A review of prevalence, complications, risk factors, knowledge assessment, selfmanagement, consciousness and treatment of diabetes mellitus in Bangladesh

Abstract

Diabetes is a non-communicable disease which is considered as a universal major health concern which is related with enhanced rate of mortality and morbidity as well as its care and treatment impose economic burden on the populations. Therefore, assessing and analyzing the extent of diabetes related knowledge among the populations, the extent to which they are being treated as well as controlling their disease condition may reveal new dimensions to decrease the mortality and morbidity rate associated with diabetes, decline diabetes related complications and household economic burden. The aim of the review article is to accumulate the existing information and evidences regarding the prevalence, risk factors, knowledge assessment, awareness, treatment and self-management scenario of diabetes mellitus in Bangladesh as well as analyze these conditions in order to guide prevention strategies in the future. Methodology of this review article was research articles and literature review from various authentic sources of journals. International Diabetes Federation specifies that the number of diabetic patients in Bangladesh is 7.1 million which is second largest in South Asian region. A rapid increasing rate of diabetic patients has been observed in Bangladesh for the previous 2 decades where the presence of non-insulin dependent diabetes mellitus patients in 1995, 2000 and 2010 were 3.8%, 5.3% and 9.0% respectively. The occurrence of diabetes among the ethnic people is higher in contrast to the non-ethnic people living in Bangladesh. In general, 16% of the diabetic patients has good knowledge, sixty six percent has average knowledge and 18% of the patients has poor basic knowledge regarding diabetes mellitus in Bangladesh. The KAP (knowledge, attitude and practice) score of diabetes were superior amongst the participants who have diabetes in comparison to the nondiabetic participants. The awareness among patients, treatment receivers and those who controlled their condition were 41.2%, 36.7% and 14.2% respectively. Furthermore, people with lack of education, poverty-stricken persons and individuals from impecunious localities were observed to have lack of diagnosis, knowledge, self-management and treatment of diabetes in contrast to the educated, high socio-economic status persons. Contradictorily, number of diabetes sufferer were higher in the urban areas than the rural areas. Several risk factors of diabetes mellitus includes smoking-59.9%, 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 veggie (8.6%) remain significantly low among the people of Bangladesh. Earlier age onset of diabetes have been observed among the participants in 2005 compared to participants of 1995 along with notable increase in body mass index indicating that people are getting affected by diabetes mellitus at an early age due to obesity which is a strong influential factor for the onset of diabetes mellitus. There was decreased occurrence in the development of diabetes among patients with IGT (impaired glucose tolerance) who controlled their diet and took regular physical exercise compared to the ones who didn’t bring any type of lifestyle modifications. Several blood glucose lowering agents used as remedy for diabetic sufferers in Bangladesh include metformin-46.9%, insulin-40.8%, sulfonylurea-38.7% and anti-hypertensive drugs-38.7% etc. Several anti-diabetic medicinal plants for example Coccinia indica, Mamordica Charantia, Trigonella foenum graceum, Azaradica indica, Ficus racemose and Terminalia chebula etc. are also used for the treatment of diabetes. Use of information technology by the government of Bangladesh by sending awareness messages related to diabetes through the cellphones also resulted in positive influence in the treatment of hyperglycemia. Moreover, launching of new oral hypoglycemic drugs Dapazin (Dipagliflozin) and launching of new generation insulin ‘Tresiba’ in Bangladesh has opened new dimensions as these medicines can play significant role to control and cure diabetes. The review article also picturized a comparative context of prevalence, knowledge assessment, treatment, self-management and control of diabetes mellitus among Bangladesh and other South Asian or South-East Asian countries. Although is now regarded as a major worrying matter for the wellbeing of individuals the treatment as well as control of diabetes mellitus remain significantly low in Bangladesh. More researches should be conducted by focusing at the root causes, environmental risk factors (arsenic contaminated water, air pollution) etc. on the occurrence of diabetes mellitus, pharmacovigilance data and survey of anti-diabetic drugs as well as the prognosis of diabetes.