6 The Open Diabetes Journal, 2011, 4, 6-13 1876-5246/11 2011 Bentham Open Open Access Prevalence of Diabetes Mellitus and its Associated Risk Indicators in a Rural Bangladeshi Population Afroza Akhter 1 , Kaniz Fatema 1 , Afsana Afroz 1 , Bishwajit Bhowmik 2 , Liaquat Ali 3 and Akhtar Hussain *,2 1 Department of Epidemiology & Biostatistics, Bangladesh Institute of Health Sciences (BIHS), 125/1 Darus Salam, Mirpur, Dhaka-1216, Bangladesh 2 Department of International Health, University of Oslo, PO Box - 1130, Blindern, 0318 Oslo, Norway 3 Deptartmen of Biochemistry & Cell Biology, BIHS, 125/1 Darus Salam, Mirpur, Dhaka-1216, Bangladesh Abstract: Background: Substantial racial heterogeneity in diabetes leads to the necessity of conducting epidemiological studies in different communities. Such studies are still inadequate in Bangladeshi population, particularly in truly respective rural areas. The objectives of the study were to estimate the prevalence of diabetes and to identify its associated risk indicators in a rural population of Bangladesh. Methods: This population based cross-sectional study was conducted in remote rural areas of Northern Bangladesh, which included a total of 836 participants aged at or above 25 years through screening in camp settings. Diabetes was diagnosed by WHO criteria after a 2-sample OGTT. BMI, waist-hip ratio, blood pressure, lipid profile and serum creatinine were also estimated. Results: The prevalence of diabetes was found to be 7.2% (95% CI 5.4-9.0) and that of impaired glucose regulation [including both impaired glucose tolerance (IGT) and/or impaired fasting glucose (IFG)] was 6.5% (95% CI 4.8-8.2). The prevalence of diabetes and impaired glucose regulation differed between males and females, but, both increased with age in males as well as females. A good correlation was observed between fasting blood glucose and 2hr after glucose (Kappa value 0.86) among the study participants. After adjusting for potential confounders BMI and WHR were found as significant independent risk indicators for the occurrence of diabetes in this population. Conclusion: A relatively high prevalence of diabetes was observed in this rural Bangladeshi population. Preventive programs, particularly targeted to body weight management through lifestyle modification should be strengthened even in rural areas. Keywords: Bangladesh, diabetes, epidemiology, prevalence. INTRODUCTION Diabetes mellitus (DM) is becoming a pandemic worldwide. The highest percentages of increases in disease prevalence are likely to be in developing nations, with major increases in the Middle-East, Sub-Saharan Africa, South Asia, and Latin America [1]. WHO listed 10 countries to have the highest numbers of people with diabetes in 2000 and 2030. According to this report, Bangladesh has 3.2 million of diabetic subjects in 2000 and the number is expected to increase to a staggering 11.1 million by 2030 placing her among the top 10 countries with diabetes [1]. Several small-scale population based studies conducted in Bangladesh at different time points have revealed an increasing trend of diabetes prevalence in rural and urban communities [2-9]. A recent population based study [3] showed a significant increase in the prevalence of DM in *Address correspondence to this author at the Department of International Health, Faculty of Medicine, University of Oslo, Fredrik Holsts House, Ullevål Terrace, PO Box - 1130, Blindern, 0318 Oslo, Norway; Tel: 00 47 22850641/43; Fax: 00 47 22850672; E-mail: akhtar.hussain@medisin.uio.no rural Bangladesh from 2.3% to 6.8% over 5 years. This prevalence was higher than found in the previous rural based studies on the same population [5, 7]. Most of these studies have been conducted near the capital city, Dhaka and the people of these areas are very much used to modern lifestyle and hence these studies might not reflect the real picture of rural Bangladesh where more than 75% people are living. No population based study on the burden of diabetes has so far been conducted in the rural areas of northern Bangladesh. The pattern of diabetes in Bangladeshi population differs from that in Europeans and Americans in several aspects: the onset is at a younger age and a large number of the diabetic people are non-obese. However, the association of obesity and diabetes in this population is not strong. Some studies showed that BMI and WHR were important predictors of diabetes in rural Bangladeshi population, although the population was considered as lean [3, 5], while the others did not [2, 4]. These clinical differences and the rising prevalence of diabetes in Bangladesh warrant well-conducted epidemiologic studies on diabetes in this population. The present study was conducted to observe the prevalence of