Risk factors of Diabetes

There are two type of risk factors 1. Risk factors we can control 2. Risk factors we cant control

Risk factors we can control.

Food habit: Consuming foods high in glucose (carbohydrate) or fat than required can lead to high level of blood glucose. That is the available glucose is higher than the actual requirements, so insulin secretion is increased more than normal to normalize blood glucose-level. In due course pancreas is not able to secrete this increasing requirements leads to diabetes. Eating right for diabetes comes down to three things:

What we eat: Our diet makes a huge difference!! You should eat mostly plant foods, cut back on refined curbs and sugary drinks, and choose healthy fats over unhealthy fats. When we eat: Diet is part of it, but keeping regular meal and snack times also affects your blood sugar levels and will help to keep them more constant. How much we eat: Portion sizes matter. Even if you eat very healthy meals, if you eat too much you will gain weight, which is a factor in diabetes.

Smoking: We're all familiar (I hope!) with the problems that cigarette smoking can cause for people with diabetes (PWD). Among others that have been described:

* People with diabetes are three times as likely to die of cardiovascular diseases. Smoking and diabetes together make you 11 times more likely to die of a heart attack or stroke. * Smoking raises your blood sugar levels AND cuts your body's ability to use insulin, making it hard to control your diabetes. Smoking ONE cigarette reduces the body's ability to use insulin by 15%. * Smoking increases your cholesterol levels and the levels of other fats in your blood. This increases your risk of having a heart attack. * Smoking cuts the amount of oxygen reaching tissues. This can lead to a heart attack or stroke. Pregnant women who smoke are more likely to have a miscarriage or stillbirth. * People with diabetes who smoke are twice as likely to have circulation and wound healing problems. These can lead to leg and foot infections, sometimes requiring amputation. * Smokers with diabetes are more likely to develop nerve damage (neuropathy) and kidney disease (nephropathy). Lack of physical activity: In research community over the years -- that there is this interaction between fitness and the ability of insulin to do its job. We talk about 'insulin action.' So if it doesn't work right, and you've probably read about this word, it's 'insulin resistance,' it's in all the newspapers, it says the insulin isn't working right. So when the muscles are fit and strong, you don't need as much insulin. In fact, a person who may be lean and close to their ideal body weight may need an average only 40 to 45 units a day. If you're overweight, you may require 80, 100, even 200 units of insulin a day. But really, walking 20, 30 minutes a day, you know, instead of taking the bus, park your car, walk a little distance, do whatever you can do -- do something. That actually dramatically decrease your body's need for insulin, because the muscle does better the more fit it is, the stronger it is, the less insulin it needs. High blood pressure/high cholesterol: Most people know about the connection between high cholesterol and diabetes. But now scientists are finding evidence that diabetes itself wreaks havoc with cholesterol, significantly increasing the likelihood of a heart attack or stroke even higher. The close ties between these two risk factors means that if you are diabetic, you have to be extremely vigilant about controlling your cholesterol.

Link between Insulin and Cholesterol Researchers are still figuring out exactly how diabetes changes cholesterol levels at the microscopic cellular level. They do know that high levels of insulin in the blood tend to adversely affect the number of cholesterol particles in the blood. High insulin levels act to raise the amount of LDL cholesterol (the "bad cholesterol") that tends to form plaques in arteries, and lower the number of HDL cholesterol particles ("good cholesterol") that help to clear out dangerous plaques before they break off to cause a heart attack or stroke. Diabetes also tends to cause higher levels of triglycerides, another type of fat circulating in the blood. Similarly, high cholesterol can also be a predictor of diabetes; elevated cholesterol levels are often seen in people with insulin resistance, even before they have developed full-blown diabetes. When LDL levels start to climb, experts recommend paying close attention to blood sugar control and starting a diet and exercise regimen to help stave off diabetes and cardiovascular disease. This is especially important if you have a family history of heart disease. For people with Type 1 diabetes, controlling blood sugar can make a big difference. Good blood sugar control is related to near-normal cholesterol levels, similar to those seen in people without diabetes. But people with poorly controlled Type 1 diabetes have increased triglyceride levels and lower HDL levels, which contribute to the development of clogged arteries. People with Type 2 diabetes, regardless of blood sugar control, tend to have increased triglycerides, decreased HDL, and sometimes increased LDL. This cholesterol profile tends to persist even if blood sugar levels are under control--pointing to an even higher likelihood of developing plaques. In fact, plaques formed in the arteries of people with Type 2 diabetes tend to be fattier and less fibrous than in people with Type 1 diabetes, leading to an even higher risk of a plaque dislodging to cause a heart attack or stroke.

Risk factors we cant control

Family history: Family history can help predict risk factors for type 1 diabetes. A person with a parent, brother, or sister with type 1 diabetes could develop the condition. Certain genes have also been linked with type 1 diabetes. Certain viruses such as the mumps have been known to trigger type 1 diabetes. Even though type 1 diabetes is difficult to predict, it is believed that genetics are the biggest indicators. Age:Each and every organ start losing it ability after 40 to 45 years, it also includes pancreas. So insulin secretion cannot be maintained as per requirement after 45 years just due to aging risk factor.

The risk of type 2 diabetes increases as you get older, especially after age 45. That's probably because people tend to exercise less, lose muscle mass and gain weight as they age diabetes is also increasing dramatically among children, adolescents and younger adults. It's a sad but true fact. The older we get, the greater our risk of type 2 diabetes. Even if an elderly person is thin, they still may be predisposed to getting diabetes. Scientists theorize that the pancreas ages right along with us, and doesn't pump insulin as efficiently as it did when we were younger. Also, as our cells age, they become more resistant to insulin as well. Ethnic Group: Certain country, region, community, hereditary, food habits, climate and lifestyle have some increased risk factor towards diabetes

RISK FACTORS OF DIABETES

Symptoms of Diabetes.
Type 2 diabetes symptoms may develop very slowly. In fact, you can have type 2 diabetes for years and not even know it. Look for: Increased thirst and frequent urination. As excess sugar builds up in your bloodstream, fluid is pulled from the tissues. This may leave you thirsty. As a result, you may drink and urinate more than usual. Frequent urination, also known as urinary frequency, is a condition in which you feel the need to pass urine more often than usual. Frequent urination may occur due to a variety of reasons, some of which are not serious or harmful. For example, frequent urination may occur after drinking a lot of fluids, especially fluids that contain caffeine or alcohol. Pregnancy can cause frequent urination due to pressure put on the bladder by an enlarging uterus. Increased hunger. Without enough insulin to move sugar into our cells, your muscles and organs become depleted of energy. This triggers intense hunger. Excessive hunger is characterized by the need for increased food intake above your usual caloric needs. It may be caused by disorders in the systems that regulate appetite and blood sugar or by circumstances such as pregnancy. Excessive hunger can also be attributed to endocrine conditions, such as Graves disease and hyperthyroidism, in which the body produces excess amounts of thyroid hormone, resulting in weight loss, hyperactivity, insomnia, or constant hunger that is unsatisfied by eating. Weight loss. Despite eating more than usual to relieve hunger, our may lose weight. Without the ability to metabolize glucose, the body uses alternative fuels stored in muscle and fat. Calories are lost as excess glucose is released in the urine. Weight fluctuations also fall under the umbrella of possible diabetes signs and symptoms. When you lose sugar through frequent urination, you also lose calories. At the same time, diabetes may keep the sugar from your food from reaching your cells leading to constant hunger. The combined effect is potentially rapid weight loss, especially if you have type 1 diabetes.

Fatigue. If your cells are deprived of sugar, our may become tired and irritable. we may feel fatigued. Many factors can contribute to this. They include dehydration from increased urination and your body's inability to function properly, since it's less able to use sugar for energy needs. Blurred vision. If our blood sugar is too high, fluid may be pulled from the lenses of our eyes. This may affect our ability to focus clearly. Diabetes symptoms sometimes involve your vision. High levels of blood sugar pull fluid from your tissues, including the lenses of your eyes. This affects your ability to focus. Slow-healing sores or frequent infections. Type 2 diabetes affects our ability to heal and resist infections. Areas of darkened skin. Some people with type 2 diabetes have patches of dark, velvety skin in the folds and creases of their bodies usually in the armpits. This condition, called acanthuses Nigerians, may be a sign of insulin resistance.

Effects of Diabetes.
It is essential that diabetics are aware of the complications that can occur as a result of being diabetic; to ensure that the first symptoms of any possible illness are spotted before they develop. Diabetes complications involve the disruption of a variety of bodily systems. Diabetes complications may occur over many different timescales, from the date of diagnosis, or many years after diabetes has developed. Heart disease and stroke: Heart attacks and strokes are the number one causes of death in people with diabetes. To help prevent heart attack and stroke, you'll need to keep a sharp eye on your cholesterol and blood pressure, in addition to watching your blood glucose levels.

Blood pressure is a biggieit's also a major factor in the risk of kidney and eye problems. "Blood pressure control is extremely important, because high blood pressure can lead to the same kinds of complications as high blood sugar," says William Bornstein, MD, an endocrinologist at the Emory Clinic in Atlanta. "And so in people with diabetes it's that much more important to control the blood pressure.Same with high cholesterol." In a landmark study of more than 5,000 patients with type 2 diabetes, researchers in the United Kingdom found that lowering hemoglobin A1C levels (by controlling blood sugar) to a median of 7% reduced the "micro vascular" (small blood vessel) complications that threaten the eyes, kidneys, and nerves. But it was blood pressure control that reduced heart problems (a "macro vascular," or large blood-vessel complication) in addition to micro vascular problems. High blood pressure: High blood pressure, or hypertension, is a major factor in the development of kidney problems in people with diabetes. Both a family history of hypertension and the presence of hypertension appear to increase chances of developing kidney disease. Hypertension also accelerates the progress of kidney disease when it already exists. Blood pressure is recorded using two numbers. The first number is called the systolic pressure, and it represents the pressure in the arteries as the heart beats. The second number is called the diastolic pressure, and it represents the pressure between heartbeats. In the past, hypertension was defined as blood pressure higher than 140/90, said as "140 over 90." Eye problem: When we look at something, light passes through the front of the eye, and is focused by the lens onto the retina. The retina is a delicate tissue that is sensitive to light. It converts the light into electrical signals that travel along the optic nerve to the brain. The brain interprets these signals to "see" the world around us. The retina is supplied with blood by a delicate network of blood vessels. These blood vessels can be damaged by diabetes. Light is focused onto an area of the retina called the macula, which is about the size of a pinhead. This highly specialized part of the retina is vital, because it allows you to see fine detail for activities such as reading and writing, and to recognize colors. The rest of the retina gives you side vision (peripheral vision). The eye is filled with a clear jelly-like substance called the vitreous gel. Light passes through the gel to focus on the macula.

The most serious complication of diabetes for the eye is the development of diabetic retinopathy. Diabetes affects the tiny blood vessels of the eye and if they become blocked or leak then the retina and possibly your vision will be affected. The extent of these changes determines what type of diabetic retinopathy you have. Forty per cent of people with type 1 diabetes and twenty per cent with type 2 diabetes will develop some sort of diabetic retinopathy. Kidney damage: Diabetic kidney disease takes many years to develop. In some people, the filtering function of the kidneys is actually higher than normal in the first few years of their diabetes. Over several years, people who are developing kidney disease will have small amounts of the blood protein albumin begin to leak into their urine. This first stage of CKD is called microalbuminuria. The kidney's filtration function usually remains normal during this period. As the disease progresses, more albumin leaks into the urine. This stage may be called microalbuminuria or proteinuria. As the amount of albumin in the urine increases, the kidneys' filtering function usually begins to drop. The body retains various wastes as filtration falls. As kidney damage develops, blood pressure often rises as well. Gum disease: um diseases are often more frequent and more severe in people with diabetes, especially if they smoke. Diabetics with poor blood sugar control are more likely to lose teeth than diabetics who have good control. There are also data suggesting that treating gum disease might help improve blood sugar control. Thats why it is important to have healthy blood sugar levels, have a wellbalanced diet, practice good oral care at home and see your dentist regularly for checkups.

Problems in pregnancy: Before pregnancy its important for people living with diabetes to manage glucose (sugar) in their blood. This is especially true for women who want to get pregnant.

During the first 8 weeks of pregnancy, a babys brain, heart, kidneys and lungs begin to form. High blood sugar levels are especially harmful to unborn babies during this early part of pregnancy. Too much glucose in the blood can cause birth defects. Unfortunately, most women dont realize theyre pregnant until about 5 or 6 weeks after conception.

If youre planning to get pregnant, use this checklist to help you get ready for pregnancy:

Get your diabetes under control 3 to 6 months before trying to get pregnant. Take a multivitamin with 400 micrograms of folic acid every day. Your health provider may increase your daily dose of folic acid to help reduce the risk of birth defects. If youre already pregnant, see your health provider right away to get prenatal care. This will help you have the healthiest outcome. Talk to your health provider about any medications youre currently taking and if theyre safe during pregnancy. Your provider may adjust some medications to help you have a healthy pregnancy. With your health providers OK, add regular physical activity to your daily routine. Talk to a dietitian or diabetes educator to help you create a healthy meal plan. Meet with any specialists that your health provider recommends. These experts can help you better manage your diabetes and any other complications that may arise during pregnancy. Some examples include: perinatologist (focuses on high-risk pregnancies) and endocrinologist (concentrates on problems of the endocrine system including diabetes). The endocrine system includes the glands that make hormones.

During pregnancy Women who have diabetes are almost as likely as women without the disease to have a healthy baby. But they must control their blood sugar levels before and throughout pregnancy. If diabetes is not well controlled, a mom and baby could face serious health complications:

The woman is more likely to have a miscarriage and stillbirth. The baby is 2 to 4 times more likely to have a serious birth defect than other babies. Heart defects and neural tube defects are more common among babies born with diabetes.

Medical Treatment of Diabetes

healthy diet and regular exercise are crucial to any diabetes treatment plan. But sometimes diet and exercise aren't enough. You need the help of medication. For people with type 1 diabetes, daily administration of the hormone insulin is essential. To live, you must supply your body with insulin medication to replace the insulin your pancreas is no longer able to produce. If you have type 2 diabetes and don't benefit from other medications, you also may need to take insulin. Use of insulin to treat diabetes, called insulin therapy, has two main goals: To maintain blood sugar (glucose) at near-normal levels To prevent long-term complications of diabetes

The long-term goals of treatment are to:

Prolong life Reduce symptoms Prevent diabetes-related complications such as blindness, heart disease, kidney failure, and amputation of limbs

These goals are accomplished through:

Blood pressure and cholesterol control Careful self testing of blood glucose levels Education Exercise

Foot care Meal planning and weight control Medication or insulin use

There is no cure for diabetes. Treatment involves medicines, diet, and exercise to control blood sugar and prevent symptoms. A successful treatment plan takes into consideration what you eat and how much you exercise in determining the amount of insulin you need each day.

LEARN THESE SKILLS

Basic diabetes management skills will help prevent the need for emergency care. These skills include:

How to recognize and treat low blood sugar (hypoglycemia) and high blood sugar (hyperglycemia) What to eat and when How to take insulin or oral medication How to test and record blood glucose How to test urine for ketones (type 1 diabetes only) How to adjust insulin or food intake when changing exercise and eating habits How to handle sick days Where to buy diabetes supplies and how to store them

After you learn the basics of diabetes care, learn how the disease can cause long-term health problems and the best ways to prevent these problems. Review and update your knowledge, because new research and improved ways to treat diabetes are constantly being developed.

SELF-TESTING
If you have diabetes, your doctor may tell you to regularly check your blood sugar levels at home. There are a number of devices available, and they use only a drop of blood. Selfmonitoring tells you how well diet, medication, and exercise are working together to control your diabetes. It can help your doctor prevent complications. The American Diabetes Association recommends keeping blood sugar levels in the range of:

80 - 120 mg/dL before meals 100 - 140 mg/dL at bedtime

Your doctor may adjust this depending on your circumstances.

WHAT TO EAT
You should work closely with your health care provider to learn how much fat, protein, and carbohydrates you need in your diet. A registered dietician can help you plan your dietary needs. People with type 1 diabetes should eat at about the same times each day and try to be consistent with the types of food they choose. This helps to prevent blood sugar from becoming extremely high or low. People with type 2 diabetes should follow a well-balanced and low-fat diet.

HOW TO TAKE MEDICATION

Medications to treat diabetes include insulin and glucose-lowering pills called oral hypoglycemic drugs. People with type 1 diabetes cannot make their own insulin. They need daily insulin injections. Insulin does not come in pill form. Injections are generally needed one to four times per day. Some people use an insulin pump. It is worn at all times and delivers a steady flow of insulin throughout the day. Other people may use inhaled insulin. See also: Type 1 diabetes Unlike type 1 diabetes, type 2 diabetes may respond to treatment with exercise, diet, and medicines taken by mouth. There are several types of medicines used to lower blood glucose in type 2 diabetes. See also: Type 2 diabetes Medications may be switched to insulin during pregnancy and while breastfeeding. Gestational diabetes may be treated with exercise and changes in diet.

EXERCISE
Regular exercise is especially important for people with diabetes. It helps with blood sugar control, weight loss, and high blood pressure. People with diabetes who exercise are less likely to experience a heart attack or stroke than those who do not exercise regularly.

Here are some exercise considerations:

Always check with your doctor before starting a new exercise program. Ask your doctor or nurse if you have the right footwear. Choose an enjoyable physical activity that is appropriate for your current fitness level. Exercise every day, and at the same time of day, if possible.

Monitor blood glucose levels before and after exercise. Carry food that contains a fast-acting carbohydrate in case you become hypoglycemic during or after exercise. Carry a diabetes identification card and a cell phone in case of emergency. Drink extra fluids that do not contain sugar before, during, and after exercise.

You may need to change your diet or medication dose if you change your exercise intensity or duration to keep blood sugar levels from going too high or low.

FOOT CARE
People with diabetes are more likely to have foot problems. Diabetes can damage blood vessels and nerves and decrease the body's ability to fight infection. You may not notice a foot injury until an infection develops. Death of skin and other tissue can occur. To prevent injury to the feet, check and care for your feet every day.

Steps of treatment for diabetes

Prevention of Diabetes
Maintaining an ideal body weight and an active lifestyle may prevent type 2 diabetes.

Currently there is no way to prevent type 1 diabetes. There is no effective screening test for type 1 diabetes in people who don't have symptoms. Screening for type 2 diabetes and people with no symptoms is recommended for:

Overweight children who have other risk factors for diabetes starting at age 10 and repeating every 2 years Overweight adults (BMI greater than 25) who have other risk factors Adults over 45, repeated every 3 years

To prevent complications of diabetes, visit your health care provider or diabetes educator at least four times a year. Talk about any problems you are having. Regularly have the following tests:

Have your blood pressure checked every year (blood pressure goals should be 130/80 mm/Hg or lower). Have your glycosylated hemoglobin (HbA1c) checked every 6 months if your diabetes is well controlled, otherwise every 3 months. Have your cholesterol and triglyceride levels checked yearly (aim for LDL levels below 100 mg/dL). Get yearly tests to make sure your kidneys are working well (microalbuminuria) and (serum creatinine). Visit your ophthalmologist (preferably one who specializes in diabetic retinopathy) at least once a year, or more often if you have signs of diabetic retinopathy. See the dentist every 6 months for a thorough dental cleaning and exam. Make sure your dentist and hygienist know that you have diabetes. Make sure your health care provider inspects your feet at each visit.

Stay up-to-date with all of your vaccinations and get a flu shot every year in the fall.

CURRENT CONDITATION OF WORLD

The Future Burden of Diabetes

iabetes is an increasing threat to the worlds health service. Formerly described as a disease of affluence, it has now become evident that, owing to demographic changes, cultural transition and population ageing, diabetes is now also a

developing countries problem (1). The prevalence of diabetes in adults globally was estimated to be 4.0% in 1995 and is projected to rise to 5.4% by the year 2025. The prevalence of diabetes is higher in developed countries 6% in 1995, 6.2% in 2000 and will 7.6% in 2025. The developing world has a lower estimated prevalence; 3.3% in 1995, 3.5% in 2000, and 4.9% in 2025. It is projected that there will be a 42% increase in the number of individuals with diabetes, from 51 to 72 million in the developed countries and 170% increase, from 84 to 228 million, in the developing countries. The majority of the people with diabetes in developing countries are projected to be younger, aged 45 to 64 years, while those in developed countries will be aged 65 years. Diabetes will be increasing concentrated in urban areas, with the greater burden among women (2). Since 1988, WHO has been collecting standardized information on the prevalence of diabetes and impaired glucose tolerance (IGT) in adult communities worldwide within the age range 30-64 years, diabetes and IGT were found to be absent or rare in a small number in Melanesia, East Africa and South America. In populations of European origin, the prevalence of diabetes and IGT lay in the range 3-10% and 3-15% respectively; but migrant Indian, Chinese and Hispanic American groups were at higher risk of DM (15- 20%). The highest prevalence was found in the Pima Indians and Arizona and in the urbanized Micronesians of Nauru, in whom approximately one half of the population in the range 30-64 years had diabetes (3). The prevalence of total glucose intolerance (diabetes and IGT combined) was greater than 10% in almost all populations, and was within the range of 11-20% for Europe and United prevalence states among white population. However, the of total glucose intolerance reached almost 30% in Arab Omanis and United

States blacks and affected one-third of all adult Chinese Mauritius, migrant Indians, urban Micronesians and lower income urban Hispanic in United States. In Naururans and Pima Indians, approximately two-thirds of all adults in the age 30-64 years range were affected (4) Thus the

highest prevalence of diabetes is now to be found in the developing countries, and in the ethnic minorities and disadvantaged populations of the industrialized countries.

Global Estimates of Diabetes

Diabetes mellitus, particularly type 2 diabetes is now recognized as a major chronic public health problem throughout the world. It affects large number of people of wide range of ethnic and economic levels in both developed and developing countries. Globally, 135 million adults with diabetes were estimated in 1995. By the year 2025, the figure is projected to rise to 300 million, an increase of approximately 120%.Whereas the rise will be of the order of 40% in the developed and 170% in the developing countries. As a result, more than 80% of persons will be diabetic in the developing countries by the year 2025 (11). For both in 1995 and 2025, the countries with the highest prevalence of diabetes are in India, China and United States of America (5) The prevalence of type 2

Whereas the rise will be all non-industrialized of the order 40% in the developed and 170% in three- quarters of the with diabetes will be in non the developed counties
almost a third in India and

diabetes is rising rapidly in populations. By 2025, worlds 300 million adults industrialized countries and China alone. This epidemic

has been triggered by social and economic development and urbanization, which is linked with general improvements in nutrition and longevity, but also with obesity, reduced physical exercise and other diabetogenic factors (5) The evidence is that high rates of disease in urban centers have arisen within a single generation. The largest increase are described in population which have under gone the most rapid and extreme change, such as Ethiopian Jews who migrated to Israel, moving from severe

Picture 1: Estimation of prevalence of diabetes (7)

Situation of type 2 diabetes in Bangladesh

angladesh is a densely populated country having approximately 130 million people in an area of 144000 sq km. Despite of having a well-structured health care delivery system, people are increasingly suffering from a variety of chronic health problems. Diabetes mellitus particularly type 2 diabetes is now recognized as a major chronic public health problem in Bangladesh. The

magnitude of diabetes remains unknown due to lack of countrywide survey. More than 80% of
country population lives in rural areas but some studies showed that the prevalence is higher in urban areas. Diabetes is becoming a serious health concern in Bangladesh. Between 2000 and 2008, the proportion of people suffering from diabetes increased from 4% to 7%. Considering the countrys average population growth of around 1.6%, the increase is even more marked in absolute terms: from 5.3 to 10.2 million people. As said earlier, there is no population-based data on cardiovascular disease, diabetes and metabolic disorders in Bangladesh. There are survey instruments which assess symptoms of

chronic heart disease, or make predictions based on risk factors. Diagnostic services are also not widely available or accessible, flagging an important health systems issue for Bangladesh. Chronic disease such as diabetes is usually diagnosed only at an advanced stage. ICDDR,B which is a renowned scientific research center assessed younger adults, aged 2750 years, in their rural field site in Matlab,chandpur for selected health outcomes, including glucose abnormality, high blood pressure and lipid abnormalities. Significantly, they found that although about 5% of the population was affected by diabetes, less than2% of the people were aware of it. This implies that two-thirds of diabetic people in the community are unaware of their condition, and this lack of awareness can often lead to complications and end organ damage such as kidney failure and blindness and also may precipitate cardiovascular disease.(8)

Recently, another study in 2005 among the rural, urban and sub urban population of Bangladesh showed that the combine prevalence among the rural and urban population was 5.2% of which rural prevalence was 3.8% and urban prevalence was 7.8%. Age adjusted (30-64 years) prevalence urban 8.0% and rural 3.8%( 9). An increasing trend of diabetes registration in all the referral centers in Bangladesh has been noticed in recent years. From Diabetes registry in Bangladesh Institute of Research and Rehabilitation in Diabetes, Endocrine and Metabolic Disorders (BIRDEM), it was found that the number of registered diabetes in the year 1956 was 39, which has been increased to 15,296 in 1998.Among the registered diabetic patients, on average 60 percent are male and 62 percent from urban, 32 percent from rural and 6 percent from semi-urban.

REFERENCE: 1. King H, Rewers M. Diabetes in adults is now a third world problem, Bulletin of
the World Health Organization, 1991, 69(6): 643-648. 2. King H, Aubert RE, Herman WH. Global burden of diabetes 1995- 2025.Prevalence numerical estimation and projection, Diabetes care 1998; 21: 1414-1431. 3. King H, Rewers M, Global estimates of prevalence of diabetes mellitus and impaired glucose tolerance in adults. Diabetes Care, 1993, 16: 157-177 4. Zimmet P, Tailor R, P Ram, H King et,al Prevalence of Diabetes and Impaired Glucose Intolerance In the Biracial ( Melanesian and Indian) Population of Fiji: American Journal Of Epidemiology, Vol 118, N0. 5 5. King H, Aubert RE, Herman WH. Global burden of diabetes 1995- 2025.Prevalence numerical estimation and projection. Diabetes care 1998; 21: 1414-1431 6. Cohen MP, Stern E,Rusecki Y, Zeidler A. High prevalence of diabetes in young adult Ethiopian immigrants to Israel. Diabetes 1988:37: 824-8[Abstract] 7. http://www.who.int/diabetes/actionnow/en/mapdiabprev.pdf
8. http://centre.icddrb.org/pub/publication.jsp?classificationID=46&pubID=10327 9. UNFPA.Gloval Report. New York: UNFPA, 1996