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2 November, 2019 00:00 00 AM / LAST MODIFIED: 2 November, 2019 12:05:38 AM

The diabetes TRACK and the track records

Not only food and lifestyle, global warming also plays an important role in diabetes prevalence
Abdul Kader Mohiuddin
The diabetes TRACK and the track records

Diabetes is one of the four major types of noncommunicable diseases that make the largest contribution to morbidity and mortality worldwide. The International Diabetes Federation (IDF) estimated that, worldwide, approximately 425 million people had diabetes in 2017, projected to be 629 million by 2045. Again, worldwide $727 billion was spent in 2017 for treating and preventing diabetes, projected to be US$776 billion by 2045. Diabetes had 2 times more days of inpatient treatment, 1.3 times more outpatient visits, and nearly 10 times more medications than non- diabetes patients, as reported by British Medical Journal. And surprisingly, 80% of people with this so called “Rich Man's Disease” live in low- and middle-income countries. According to a recent study of American Medical Association, China and India collectively are home of nearly 110 million diabetic patients.

Bangladesh was ranked as the 8th highest diabetic populous country in the time period of 2010-2011. About 129,000 deaths were attributed to diabetes in Bangladesh in 2015, as reported by leading research organization ICDDR, B. According to the WHO-Diabetes country profile of Bangladesh in 2016, the physical inactivity was prevailing among 25.1% of population. Around 85% population of age group 25-65 never checks for diabetes. A recent study by British Medical Journal says, 1 in 10 Bangladeshi adults aged ≥18 years have hyperglycemia (high levels of blood sugar). And IDF says, there are 7.1 million people with undetected diabetes in Bangladesh and this number will be double by 2025. A Hong Kong based journal says, among 8400 stroke patients from different hospitals in Bangladesh over a period of sixteen years, diabetic patients were nearly 25%. The age adjusted death rate 40 per 100,000 of population ranks Bangladesh 57 in the world, says WHO.

In a newspaper interview, Professor AK Azad Khan, President, Diabetic Association of Bangladesh said 40% school going children of Dhaka city were either obese or overweight. “Children with type 2 diabetes is rising “alarmingly” in Bangladesh. A 300% raise in the last five years”, according to the Changing Diabetes in Children Program of the BIRDEM hospital. A study shows 97.4% students consume fast food contain Monosodium Glutamate which causes obesity, headache, asthma and other body discomforts. In a similar study among students of 4 private universities of Dhaka, 98% of the students were well informed about the negative effects associated with excessive fast food consumption, they were still profoundly addicted to it.  Not only food and lifestyle, global warming also plays an important role in diabetes prevalence. A Netherlands based study in CNN Health says, "a 1-degree Celsius rise in environmental temperature could account for more than 100,000 new diabetes cases per year in the USA alone." A similar study says Bangladesh will exceed 35-degree Celsius before the end of the century. Consuming arsenic contaminated food grains could be another reason of high diabetes prevalence (Chemical residues in food grains: A serious cause for concern, The Independent, 17 September, 2019). Again, 15% of expecting women are diagnosed with gestational among these 60% contribute to permanent diabetes within 10 years, says Dr Samsad Jahan (professor of Obstetrics and Gynecology, BIRDEM).

TRACK: A programme of National Institute of Health (NIH), England to memorise the factors that can contribute to health while living with diabetes.

Fasting during Ramadan is significantly associated with decrease in blood lipid profile, blood pressures, glucose, and HbA1C level among diabetic patients. The total energy intake decreases during Ramadan, whereas the dietary fat consumption increases because of an augmentation of fatty food that does not occur during other periods. Even more unfortunate is the fact that nefarious practice food adulteration increases exponentially during the month of Ramadan in Bangladesh, according to a study of European Journal of Sustainable Development Research, 2019. The number of patients suffering from cancer, diabetes, and kidney diseases is on the rise due to food adulteration.

Tobacco kills more than seven million people a year worldwide and responsible for 1 in 5 deaths in Bangladesh. A number of experimental and clinical studies suggest that smoking decreases insulin sensitivity, and indirectly role plays in elevated blood sugar and LDL, decreased HDL and postprandial lipid intolerance. A 2018 survey by BRAC University shows several risk factors of diabetes includes smoking (almost 60%), abdominal obesity (43.3%), hypertension (14.3%), depression (43%) whereas the incidence of routine bodily exercise (only 1.3%) and the habit of consuming seasonal fruits as well as vegetables (8.6%) remain significantly low among the people of Bangladesh. Poor adherence is a well-documented obstacle in therapeutic control of diabetes. For an effective control and prevention of diabetes, 87% of Bangladeshis were noncompliant, compared to 71% of Indians and 52% Europeans. Out-of-pocket expenditure, emotional status, frequency of counseling, patient’s family priorities, availability of medication (mainly insulin) are the factors greatly influence patient compliance to treatment guidelines. In 2016, the median monthly cost of diabetes maintenance was close to $10, approximately 10% of the median monthly income. According to a 2018 BBC record, insulin availability found supplies were low in six countries - Bangladesh, Brazil, Malawi, Nepal, Pakistan and Sri Lanka. Also, huge gap between the number of diabetic patients and doctors are well-known. The Diabetic Association of Bangladesh (DAB) record shows, except Dhaka and Chittagong, there are no tertiary facilities in Bangladesh to preventing blindness due to diabetic retinopathy.

However, emphasizing medication adherence with multiple comorbid diseases should be strongly considered in future diabetes management programs to improve glycemic control in patients with type 2 diabetes. The most important thing is patient education, that the modern world is giving the highest priorities. Rich or poor, privileged or unprivileged, all segment of population should be brought under the arena of compliance through patient education, at least by health campaign. Both government and profit taking medicine companies should take initiatives in this regard.

The writer is Secretary & Treasurer, Dr. M. Nasirullah Memorial Trust, Dhaka.




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Published by the Editor on behalf of Independent Publications Limited at Media Printers, 446/H, Tejgaon I/A, Dhaka-1215.
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Editor : M. Shamsur Rahman
Published by the Editor on behalf of Independent Publications Limited at Media Printers, 446/H, Tejgaon I/A, Dhaka-1215.
Editorial, News & Commercial Offices : Beximco Media Complex, 149-150 Tejgaon I/A, Dhaka-1208, Bangladesh. GPO Box No. 934, Dhaka-1000.

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