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Urban Diabetes: a Cross-sectional Study in a Ward of Dhaka Metropolitan City

Rumana Rashid
Primeasia University, Banani, Dhaka- 12121

Nurun Nahar Dillruba
National University, Gazipur-1704

Abu Torah M A Rahim
Institute of Nutrition and Food Science, University of Dhaka, Dhaka-1000

Abstract/ Executive Summary:

A cross-sectional study was conducted among the inhabitants of the Ward 27 (Bashaboo) of Dhaka Metropolitan City. Out of 52000 people (+20 years, according to the voter list), a total of 450 subjects were selected for interview by purposive sampling. Subjects were categorized as nondiabetic, NDM (n=166) and diabetic, DM (n= 284) groups. The DM group was further categorized after data collection into previously diagnosed diabetes mellitus, DMPD (n= 117) and newly diagnosed diabetes mellitus, DMND (167). Sociodemogrphic, clinical, anthropometric, biochemical, and dietary data were collected using standardized protocols. The findings showed that majority of the respondents were female (60.3%) and belonged to middle income group (Tk 5000-14999) (62.4%). The main clinical complications of the respondents were hypertension (DMPD=26% and DMND=21%), vertigo (DMPD=22% and DMND=27%), joint pain (DMPD=22% and DMND=21%), back pain (DMPD=18% and DMND=20%) and cataract (DMPD=12% and DMND=12%). The level of plasma triglyceride, plasma cholesterol and urine n-albumin were significantly higher among the newly diagnosed DM subjects. The group of middle aged and middle income subjects had significantly higher level of these parameters. The data, therefore, indicate that diabetic related complications among DMND subjects were relatively higher compared to DMPD subjects thus pointing to the notion of a positive effect of a controlled life-style among DMPD patients as per the medication guideline.

Keywords: Urban diabetes mellitus, Diabetes morbidity, Sedentary life

Location: Eastern area of Dhaka Metropolitan City, Bangladesh

Start Date:

End Date:

Program Area: Food Safety and Security

Commodity: Nutrition

Objectives:

To investigate the prevalence of DM and DM-related health morbidity in urban middle to poor population by cross-sectional survey method.

Methodology:

The study was carried out in Ward 27 (Bashaboo), eastern area of Dhaka Metropolitan City. The ward is mainly dwelled by middle to poor income groups along with several slum areas. The study area has a population of 52,000 over the age of 20 years according to local voter list. People who came to the Ward Community Field Clinics with physical and clinical complications were included in the study provided they had their names in the voter list of the ward. Physicians clinically examined them and recommended for inclusion. With the desired precision of 0.05, statistical confidence level of 95% (Z= 1.96) and expected prevalence of 0.5, the sample size was calculated with the formula, n=Z²pq/d². A total 450 subjects were selected for interview by purposive sampling i.e., subjects who came to the community clinic and scrutinized to match the selection criteria were including in the study after receiving a duly signed consent letter. A structured questionnaire which was validated in a pilot study in a different area of the city. The study variables are socio-demographic (Sex, Age, Occupation, Education, Income per month), anthropometric (Ht. Wt, BMI, Hip-waist ratio), biochemical (Fasting glucose. Postprandial glucose. Lipid profiles. Urinary µ-albumin), clinical (Blood pressure, CHD, Obesity), dietary (Energy-yielding nutrients. Diabetes-related nutrients. Food groups). Based on fasting plasma glucose (FPG), the participants were classified into two groups. Those with FPG ≤6.0 mmol/L were considered as normal serum glucose tolerance (NOT) subjects and those with FPG>6.0 mmol/L were considered as abnormal glucose tolerance (AGT) subjects. All DM subjects identified were tested further with oral glucose tolerance (OGT) test according to WHO criteria. Subjects were categorized as non-diabetes mellitus, NDM (n=166) and diabetes mellitus, DM (n=284) groups. After data collection, DM group was further categorized into DM previously diagnosed, DMPD (n= 117) and DM newly diagnosed, DMND (n=167). Blood pressure was measured thrice and taking the mean to rule out hypertension among the study subjects. Who were taking antihypertensive drug was taken as hypertensive subjects. Serum and urine samples were collected by a standard protocol for biochemical analysis. Plasma glucose was measured by glucose oxidase-peroxidase method using Technicon M-II auto analyzer. To measure total lipid profile of blood. Cholesterol, TG and HDL-cholesterol were estimated by Hitachi-704 auto-analyzer using enzymatic method^ When the measurements of total Cholesterol, HDL-cholesterol and TG (<400mg/dl) were available, the value of LDL-cholesterol was calculated as: LDL-cholesterol = Total Cholesterol - (HDL-cholesterol + TG/5). Urine ji-albuminuria was tested by enzymatic method. AU biochemical examination was done at the Immunology department of BIRDEM. Individual anthropometric data was recorded meticulously for each subject. The nutritional status of the subjects was determined on their body mass index (BMI) into three categories according to WHO (1995) classification. On the other hand, Physical Activity Level (PAL) of the DM respondents was determined from the day-to-day activity description of each individual subject recorded in the questionnaire for three consecutive days. To calculate the PAL value of the subjects, their day-to-day activity values in terms of energy cost were taken from FAOAVHO/UNU 2001Report. All activity values were summed up to get the PAL of an individual subject. Finally data was analyzed by a SPSS software package (SPSS Inc.).

Source of Information: Bangladesh Journal of Nutrition, Vol. 28-31, December 2018

Article Link (Online Journal):

Funding Source:

Budget:

Total Budget (Tk.) :

Achievement/Findings:

Subjects were screened according to the plasma glucose level along with the clinical sign and symptoms of DM. Out of 450 respondents, 284 subjects were found diabetic off which 167 were newly diagnosed and 117 were previously diagnosed subjects. It also showed that plasma postprandial glucose load was higher among the DMPD subjects. Percentage of the subjects with weight loss and general weakness were almost similar. While the data showed that DM is a disease of post forties among the studied population. The nutritional status of the subjects was determined by their body mass index (BMI) into three categories according to WHO (1995) classification. The figure showed that most of the over weight subjects was suffering from diabetes. About 45% DMPD and 40% DMND subjects was found to be overweight. Similarly the tendency of underweight subjects to become diabetic was found lower (11% and 7%). The nutrient profile reflected the food consumption behavior in terms of nutrients. Since majority of the respondents belonged to low to middle income groups, intake of energy and other nutrients were found low as per recommended daily requirements.

Knowledge Management: Journal