title: High prevalence of type 2 diabetes among the urban middle class in Bangladesh.
abstract: BACKGROUND
  The prevalence of type-2 diabetes and metabolic syndrome are increasing in the developing world; we assessed their prevalence among the urban middle class in Bangladesh.
  
  
  METHODS
  In this cross-sectional survey (n = 402), we randomly selected consenting adults (≥ 30 years) from a middle-income neighborhood in Dhaka. We assessed demography, lifestyle, and health status, measured physical indices and blood pressure and obtained blood samples. We evaluated two primary outcomes: (1) type-2 diabetes (fasting blood glucose ≥ 7.0 mmol/L or hemoglobin A1C ≥ 6.5% (48 mmol/mol) or diabetes medication use) and (2) insulin resistance (type-2 diabetes or metabolic syndrome using International Diabetes Federation criteria).
  
  
  RESULTS
  Mean age and Quételet's (body mass) index were 49.4 ± 12.6 years and 27.0 ± 5.1 kg/m²; 83% were married, 41% had ≥12 years of education, 47% were employed, 47% had a family history of diabetes. Thirty-five percent had type-2 diabetes and 45% had metabolic syndrome. In multivariate models older age and family history of diabetes were significantly associated with type-2 diabetes. Older age, female sex, overweight or obese, high wealth index and positive family history of diabetes were significantly associated with insulin resistance. Participants with type-2 diabetes or insulin resistance had significantly poorer physical health only if they had associated cardiovascular disease.
  
  
  CONCLUSIONS
  The prevalence of type-2 diabetes and metabolic syndrome among the middle class in Dhaka is alarmingly high. Screening services should be implemented while researchers focus on strategies to lessen the incidence and morbidity associated with these conditions.
authors.forename: Nazmus
authors.initials: N
authors.lastname: Saquib
authors.forename: Masuma Akter
authors.initials: MA
authors.lastname: Khanam
authors.forename: Juliann
authors.initials: J
authors.lastname: Saquib
authors.forename: Shuchi
authors.initials: S
authors.lastname: Anand
authors.forename: Glenn M
authors.initials: GM
authors.lastname: Chertow
authors.forename: Michele
authors.initials: M
authors.lastname: Barry
authors.forename: Tahmeed
authors.initials: T
authors.lastname: Ahmed
authors.affiliation: Stanford University School of Medicine, General Medical Disciplines, Stanford University, Stanford, CA, USA. mrcullen@stanford.edu.
authors.forename: Mark R
authors.initials: MR
authors.lastname: Cullen
mesh_terms: D000328:Adult; D000367:Age Factors; D001459:Bangladesh / Q000453:epidemiology; D001786:Blood Glucose / Q000032:analysis; D003430:Cross-Sectional Studies; D003924:Diabetes Mellitus, Type 2 / Q000453:epidemiology*; D005260:Female; D006442:Glycated Hemoglobin / Q000032:analysis; D006801:Humans; D007333:Insulin Resistance; D008297:Male; D024821:Metabolic Syndrome / Q000453:epidemiology; D008875:Middle Aged; D015995:Prevalence; D012307:Risk Factors; D012737:Sex Factors; D012923:Social Class; D014505:Urban Population
chemical_list: D001786:Blood Glucose; D006442:Glycated Hemoglobin; C517652:hemoglobin A1c protein, human