Problems with Diabetes and Awareness to Its Control: Experience from Diabetes Patients of Rajshahi City Corporation in Bangladesh

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1 ISPUB.COM The Internet Journal of Health Volume 8 Number 1 Problems with Diabetes and Awareness to Its Control: Experience from Diabetes Patients of Rajshahi City M Rahman, J Islam Citation M Rahman, J Islam. Problems with Diabetes and Awareness to Its Control: Experience from Diabetes Patients of Rajshahi City. The Internet Journal of Health Volume 8 Number 1. Abstract This study is meant to contribute to understanding problems with diabetes and patients awareness to control it of Bangladesh by examining the situation prevailing in one particular area Rajshahi. The data were collected three diabetic centers of Rajshahi City Corporation from 300 diabetic patients by interview methods. Findings reveal that largest percentages of patients are within the age range 35 to 55. About 22.7 percents patients are sufferings from type I diabetes or insulin-dependent diabetes and 77.3 percents are suffering from type II diabetes or non insulin-dependent diabetes also it was found that majority of the respondents are overweighed within the BMI index. The findings reveal that patients aged 55 and over are suffering less from type-ii diabetes than who is young and middle aged. Male respondents are suffering more from type-i diabetics on the other hand female respondents are more from type-ii. Patients reported to have family history of diabetic are sufferings more from type I diabetes. With regard to BMI index it is observed that respondents who are within the normal range are suffering more form type-ii diabetics and respondents who are within the overweigh range are suffering more form type-i diabetics. It was also observe from that patients who suffering from type-ii diabetic reported more about kidney diseases and hypertension that they currently suffer. The path analysis indicates that family history of patients and suffering from what kind of problem of a diabetic's patient faced have significant direct negative influence on type of diabetics. INTRODUCTION Diabetes mellitus, with its two main types, Type 1 diabetes (T1D) and Type 2 diabetes (T2D) represents a global health problem due to increasing prevalence and associated risk of devastating complications such as gangrene, blindness, kidney failure as well as premature morbidity and mortality due to heart and vascular diseases1. Diabetes is still a serious disease even in countries where treatment is available. Furthermore, lifestyle-induced health problems combined with ageing of populations in the developed world and improved general living standards and survival in the developing world are producing more, not less people with diabetes2 The prevalence of diabetics is increasing rapidly in the developing countries including Bangladesh3. It is a chronic disease which is never cured, but a diabetic's patient can lead a normal life by controlling the disease through balanced diet, taking appropriate drug, and exercising regularly4. In 2007, the International Diabetes Federation (IDF) estimates that 3.8 million or 4.8% of people living in Bangladesh will have diabetes. By 2025, that number is expected to grow to 7.4 million or 6.1% of the population. This explosion in diabetes prevalence will place Bangladesh among the top ten countries in terms of the number of people living with diabetes in At that date, 80% of all diabetes cases will be in low-and-middle income countries5. The increase in diabetes in Bangladesh is expected to follow global gender patterns, whereby more women than men will live with diabetes. IDF and WHO predict that the number of women in the world with diabetes will double in less than 20 years. In Bangladesh the number of women with diabetes will grow from the current 2 million to 4 million by During the same period, men with diabetes will rise from 1.8 million to 3.4 million. This paper makes an attempt to describe differences in prevalence of type 1 and type 2 diabetes mellitus with its associated risk factors. METHODS The data were collected from three diabetic centers of Rajshahi City Corporation. Information was collected from 1 of 6

2 300 diabetic patients by interview methods who were admitted in these three diabetic centers of Bangladesh Diabetic Association. Data analytic methods envisaged in this paper are percentage distribution and path model analysis. RESULTS PROFILE OF THE PATIENTS It is observed from table 1 that largest percentages of patients are within the age range 35 to 55 (56 percent) and only (7.3 percent ) are below age under 35 and 66 percent out of the total patients are male and 34 percent are female. It is also found that majority of them have weight 55kg to 75kg and only a few portion of the total patients have weight under 35kg. Education and knowledge of diabetics is closely related. Since diabetics are a life long disease so the patient's education is essential about it6. He must have programmatic knowledge about the disease table 1 elucidates that about 19 percent of the patients have no education and about 58 percents completed secondary education and higher education. Figure 1 Table 1: Profile of the diabetic patients those with a family history of the disease have a higher risk of developing diabetes than those without such a background. The table 1 shows that 60.7 percent of the patients reported to have family history of diabetic and 22.7 percents patients are sufferings from type I diabetes, formerly called juvenile diabetes or insulin-dependent diabetes and 77.3 percents are suffering from type II diabetes, formerly called adult-onset diabetes or non insulindependent diabetes, is the most common form of diabetes. Having diabetes increases the risk of developing high blood pressure and other cardiovascular problems, because diabetes adversely affects the arteries, predisposing them to atherosclerosis (hardening of the arteries). Atherosclerosis can cause high blood pressure, which if not treated, can lead to blood vessel damage, stroke, heart failure, heart attack, or kidney failure. It is observed that although majority of patients blood pressure within the normal range (less than 120 mm Hg) a large portion of them sufferings from high blood pressure. Table 1 also shows that majority of the respondents are overweighed with in the BMI index. DIFFERENTIALS OF DIABETIC'S PATIENTS ACCORDING TO SOME SELECTED CHARACTERISTICS The table 2 shows that patients aged 55 and over are suffering less from type-ii diabetes than who is young and middle aged. Male respondents are suffering more from type-i diabetics on the other hand female respondents are more from type-ii. Patients reported to have family history of diabetic are sufferings more from type I diabetes. The table also elucidate that patients who reported that they are suffering from diabetics less than 5 years are more suffering form type-ii diabetics on the other hand patients who reported that they are suffering from diabetics less than 10 years and above are more suffering form type-i diabetics with regard to BMI index it is observed that respondents who are within the normal range are suffering more form type-ii diabetics and respondents who are within the overweigh range are suffering more form type-i diabetics. In our present study, a great portion of patients are nonmanual workers (e.g., serviceman, business man etc.,), besides other patients are engaged with different types of works e.g., day labor, rickshaw-pollar, etc. Heredity is a major factor that causes diabetics7, diabetes can be inherited has been known for centuries. However, the pattern of inheritance is not fully understood. Statistic indicates that 2 of 6

3 Figure 2 Table 2: Percentage distribution of patients according to some selected characteristic the selected set of variables into three groups that are given below: Figure 4 This model is a recursive path model in which each variable is assumed to be dependent upon all prior causal variables. The system of equation for the method can be written as Figure 5 It was also observe from that patients who suffering from type-ii diabetic reported more about kidney diseases and hypertension that they currently suffer Direct and Indirect Effects of Socio-Demographic, Personal Habit and Genetic Variables on Diabetic's Patients: a Path Model Analysis From the path analysis we are able to find out the direct and indirect effect of the exogenous and endogenous variables over dependent variable. Also the path analysis is used for the strong interrelationship among the independent variables. Table 3 shows the variables used for path analysis. Figure 3 Table 3: Variables Used in the Path Analysis Where P n 's are path co-efficient from X 1 to X 10 and R u, R v, R w and R x are random disturbance terms. All the random disturbance terms are mutually independent and are independent of their corresponding explanatory variables. Then multiple regression method is applied for each causal relationship. The different types of effects are presented in table 3 and zero order correlation coefficient between types of diabetics and all explanatory variables should be the same as the total effect of that explanatory variable on types of diabetics. Table 4 indicates that, with few expectations of the zero order correlation coefficients between types of diabetics and each of the selected exogenous variables generally do not differ much from their corresponding total effects. We observe that there are 5 paths out of 40 hypothesized paths are found to be statistically significant. In our study we have to mention about the significant path coefficients only. In our model out of 10 variables, 4 are found to have significant direct effect on the index of diabetics. Among them family history of patients(x 6 ) and suffering from(x 9 ) have direct significant negative effect while age of respondents(x 7 ) and weight of respondents(x 8 ) have direct significant positive effect on the index of types of diabetics (X 10 ). The total effect of respondent's occupation (X 1 ), exercise(x 2 ) and check up time(x 4 ) is negative while work before diabetics(x 3 ) and what type of methods(x 5 ) are positive. According to the causal ordering of variables, we may divide 3 of 6

4 Figure 6 Table 4: Zero order Correlation Coefficient among diabetics related variables Figure 7 Figure 1: Path diagram of Diabetics related variables The total effect of exercise X 2 on types of diabetics(x 10 ) is.30 of which about 53% and 49% are transmitted through the family history of patients (X 6 ) and suffering from (X 9 ) and about 25% is transmitted through its implied effect in the same direction. These show that exercise (X 2 ) is strongly related to types of diabetics. It appears that diabetic goes down when exercise takes place. The total effect of age of respondents (X 7 ) on types of diabetics(x 10 ) is.043 of which about 25% and 35% are transmitted through the weight of respondents (X 8 ) and suffering from(x 9 ) in the same direction.this also shows that weight of respondents are strongly related to types of diabetics. Most of the people of Bangladesh are ignorance about diabetics. It is depicted that suffering from(x 9 ) is negatively related to types of diabetics(x 10 ). Suffering from(x 9 ) has total negative effect on types of diabetics is This also shows that suffering from diabetics is strongly related to types of diabetics. DISCUSSIONS Figure 8 Table 5: Direct and Indirect Effect of some selected variables on diabetic's patients. Non-causal Effect = total effect-total association It is observed that largest percentages of patients are within the age range 35 to 55. It is also found that majority of them have weight 55kg to 75kg and only a few portion of the total patients have weight under 35kg. About 60.7 percent of the patients reported to have family history of diabetic and 22.7 percents patients are sufferings from type I diabetes, formerly called juvenile diabetes or insulin-dependent diabetes and 77.3 percents are suffering from type II diabetes, formerly called adult-onset diabetes or non insulindependent diabetes, is the most common form of diabetes, also it was found that majority of the respondents are overweighed with in the BMI index. The findings reveal that patients aged 55 and over are suffering less from type-ii diabetes than who is young and middle aged. Male respondents are suffering more from type-i diabetics on the other hand female respondents are more from type-ii. Patients reported to have family history of diabetic are sufferings more from type I diabetes. With regard to BMI index it is observed that respondents who are within the normal range are suffering more form type-ii diabetics and respondents who are within the overweigh range are suffering more form type-i diabetics. It was also observe from that patients who suffering from type-ii diabetic reported more about kidney diseases and hypertension that they currently suffer. The path analysis indicates that family history of patients and suffering from what kind of problem of a diabetic's patient faced have significant direct negative influence on type of diabetics. 4 of 6

5 From the above findings the following recommendations should be made As diabetic affect more female persons than the male ones, the female persons should be much more conscious of the disease. From the study we also find that maximum of these patients have the weight of 55kg to 75kg. They would have to reduce the exercise, doing manual labor. The diabetic patients should have a test of blood and urine regularly. If the amount of glucose increases in a large scale, the patient should meet the doctor for further treatment. From the result of the research, it has been found that the patients who don't need to depend on insulin are high in number. The treatments of the insulin dependent patients are of two types. One is for the people of much weight; the other is for those having less weight. People having much weight should lose their excessive weight by taking physical exercise. If diabetic does not remain under control even by this, then they can take tablets as a treatment method. If the tablet fails to work in this regard, then giving insulin should treat them. Again people who have less weight should take more amount of food. As diabetic is a lifelong disease, sufficient knowledge about the disease can play a vital role to control it. The patient must possess clear conception about the disease. He must know what to do in which situations. If there's any problem he finds, he must meet the doctor without any delay. Besides, the diabetic patient should go under a regular test of the cardiac specialist and medicine specialist. He can have a test of his eyes and kidneys by them. He must seek for the consultancy with the doctor in case of any problem. CORRESPONDENCE TO Mosiur Rahman MD Lecturer, Department of Population Science and Human Resource Development University of Rajshahi, Rajshahi-6205, Bangladesh. swaponru_2000@yahoo.com References 1. International Diabetes Federation. Diabetes Atlas (second edition). Brussels: The International Diabetes Federation, Kristensen JK. Identification of the Type 2 diabetes population in a Danish county and evaluation of the performed care in a five-year period. Ph.D. Thesis, University of Aarhus, Ali M. Socio-economic condition of diabetic's patients and complexity of diabetics. M.Sc Report, Statistics Department, Jahanginagar University, Syad MA, Hussain A and Khana A. Characteristics of the diabetic subject. BIRDEM diabetic registry, Knowler W, Barrett-Connor E, Fowler S, Hamman R, Lachin J, Walker E, Nathan D. Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. N Engl J Med 346 (6): , Sarnblad, C.M. Ingberg, J. Aman and E. Schvarcz. Body composition in young female adults with Type 1 diabetes mellitus. A prospective case-control study. Diabetic Medicine 24:7, , Walley AJ, Blakemore AI, Froguel P. Genetics of obesity and the prediction of risk for health". Hum. Mol. Genet. 15 Spec No 2: R of 6

6 Author Information Mohammed Mosiur Rahman, MD Lecturer, Department of Population Science and Human Resource Development, University of Rajshahi Jahirul Islam, MD Student of Master of Science, Department of Population Science and Human Resource Development, University of Rajshahi 6 of 6