Diabetes in East Pakistan.

Abstract

Since the advent of oral hypoglycaemic agents in diabetic therapy newer vistas have been opened up in research on diabetes mellitus in regard not only to its management but also to its aetiology and pathogenesis. Peculiarities in the character of diabetes in tropical regions were noted in the early part of this century, and various authors discussed their observations in a symposium in the Section of Tropical Medicine of the British Medical Association's Annual Meeting in 1907 (British Medical Journal, 1907). The most significant of these peculiarities were rarity of juvenile diabetes, infrequency of ketosis, and diabetic coma. During the last decade clinical studies by DeZoysa (1951), Hugh-Jones (1955), and Cosnett (1959) clearly showed that diabetes in the tropics differs widely from that in temperate climates. Different authorities have described various types of diabetes, such as type 1 and type 2 (Lawrence, 1951) and type J (Hugh-Jones, 1955). In a stimulating leading article in the British Medical Journal (1959) the types of diabetes were discussed and the need for further studies in the tropics was stressed, concluding with the remark of Sir Harold Himsworth that a primary deficiency of insulin is only one, and then not the commonest, cause of the diabetic syndrome. The present paper records the result of a study of 894 cases of diabetes in East Pakistan. As there was no special clinic in the country to deal with these cases, and as illiteracy, poverty, and superstition often made dietary control and insulin treatment difficult or uncer tain, a Diabetic Association was organized in the early part of 1956 and arrangements were made to contact as many diabetics as possible by newspapers, seminars, and conferences. A research section was started under the auspices of the Pakistan Medical Research Council in the Medical Research Centre at Dacca, where all the examinations, including repeated glucose-tolerance tests and other relevant biochemical procedures, were done free of cost. Method and Materials.-The period covers the 28 months from August, 1957, to December, 1959. All the 894 patients were studied in the Medical Research Centre and arrangements were made to call them at regular intervals, fortnightly or monthly, for assessment and glucose-tolerance tests. The procedure of examina tions has been fully described (Ibrahim, 1959).