TITLE:
A Study of Evaluation for the Management of Diabetes in Bangladesh
AUTHORS:
Zakia Sultana, Md. Ershad Ali, Most. Afia Akhtar, Md. Sala Uddin, Md. Mominul Haque
KEYWORDS:
Diabetes; Management; Blood Glucose; Clinical Targets; Metabolic Control
JOURNAL NAME:
Pharmacology & Pharmacy,
Vol.4 No.3,
June
20,
2013
ABSTRACT: Diabetes Mellitus is a leading cause of death in
present world. This study was carried out to evaluate the management, control,
complication profile and treatment strategies in patients with diabetes and to
determine what extent management of
diabetes in a tertiary-care diabetic hospital in Bangladesh adhered to current
guidelines. Total 140 diabetic pa- tients (type-1 = 3, type-2 = 137) were
randomly selected from outpatient department of a tertiary care diabetic hospital
in the Rajshahi city, Bangladesh, during the month of August to September. A
standard questionnaire was constructed in local language and interview was
administrated. The result was expressed as mean ± SD and the age was 53.2 ± 10.5 yr,
duration of diabetes was 6.3 ± 5.6 yr and age at the onset of diabetes was 46.9 ± 9.9 yr. The
study group comprised of about 43% male and 57% female with varying risk
factors including family history (49%), smoking (11%) and both smoking and
family history (4%). Results showed deteriorating glycemic control with mean FBG (fasting blood glucose) and
PPG (postprandial blood glucose) level was 8.9 ± 3.6 mmol/L and 11.2 ± 4.7 mmol/L respectively. About 25% patients had FBG level 7.8 mmol/L.
Of the 51% patients with hypertension, 94% were taking anti-hypertensive
medicine and 21% patients with dyslipidemia, 59% were treated with lipid
lowering agents. Micro-vascular and Macro-vascular complications were reported
in 49% and 11% patients respectively. The rates of diabetic complications were
cataract 19%, diabetic retinopathy 14%, neuropathy symptoms 35%, nephropathy
6%, MI 6%, cerebral stroke 4% and history of angina pectoris was 7%. Proportion
of patients on diet control alone, oral hypoglycemic
agent (OHA), insulin and combination of insulin & OHA was 10, 44, 25 and 21
percent respectively. Quality of life evaluation showed that about half of
patients have poor quality of life as well as poor adherence to diet, exercise
and self testing of blood glucose. In conclusion, majority of the patients were
still not satisfactorily controlled. There is an urgent need for effective
remedial measures to increase adherence to practice
guidelines and to educate both patients and healthcare personnel on importance
of achieving clinical targets for metabolic control.