title: Overweight and abdominal obesity as determinants of undiagnosed diabetes and pre-diabetes in Bangladesh.
abstract: BACKGROUND
  Type 2 diabetes and pre-diabetes are an increasing pandemic globally and often remain undiagnosed long after onset in low-income settings. The objective of this study is to assess the determinants and prevalence of undiagnosed diabetes and pre-diabetes among adults in Bangladesh.
  
  
  METHODS
  In an exploratory study, we performed oral glucose tolerance test on 1243 adults ≥20 years of age from urban Mirpur, Dhaka (n = 518) and rural Matlab, Chandpur (n = 725) who had never been diagnosed with diabetes or pre-diabetes. We collected data on socioeconomic, demographic, past medical history, physical activity, and measured weight, height, waist and hip circumferences, and blood pressure. Risk factors associated with undiagnosed diabetes and pre-diabetes were examined using a multiple logistic regression model.
  
  
  RESULTS
  Overall prevalence of diabetes and pre-diabetes was 6.6 % (95 % CI 5.3, 8.1) and 16.6 % (14.5, 18.7) respectively, with both being significantly higher in urban than rural populations (diabetes 12.2 % vs 2.6 % respectively, p < 0.000; pre-diabetes 21.2 % vs 13.2 %, p < 0.001). After adjustment the variables, urban residence (OR 2.5 [95 % CI 1.02, 5.9]), age group 40-59 y (2.9 [1.7-5.2]), ≥60 y (8.1 [2.8-23.8]), overweight (2.2 [1.3-3.9]), abdominal obesity (3.3 [1.8-6.0]) and high WHR 5.6 (2.7-11.9) were all significant predictors of diabetes. Significant predictors of pre-diabetes included age group 40-59 (1.6 [1.1-2.2]), female sex (1.5 [1.0-2.2]), abdominal obesity (1.7 [1.2-2.4]) and high WHR (1.6 [1.2-2.3]).
  
  
  CONCLUSIONS
  Both overweight and abdominal obesity contribute to the hidden public health threat of undiagnosed diabetes and pre-diabetes. Awareness raising and screening of high risk groups combined with a tailored approach are essential for halting the epidemic of diabetes and pre-diabetes in Bangladesh.
authors.affiliation: School of Kinesiology and Health Science, Faculty of Health York University, Room 362, Stong College, 4700 Keele St, Toronto, ON M3J 1P3 Canada.
authors.forename: Dewan S
authors.initials: DS
authors.lastname: Alam
authors.affiliation: Eminence, Hena Nibash, 3/6, Asad Avenue, Mohammadpur, Dhaka 1207 Bangladesh.
authors.forename: Shamim H
authors.initials: SH
authors.lastname: Talukder
authors.affiliation: Centre for Control of Chronic Diseases, icddr,b, Mohakhali, Dhaka, Bangladesh.
authors.forename: Muhammad Ashique Haider
authors.initials: MA
authors.lastname: Chowdhury
authors.affiliation: Centre for Control of Chronic Diseases, icddr,b, Mohakhali, Dhaka, Bangladesh.
authors.forename: Ali Tanweer
authors.initials: AT
authors.lastname: Siddiquee
authors.affiliation: Centre for Control of Chronic Diseases, icddr,b, Mohakhali, Dhaka, Bangladesh.
authors.forename: Shyfuddin
authors.initials: S
authors.lastname: Ahmed
authors.affiliation: Centre for Control of Chronic Diseases, icddr,b, Mohakhali, Dhaka, Bangladesh.
authors.forename: Sonia
authors.initials: S
authors.lastname: Pervin
authors.affiliation: Eminence, Hena Nibash, 3/6, Asad Avenue, Mohammadpur, Dhaka 1207 Bangladesh.
authors.forename: Sushmita
authors.initials: S
authors.lastname: Khan
authors.affiliation: Centre for Control of Chronic Diseases, icddr,b, Mohakhali, Dhaka, Bangladesh.
authors.forename: Khaled
authors.initials: K
authors.lastname: Hasan
authors.affiliation: Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, Maryland, 20814-4799 USA.
authors.forename: Tracey L P
authors.initials: TL
authors.lastname: Koehlmoos
authors.affiliation: Centre for Apllied Health Research and Delivery, Liverpool School of Tropical Medicine, Pembroke Place, L3 6PQ Liverpool, UK.
authors.forename: Louis W
authors.initials: LW
authors.lastname: Niessen
keywords: Bangladesh; Determinants; Diabetes; Pre-diabetes; Prevalance; Rural; Screening; Urban