass index (BMI), blood pressure, lipids, and safety parameters. Results:The mean age was 46.2 ± 13.1 (SD) years, with 67% being female. Baseline HbA1c decreased from 9.2±1.4% to 7.1±1.0% at 6 months (mean change: -2.1%, p<0.001). FPG reduced from 9.37±2.53 to 7.28±4.63 mmol/L (p<0.001) and PPPG from 14.36±3.29 to 8.95±1.76 mmol/L (p<0.001). BMI decreased from 28.1±4.2 to 25.6±3.6 kg/m2 (p<0.001). Significant improvements occurred in blood pressure, lipids, and renal parameters. Adverse events were mild; 3.6% reported ≥1 event (gastrointestinal 2.4%, dehydration 1.3%). No serious adverse events occurred. Conclusion:Imeglimin demonstrated substantial glycemic improvements and favorable safety in real-world Bangladeshi patients with poor glycemic control.

Background: Women in reproductive age groups face menstrual irregularities that affect regularity, bleeding patterns, and symptomatology. Medical problems and endocrine disorders are the main causes of amenorrhea, oligomenorrhea, and menorrhagia. Objectives: The purpose of the study was to assess menstrual health in a representative sample of women in Bangladesh and evaluate the correlation between irregular menstruation and associated systemic diseases in Bangladesh. Methods: The study was cross-sectional in nature. The data was collected from July 2015 to December 2025 at the Department of Endocrinology, Bangabandhu Sheikh Mujib Medical University in Bangladesh. The study consisted of 154 married women. The descriptive analysis was performed by IBM SPSS 29 software. Results: The study revealed that 9.1%, while the number of women who were newly detected adult hypothyroid women. The major menstrual problems experienced by the women included amenorrhea (22.7%), oligomenorrhea (11.7%), irregular menstrual cycles (10.4%), and menorrhagia (9.7%), while paraesthesia (26.0%) was the most common non-menstrual symptom. Multivariable logistic regression analysis revealed that Goiter Grade 1 was significantly associated with the outcome (OR = 11.77, 95% CI: 2.99-46.27, p<0.001. Conclusion: This study identified a high incidence of menstrual disorders such as amenorrhoea and oligomenorrhoea. This clearly indicates that there is a need for more awareness, early diagnosis, and treatment. This study clearly indicates that public health services help women to live a better life and avoid problems. Systemic diseases like joint pains and cognitive disturbances may be related to menstrual health. This study clearly indicates that more research should be done to identify the causes and their socioeconomic and cultural impact.

Objectives:Transcription factor 7-like 2 (TCF7L2) has emerged as a promising candidate gene associated with type 2 diabetes mellitus (T2DM), and the intronic variant rs12255372 of the TCF7L2 gene has demonstrated a robust association with T2DM across various ethnic groups. We sought to determine the frequency of rs12255372 polymorphism in the Bangladeshi adult population, both with and without T2DM. Methods:This cross-sectional study was conducted in the Endocrinology Department of Bangabandhu Sheikh Mujib Medical University. Eighty patients with T2DM and 80 normoglycemic controls were included in the study. The rs12255372 polymorphism was genotyped using the polymerase chain reaction-restriction fragment length polymorphism technique. Results:An allelic odds ratio (OR) of 3.29 (95% CI: 1.78-6.05; p < 0.001) was found for the minor T allele of rs12255372, significantly increasing the T2DM risk. A significant difference in TT and GT genotypes was noted between participants with T2DM (OR = 5.26, 95% CI: 1.39-19.9; p = 0.008) and normoglycemic controls (OR = 3.00, 95% CI: 1.33-6.75; p = 0.007), respectively. The dominant model appears to be the most suitable for representing the susceptibility gene effect. Conclusions:The frequency of the minor T allele of rs12255372 was about one-fourth and one-tenth among patients with T2DM and normoglycemic controls, respectively, indicating that this polymorphism may be associated with the risk of developing T2D in the studied population.

Aims:Evidence on cardiovascular (CV) risk stratification in Bangladeshi patients with type 2 diabetes mellitus (T2DM) who are asymptomatic for cardiovascular disease (CVD) is limited. This study aimed to assess the 10-year CV risk in newly diagnosed patients with T2DM. Methods:In 2023, a cross-sectional study was carried out at endocrinology clinics in tertiary hospitals throughout Bangladesh, involving newly diagnosed patients with T2DM aged 25 to 84 who had no prior history of CVD and were asymptomatic for the condition. CV risk was assessed and classified using QRISK3. Results:1617 newly diagnosed patients with T2DM (age 44.92 ± 11.84 years, male 49.5 %) were analyzed. Their median QRISK3 score was 11.0 %, with 46.5 % at low, 25.7 % at moderate, and 27.8 % at high 10-year CV risk, respectively. The QRISK3 score increased with age for both men and women, with men consistently scoring higher than women in every age group. Among the age groups 25-39, 40-64, and 65-84, the percentages of patients with high 10-year CV risk were 3.3 %, 34.0 %, and 94.5 %, respectively. The median relative risk (RR) of CVD was 4.3. RR decreased with age for both sexes, and men had a lower RR than women across all age groups. A sleep duration of 6-9 h was associated with a lower 10-year CV risk. Conclusions:Many newly diagnosed Bangladeshi patients with T2DM have substantial CV risk. QRISK3 can assist clinicians in predicting 10-year CV risk and choosing appropriate treatments to prevent CVD.

A BSTRACT Context: The fast-growing noncommunicable disease known as diabetes mellitus (DM) poses a significant danger to global public health. In different population groups, knowledge and attitude are the primary indicators of awareness that require investigation. Aims: This study focused on evaluating the awareness, attitudes, and practices associated with type 2 DM. Settings and Design: The design of the survey was cross-sectional, descriptive, and quantitative. Materials and Methods: A semi-structured self-administered questionnaire was taken. Questionnaire was given to them in the Bengali language to gather the information from 201 respondents. Statistical Analysis Used: Finally, the Statistical Package for the Social Sciences (SPSS) software version 25 was used to analyze the collected data. Results: The study received responses from 201 patients, including 121 (56.3%) female and 80 (37.2%) male respondents. A total of 103 patients between the age ranges of 58 and 65 years, 148 had 1–6 months duration diabetes ( P = 0.033), and most of the correspondent occupations were housemakers ( P = 0.001). Results show that among the respondents, 72.80% know that diabetes is a genetic disease while 19.8% were not sure about the issue. Besides, 107 respondents thought that a combined approach, including exercise, medication, and stopping smoking can reduce the complications of diabetes ( P = 0.023). Elevated blood sugar levels exceeding 11.1 mmol/L were observed in 17 respondents (16.9%) among light-workers, comprising both males and females. This finding was statistically significant ( P = 0.049). Conclusions: The population of Pabna district in Bangladesh possesses an average degree of awareness and practice of diabetes. We recommended that stopping diabetes complications; more focused in diabetes education and self-care management programs should be included in the treatment protocol may help reduce the burden of diabetes on society.

Enterobacter asburiae (E. asburiae) is a gram-negative rod-shaped bacterium which has emerging significance as an opportunistic pathogen having high virulence pattern and drug resistant properties. In this study, we present the detailed analysis of the whole genome sequence of a multidrug-resistant (MDR) E. asburiae strain BDW1M3 from Bangladesh. The isolate was collected from an infected foot wound of a diabetic foot ulcer patient. Through sophisticated genomic techniques encompassing whole genome sequencing and in-depth bioinformatic analyses, this research unveils a profound understanding of the isolate’s antimicrobial resistance patterns, virulence determinants, biosynthetic gene clusters, metabolic pathways and pathogenic potential. The isolate displayed resistance to Ampicillin, Fosfomycin, Cefoxitin, Tigecycline, Meropenem, Linezolid, Vancomycin antibiotics and demonstrated the capacity for biofilm formation. Several antimicrobial resistance genes such as blaACT−2,fosA2, baeR, qnrE2, vanA and numbers of virulence genes including ybaJ, csrA, barA, uvrY, pgaD, hlyD, hlyC, terC, purD were detected. Metal resistance genes investigation revealed the presence of cusCFBA operon system, and many other genes including zntA, zitB, czrB. Prophage region of Myoviridae was detected. Comparative genomics with 47 whole genome sequence (n = 47) shed light on the genetic diversity of E. asburiae strains from diverse sources and countries, with a notable observation that strains from both human and non-human origins exhibited significant pathogenicity potential, genomic and phylogenomic relations hinting at potential cross-species transmission. Pangenome analysis indicated toward an expanding pangenome of E. asburiae. Further research and in-depth comprehensive studies are required to investigate the prevalence of E. asburiae in Bangladesh and emphasize towards unraveling the bacterium’s inherent pathogenic potential and the intricate molecular mechanisms that underlie its resistance traits and virulence properties.

Background: Graves' orbitopathy (GO) is a debilitating autoimmune condition associated with thyroid disease. Despite corticosteroids being the primary treatment, many patients show inadequate responses or relapse. Aim: To evaluate the outcome of mycophenolate mofetil combined with low-dose steroids in treating active moderate to severe GO. Methods: In this hospital-based prospective observational longitudinal study, a total of 40 patients with GO were included. Three follow-ups were conducted during the study period. Data were collected using case-record forms and analyzed with SPSS-26. Results: Comparing CAS at 6 months with treatment and baseline CAS shows significant improvement in both eyes (right eye's P value is 0.001 and left eye's P value is 0.025). Spontaneous retro-orbital pain, pain on eye movement, redness, and swelling of the caruncle and conjunctiva significantly reduced over the treatment period, while eyelid swelling showed a slight decrease. Lid retraction and soft tissue involvement improved in both eyes, although changes in diplopia and ocular motility are not statistically significant. Regarding outcome pattern, the majority of participants (68.8%) demonstrated significant improvement, while 31.3% showed unchanged/static. Conclusion: MMF combined with low-dose prednisolone may be considered for the treatment of moderate to severe GO as a steroid-sparing agent. [J Assoc Clin Endocrinol Diabetol Bangladesh, 2025;4(Suppl 1): S40]

Background: The association between type 2 diabetes mellitus (T2DM) and bone mineral density (BMD) remains unclear. Screening, identification and prevention of potential risk factors for osteoporosis in T2DM patients are important and necessary for preserving a good quality of life and decreasing the risk of fracture. This study is expected to help us find the trend of BMD in T2DM patients in Bangladesh and identify any risk factors that may predispose to low BMD. Objective: To evaluate the bone mineral density in patients with long term history of type-2 diabetes mellitus. Procedure: This cross sectional observational study was conducted in NINMAS for a period of 18 months among 200 patients with history of T2DM for more than five years who were referred for BMD test. The study subjects were divided according to duration of DM, glycemic status, BMI, menstrual status etc. DEXA scan was done and BMD was measured at lumbar (L1 to L4) vertebrae, right and left femoral necks. After getting the BMD report (normal, osteoporosis, osteopenia), the effects of independent variables (age, gender, duration of diabetes, status of diabetes and BMI) on dependent variable (BMD) were analyzed. Result: Most patients were older (>50-60 and >60-70 years age group), female (85%), overweight and pre-obese. Mean age was 57.86 ±9.69 years. Most of them (158) were post-menopausal. Only 25.5% patients had good controlled diabetes. According to duration, most patients (61%) belonged to >5-10 years group. No statistically significant difference was found between the T-scores of the ‘pre-menopausal’ and ‘post-menopausal’ female. Among the patients, 67.5% had low spine BMD and 38% and 41% had low right and left femoral neck BMD respectively. Duration of DM had statistically significant association on BMD only in left femoral neck (p= 0.046). No statistically significant correlation was found between HbA1c and T-score. Women have more than five times chance of having low BMD than men (odds ratio= 5.185, p = <0.001) in spine. Independent risk factors for low BMD were female gender, increasing age and low BMI. Conclusion: Significant portion of T2DM patients had low BMD. Low BMD in left femoral neck has statistically significant association with duration of T2DM. Low BMD is also related to increasing age, female gender and low BMI. Bangladesh J. Nuclear Med. 27(2): 260-266, 2024