Diabetic Association Of Bangladesh Research Articles

Use of Telemedicine for the Management of Type 1 Diabetes in Children and Adolescents in Bangladesh During the COVID-19 Pandemic

Background: Telemedicine has been an option for healthcare during the COVID-19 pandemic time. According to the COVID-19 forum on the International Society for Pediatric and Adolescent Diabetes, telemedicine is now the reality for all pediatric diabetes centers around the globe. We report here the analysis of telemedicine care provided to children and adolescents with type 1 diabetes by our diabetes team during the first phase of lockdown in Bangladesh. Materials and Methods: The Diabetic Association of Bangladesh (BADAS) is providing a highly structured and organized system of diabetes care as an extended arm of the government. Since the lockdown, diabetes care for children was started through telemedicine by the diabetes team in our center. Results: We analyzed our phone calls, text messages from March 26 to April 30, 2020. During lockdown, more than 645 calls, including text messages and WhatsApp messages, were received. A total of 235 patients were given advice over the phone in 1 month. Fifty-two percent of phone calls were from the capital city Dhaka and rest from other districts of Bangladesh. While analyzing the problems, three of our patients noticed mild fever, but there was no history of contact with infected persons, and they recovered within 2–3 days. No laboratory test was done for the confirmation of COVID-19. Most of the patients developed hyperglycemia during this period. None of them required hospital admission during this month. Free insulin from CDiC (Changing Diabetes in Children) and LFAC (Life for a Child) programs was sent to the BADAS centers in different districts through courier service even during the lockdown. So, there was no patient without access to insulin during pandemic time. Conclusion: Telemedicine service has been found to be a useful medium for the care of children with diabetes in Bangladesh during COVID-19 crisis. In the future, telemedicine service could be a solution for routine care of diabetic children who are unable or unwilling to travel long distances to a clinic.

Homeostatic Insulin Sensitivity Indices Is the Detection of Gestational Diabetes Mellitus

Background: Early identification of GDM is strongly warranted for prevention of both maternal and fetal complications, but well known disadvantages of the present methods based on oral glucose challenge reduces the compliance and applicability of these methods in the screening of the disorder. Aims: The study aimed to assess FBG-based insulin sensitivity indices (ISIs) regarding their suitability as alternatives of 2 hr 75-g OGTT. Methods and Materials: Out of 300 subjects, 112 had GDM. Finally 84 GDM and 82 normal mothers were analyzed. A nested case control study was conducted with group of pregnant mothers, at 24 to 32 weeks of gestation, were recruited from BIRDEM (the tertiary hospital of Diabetic Association of Bangladesh) was screened for GDM by adapting WHO criteria. Serum glucose and insulin was measured by glucose oxidase and chemluminescence based ELISA. (ISIs) as well as glycemic and insulinemic indices were calculated their ability to detect GDM. Homeostatic formulas were used to quantify insulin sensitivity and B-cell function. McNamara test was used to calculate sensitivity, specificity, PPV and NPV of various tests against the gold standard of OGTT. Results: HOMA%B was significantly (p<0.001) lower in GDM (113.3±51.4) than their non-GDM counterparts (207.9±91.3). In Pearson’s correlation, HOMA%B had a significant correlation with age, FBG, 75-g OGTT and fasting insulin level. HOMA%S showed significantly correlation with FBG, 75-g OGTT, fasting insulin, HOMA%B and QUICKI. Logistic regression provided significant association of HOMA%B with GDM (p=0.002) after adjusting the effect of the confounders. The value of different screening markers for predicting GDM was explored. HOMA%S at optimum cut-off value of 50 showed sensitivity of 50% and specificity of 56%, with PPV and NPV 56% and 55% respectively. QUICKI had 28% and 31% respectively at an optimum cut-off value of 0.54. Fasting insulin showed 54% and 49% respectively at cut-off value of 12.9µU/ml with PPV 50% and NPV 50%. At an optimum cut- off value of 5mmol/l, the sensitivity, specificity, PPV and NPV of FBG was 82%, 78%, 79% and 81% respectively The corresponding value for combined fasting glucose and fasting insulin were 84%, 79%, 82% and 82%.Conclusion: The data suggest that (ISIs), such as simple fasting blood glucose with a cut-off value of 5.0mmol/l, for Bangladeshi population, seems to be an acceptable test in the detection of GDM.

Pattern of Practices of General Physicians in Overt Diabetic Nephropathy- A Pilot Study in A Developing Country

Introduction: Diabetes is the most common cause of chronic kidney disease (CKD) and end-stage renal disease (ESRD) in most parts of the world. Around 20 to 30% of type 1 and type 2 diabetic patients have diabetic nephropathy. General physicians can play an important role in the detection of diabetic nephropathy (DN) and its early primary management and thus prevent its long term dreaded complications. This study was designed to assess the levels of physicians practice, working in diabetic care facilities in terms of early detection and management of DN.Method: A cross-sectional study was conducted among Physicians working in various affiliated associations of Diabetic Association of Bangladesh (DAB), using a pre-validated self-administered questionnaire. It was conducted in the month of April 2016. Data were collected based on the printed series of questionaries regarding “the actions when overt proteinuria was first detected in Urine R/M/E or conventional dipstick test”.Results: In total, 51 general physicians were included. The average age was 34.39 ± 8.54 years ranging from 25 to 64 years. Thirty (58.9 %) of them are in younger age group (25-34 age range) others in senior group (35- 64). A male predominance was observed with 1.5 sex ratio. Twenty-two (43.1%) of them had undergone a Certified Course on Diabetes (CCD). Regarding intervention following first ever detection of overt proteinuria only 29.41% wanted to investigate further and 58.8% wants to repeat the test. To see the extent of renal damage 58.8 and 74.5% of the physicians wanted to do 24-hours urinary total protein (24-h UTP) and serum creatinine respectively. Twenty-seven (52.9%) physicians thought it is right to use angiotensin converting enzyme (ACE) inhibitors / angiotensin receptor blockers (ARBs) for proteinuria. Thirty-three (64.7%) of them wanted to refer to a nephrologist for proteinuria. To see the presence of other microvascular complications, 52.9 % of doctors wanted to examine for the presence of neuropathy and 62.7% wanted to exclude retinopathy by examining the fundus or referring the patient to an ophthalmologist.Conclusion: Overall, the collective response of the doctors having done Certificate Course on Diabetes were much better than others. Junior doctors also fare better than seniors.Birdem Med J 2018; 8(1): 63-67

Type 1 diabetes: The Bangladesh perspective.

Diabetes mellitus (DM) is a common endocrine disorder among children and adolescents in Bangladesh. The latest International Diabetes Federation atlas estimated the incidence of type 1 DM (T1DM) in Bangladesh as 4.2 new cases of T1DM/100,000 children (0–14 years)/year, in 2013. Diabetes, being a lifelong disease, places a huge burden on the economy of the most densely populated, and resource-poor country of the world. The Diabetic Association of Bangladesh (BADAS), the largest of its kind in the world, provides comprehensive care to the biggest number of diabetics at any one centre and is engaged in advocacy. Although sounding grandiose, it's aims that ‘no diabetic shall die untreated, unfed or unemployed, even if poor’ is pursued with a passion. Recently BADAS has been supported in its endeavor for children and adolescents by two programmes; viz the Changing Diabetes in Children program (a joint initiative of BADAS, the World Diabetes Foundation and Novo Nordisk), and the Life for a Child Programme (LFAC) supported by the IDF. Numerous studies from the prosperous countries have demonstrated the incidence of T1DM is increasing. Data from the CDiC clinic at BIRDEM shows a rising trend in patients presenting with classical T1DM. In addition, the pattern of DM is changing.

Non-adherence to life-style modification and its factors among type 2 diabetic patients

Non-adherence to preventive and therapeutic life-style recommendations among patients with diabetes is special challenge in the management of these patients. This study aimed to measure the proportion of non-adherence to life-style modification and factors associated with these among a group of Bangladeshi type 2 diabetic patients. Under an analytical cross-sectional design 374 type 2 diabetic patients (age >20 years), diagnosed for at least 1 year, were selected from different health care centers operated by the Diabetic Association of Bangladesh. Non-adherence rate were assessed for: Diet (88%), exercise (25%), routine blood glucose testing (32%), foot care (70%), smoking (6%) and betel quid chewing habit (25%). Binary logistic regression suggests that higher education group (P = 0.013), rural area (P = 0.013) and attendance to diabetes education classes (P = 0.043) showed good adherence to diet and non-attendance to diabetes education class (P = 0.014), older age (P = 0.037) are associated to non-adherence to exercise. Unemployed patients showed more non-adherence to blood glucose testing (P = 0.045) than others. Non-attendance to diabetes education class (P = 0.037) and business occupation group (P = 0.039) showed significant association to smoking and betel quid intake habit respectively.

Social and economic consequences of diabetes in women from low-income countries: A case study from Bangladesh

Diabetes poses a serious threat to low-income countries such as Bangladesh. It is one of the leading causes of premature morbidity and mortality, and requires life-long healthcare services. Women with diabetes are affected in all stages of their lives. Uniquely, diabetes affects the health of mothers and their unborn children. Poverty, ignorance, and gender discrimination adversely affect women with diabetes. However, the Diabetic Association of Bangladesh has played an increasingly effective role in providing comprehensive socio-medicare and life-long follow-up of diabetic women, free of charge. This is reflected by the increasing attendance of women with diabetes, especially from rural areas.