Prevalence and incidence of micro- and macro-vascular complications in a diabetic population of Bangladesh: a retrospective cohort study

Abstract

Background and objectives: Diabetes mellitus (DM) is a major health problem in South Asian Region including Bangladesh. Increasing prevalence of DM is likely to cause higher morbidity and mortality. The objective of this study was to find out the prevalence and incidence of diabetic complications in a Bangladeshi diabetic cohort attending BIRDEM, a largest referral center in Bangladesh for endocrine and metabolic diseases. Methodology: The study was conducted in BIRDEM-OPD (outpatient department) from 1 January to 31 December of 1995 and analyzed the data of diabetic cases preserved in BIRDEM registry since 1956. Up to 31 December 1985, the REFERENCE NUMBER (Ref No) of last case was ‘49,510’. Therefore, this retrospective cohort comprised of all those patients having Ref No 49,510 or less and attending BIRDEM-OPD for follow-up. In the year 1995, the cohort had follow-up for at least ten years. The duration of follow-up was 39 years (1956 to 1995). The study also retrieved follow-up data from the guidebook of each registered diabetic patient. All data regarding clinical, anthropometric and biochemical investigations preserved in BIRDEM registry and in the patient's guidebook were retrieved and analyzed. The cohort was categorized into three groups (Gr1, 2 and 3) based on follow-up duration: >15, 10-15 and <10years, respectively. Results: Micro-vascular complications (retinopathy and nephropathy) were the highest among both Gr1 with follow-up >15y and Gr2 with follow-up 10-15y. Compared with the Gr2, retinopathy (34.4 vs. 48.5 %: c2 =11.5, p <0.001) and nephropathy (24.0 vs. 39.2 %: c2 = 15.6, p<0.001) were significantly higher in the Gr1. In contrast, HTN, skin-lesion and periodontal diseases were significantly higher in the Gr2 than in Gr1. All types of complications were found increasing with the duration of follow-up. For Gr1, the increasing trend of cerebrovascular accident (CVD/ stroke) and CHD was significant (p<0.01 and p<0.001). Mean blood glucose of study population revealed moderate to severe hyperglycemia in successive follow-up visits. The comparison between patients with and without severe hyperglycemia (2hPG: <10.0 vs. ³10.0 mmol/l) showed very little difference of complications. The increasing age over 40 years showed significant risk for CHD and hypertension. Conclusion: CHD, stroke and PVD were less frequent compared to those with retinopathy and nephropathy. Compared to microvascular complications the macrovascular events resulted in either early death or complete disability to pursue long-term follow-up. The most important and consistent predictors were female gender and duration of diabetes. IMC J Med Sci 2022; 16(1): 002 *Correspondence: M. Abu Sayeed, Department of Community Medicine, Ibrahim Medical College, 1/A Ibrahim Sarani, Segunbagicha, Dhaka-1000. email: sayeed@imc.ac.bd; sayeed1950@gmail.com