Original Article Macro- and micro-vascular complications and their determinants among people with type 2 diabetes in Bangladesh Afsana Afroz a , Wen Zhang b , Andre Jin Wei Loh b , Darryl Xing Jie Lee b , Baki Billah a, * a Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia b Monash University, Melbourne, Australia article info Article history: Received 1 July 2019 Accepted 29 July 2019 Keywords: Bangladesh Complications Type 2 diabetes Risk factors abstract Objectives: To identify the prevalence of micro- and macro-vascular complications and their associated factors for type 2 diabetes mellitus in Bangladesh. Methods: This retrospective and cross-sectional study was conducted in six diabetes hospitals, covered urban and rural population. From April to September in 2017, a total of 1253 type 2 diabetes patients aged 18 years were recruited. Participants answered a pre-tested electronic questionnaire, and their medical records were reviewed for documented diabetes complications. Results: Mean age was 55.1 (±12.6) years. Among macrovascular complications, the prevalence of cor- onary artery disease was found to be 30.5%, 10.1% for stroke and 12.0% for diabetic foot. Among micro- vascular complications, nephropathy was prevalent among 34.2%, retinopathy among 25.1% and neuropathy among 5.8% of patients. Risk factors found to be associated with one or more of the com- plications were female gender, higher age, lower education level, an urban area of residence, higher household income, smoking, physical inactivity, hypertension, poor glycaemic control, poor adherence to treatment, longer duration of diabetes, and insulin use. Conclusion: Diabetes complications are highly prevalent among type 2 diabetes population in Bangladesh. Prevention strategies should focus on increasing physical activity, weight loss, smoking cessation, and more strict control of hypertension and glycaemic level. © 2019 Diabetes India. Published by Elsevier Ltd. All rights reserved. 1. Introduction Diabetes mellitus is a growing problem worldwide, affecting 425 million or 8.8% of adults in 2017. The International Diabetes Federation (IDF) reports that a staggering 79% of adults with dia- betes live in low- and middle-income countries [1]. By far the most prevalent type of diabetes, Type 2 Diabetes Mellitus (T2DM) constituted around 90% of all diabetic cases [2]. In Bangladesh, the prevalence of diabetes in adults aged 20e79 years was reported at 6.9%, affecting just below 7 million adults of the population and it is anticipated to increase to 13.7 million by 2045 [1]. The projected increase in prevalence is in line with the epidemiologic transition which Bangladesh is undergoing, whereby its burden of disease shifts from acute infectious and deficiency diseases to non- communicable chronic diseases, such as diabetes [3]. This trend is also seen in the wider context of South Asia, where rapid urbani- sation has led to an increasingly sedentary lifestyle, increased intake of dietary fats and more stressful lifestyles. Biological factors have also been found to predispose South Asians to diabetes, and both lifestyle and biological factors are responsible such that South Asians have a 3-fold higher prevalence of diabetes compared to Europeans [4,5]. (see Table 1) Diabetes mellitus is a disease characterised by either the lack of insulin (Type 1 Diabetes), or loss of insulin sensitivity (T2DM). This results in a chronic hyperglycaemic state, causing an increase in products of glycosylation. These molecules induce inflammation and injury to arterial walls, causing changes in vascular tissue, and promoting atherosclerosis. The resultant narrowing of arteries in turn increases the risk of coronary artery diseases, stroke and pe- ripheral vascular disease, which are termed the macrovascular complications such as coronary artery disease (CAD), stroke and diabetic foot related to T2DM. Smaller blood vessels are also affected by atherosclerotic damage, leading to microvascular complications such as diabetic peripheral neuropathy, retinopathy * Corresponding author. Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, 553 St. Kilda Rd., Level 4, Melbourne, VIC, 3004, Australia. E-mail address: baki.billah@monash.edu (B. Billah). Contents lists available at ScienceDirect Diabetes & Metabolic Syndrome: Clinical Research & Reviews journal homepage: www.elsevier.com/locate/dsx https://doi.org/10.1016/j.dsx.2019.07.046 1871-4021/© 2019 Diabetes India. Published by Elsevier Ltd. All rights reserved. Diabetes & Metabolic Syndrome: Clinical Research & Reviews 13 (2019) 2939e2946