Bangladesh is among the top 10 countries with the highest rates of projected age-standardized mortality among selected Low-Income and Middle-Income Countries (LMICs) due to chronic diseases, particularly for Cardiovascular Diseases (CVDs) and diabetes . The age adjusted death rate 40 per 100,000 of population ranks Bangladesh 57 in the world, says World Health Organization (WHO) . Diabetes is one of the four major types of non-communicable diseases that make the largest contribution to morbidity and mortality worldwide. The International Diabetes Federation (IDF) estimated that, worldwide, approximately 425 million people had diabetes in 2017, projected to be 629 million by 2045.
Again, worldwide $727 billion was spent in 2017 for treating and preventing diabetes, projected to be US$776 billion by 2045 . InBangladesh, specifically, the IDF projects the prevalence of diabetes will increase to more than 50% in the next 15 years . About 129,000 deaths were attributed to diabetes in Bangladesh in 2015, as reported by leading research organization ICDDR, B . According to the WHO-Diabetes country profile of Bangladesh in 2016, the physical inactivity was prevailing among 25.1% of population . Around 85% population of age group 25-65 never checks for diabetes . A recent study by British Medical Journal says 1 in 10 Bangladeshi adults aged ≥ 18 years have hyperglycemia (among urban residents) .
Even in rural Bangladeshi community, undiagnosed diabetes was high, 7.2% found in a 2016  and 10% in 2019. Roughly 20%-30% of adults in rural areas of Bangladesh have abnormal fasting glucose or impaired glucose tolerance, with the prevalence of diabetes (mostly type 2 diabetes) expected to reach 24%-34% by 2030 . And IDF says, there are 7.1 million people with undetected diabetes in Bangladesh and this number will be double by 2025 .
Das, et al., 2019 reported prevalence of dyslipidemia was over 70% to both male and female subjects, which indicates the urgency of lifestyle intervention strategies to prevent and manage this important health problem and risk factor . Among 8400 stroke patients from different hospitals in Bangladesh over a period of sixteen years, diabetic patients were nearly 25% . Prevention strategies should focus on increasing physical activity, weight loss, smoking cessation, and stricter control of hypertension and glycemic level .
Material and Methods
A. The TRACK Concept
National Eye Health Education Program (NEHEP) developed a tool using the word TRACK to help you remember how to stay on track with diabetes. To keep blood sugar level on target and avoid problems with eyes, kidneys, heart and feet, patients should eat right and be active, and may need to take medication. This helps them make choices in eating and being active so body can perform at its best. By regularly monitoring, patients get it on track and prevent long-term health problems [14,15]. TRACK was developed for diabetic retinopathy prevention but in real life it prevents all other diabetic complication by disease progression. The criteria, in short are regular health checkup and compliance of treatment guidelines along with some lifestyle modifications.
Research conducted a year-round comprehensive literature search, which included technical newsletters, newspapers journals, and many other sources. The present study was started at the beginning of 2019. PubMed, ALTAVISTA, Embase, Scopus, Web of Science, and the Cochrane Central Register were thoroughly searched. The keywords were used to search for different publisher’s journals such as Elsevier, Springer, Willey Online Library, and Wolters Kluwer which were extensively followed. Medicine and technical experts, pharmaceutical company representatives, hospital nurses, and journalists were given their valuable suggestions. Projections were based on TRACK criteria of regular health checkup by diabetic and non-diabetic Bangladeshi population. There are many studies regarding diabetes in Bangladeshi population. This is the first study so far, where TRACK criteria (suggested by NEHEP of National Institute of Health, England) fulfillment is studied in Bangladesh.
Results and Discussion
TRACK Vs. Bangladesh: Perplexity of the Present Situation
A. Compliance Issue: Poor adherence is a well-documented obstacle in therapeutic control of diabetes. For an effective control and prevention of diabetes, 87% of Bangladeshis were noncompliant, compared to 71% of Indians and 52% Europeans . Out-of-pocket expenditure, emotional status, frequency of counseling, patients family priorities, availability of medication (mainly insulin) are the factors greatly influence patient compliance to treatment guidelines. In 2016, the median monthly cost of diabetes maintenance was close to $10, approximately 10% of the median monthly income . According to a 2018 BBC record, insulin availability found supplies were low in six countries- Bangladesh, Brazil, Malawi, Nepal, Pakistan and Sri Lanka .
Also, huge gap between the number of diabetic patients and doctors are well-known. The Diabetic Association of Bangladesh (DAB) record shows, except Dhaka and Chittagong, there are no tertiary facilities in Bangladesh to preventing blindness due to diabetic retinopathy . Children with diabetes are still managed by adult physicians or occasionally by adult diabetologists, except in institutions like BIRDEM, and Dhaka Shishu Hospital. Children and adolescents have special needs at different stages e.g., nutrition, schooling, growth, puberty etc. Improving detection, awareness, and treatment strategies is urgently needed to prevent the growing burden associated with diabetes .
B. Overweight Issue: Overweight or obese children have a higher risk of becoming obese in adulthood and are at higher risk of associated chronic diseases . Al Muktadir et.al, 2019 revealed that around 22% to 27% Bangladeshi youth were recorded as obese with different stages of obesity . Another study says nearly 40% Bangladeshi youth, taking fast foods were recognized as overweight where 32% were noted as obese with different phases of obesity and overall prevalence of fast food consumption was about 53.8% . In a newspaper interview, Professor AK Azad Khan, President, Diabetic Association of Bangladesh said 40% school going children of Dhaka city were either obese or overweight . Children with type 2 diabetes are rising alarmingly in Bangladesh. A 300% raise in the last five years, according to the Changing Diabetes in Children Program of the BIRDEM hospital .
A community level study shows 35% of mothers perceived that childhood overweight/obesity could be a health problem and nearly 70% were not aware of any health consequences of childhood obesity . Another study shows 97.4% students consume fast food contain Monosodium Glutamate which causes obesity and other body discomforts . In a similar study among students of 4 private universities of Dhaka, 98% of the students were well informed about the negative effects associated with excessive fast food consumption, they were still profoundly addicted to it . Prevalence rates of overweight and obesity are higher in urban peoples compared to rural peoples living in Bangladesh. Hoque et.al, 2015 reported higher average annual rate of reduction of underweight was found among wealthier, highly educated, urban-living women, while a higher average annual rate of increase of overweight was found among poorer, uneducated, rural-living women .
Tanwi, et al., 2019 reported prevalence of overweight and obesity was 34% among urban Bangladeshi women , increased by 17.5% between 1996 and 2011 . Another study reveals that a nearly 30% married women in Bangladesh are overweight . Womens employment status was only associated with overweight or obesity for urban residents. Working urban women had a lower probability of being overweight. Socio-demographic factors including age, education, wealth index, marital status, watching TV and employment status were associated with the increased trend of overweight and obesity . The highest prevalence of overweight and obesity were observed in those women with the highest education level and wealth, larger family size, living in urban areas and not being in paid employment .
C. Lifestyle Issues: According to the WHO-Diabetes country profile of Bangladesh in 2016, the physical inactivity was prevailing more than 25% of population. Bangladeshi women more at health risk than men due to inactivity. Two big reasons to diabetes among Bangladeshi people are carbohydrate-dependent food pattern and sedentary lifestyle [35-37]. While males can go outside, socialize and take part in outdoor activities such as cricket or football or cycling, females are often confined to domestic chores and not allowed to go outside freely. Parents are likely to restrict or discourage their daughters from outdoor activities such as recreational walking or bicycling. Young females are vulnerable to crime while travelling and so are more likely to avoid walking. Uddin, et al., 2019 reported that 80% young adults in Dhaka City, did not meet the WHO recommended level of physical activity (150 minutes of moderate to vigorous-intensity activity per week) for optimal health, with higher rates of insufficient activity among females than males . Unplanned urbanization in the capital is clear, where people have very limited scope for physical activities. Even in the rural areas people now take rickshaw/vans or other rides to go to market places. Evidence shows that prevalence of physical inactivity 35% to 38% in Bangladeshi adults aged 25 years and older . Adults engage in high levels of sedentary behavior during waking hours, said another study . Prevalence of self-reported depression was respectively 47.7% in Bangladesh. Lower frequency of vigorous physical activity was significantly associated with higher rates of depression diagnosed . People with depressive disorders have a 65% greater risk of developing diabetes than the general population, which is a double-trouble according to the WHO .
D. Regular Health Checkup: Despite the high levels of diabetes and intermediate hyperglycemia, awareness and control of the condition is low in rural Bangladesh. In Bangladesh, one in three people over the age of 35 are diabetic or pre-diabetic, only 12% of them have their condition under control . Fottrell, et al., 2019 reported only 25% of diabetics were aware of their status, women with diabetes were 37% less likely than men to know that they were diabetic and, even among known diabetics, 75% had suboptimal control of the condition . It is mentioned earlier that 1 in 10 Bangladeshi urban adult (aged ≥ 18 years) have hyperglycemia, with dyslipidemia prevalent over 70% male and females. Among those aged over 35, the Bangladesh Demographic and Health Survey (BDHS) reported that approximately 25% had abnormal fasting glucose . The glycated hemoglobin (HbA1c) method does not require the candidate to fast for eight hours or take glucose and he or she can have the test done by the HbA1c method any time . However, for individuals diagnosed with diabetes, screening is associated with a reduction in mortality and cardiovascular disease risk .
E. Tobacco Smocking: Tobacco kills more than seven million people a year worldwide and responsible for 1 in 5 deaths in Bangladesh, according to the WHO, kills more than 161,000 people on average every year . A number of experimental and clinical studies suggest that smoking decreases insulin sensitivity, and indirectly role plays in elevated blood sugar and LDL, decreased HDL and postprandial lipid intolerance [49-57]. A 2018 survey by BRAC University shows several risk factors of diabetes includes smoking (almost 60%), abdominal obesity (43.3%), hypertension (14.3%), depression (43%) whereas the incidence of routine bodily exercise (only 1.3%) and the habit of consuming seasonal fruits as well as vegetables (8.6%) remain significantly low among the people of Bangladesh . Bangladesh has been identified as a high-achieving country for several tobacco control measures, including tobacco taxation, health warning labels and anti-tobacco mass-media campaigns.
The high level of achievement for Bangladesh in cigarette taxation is, however, contradicted by an increase in per capita cigarette consumption . Urban male smokers in Bangladesh consume more cigarettes than bidis and smoke more per day than rural smokers. More than half of Bangladeshi men over the age of 25 years smoke cigarettes or bidis, small handmade cigarettes containing about one fourth the amount of tobacco found in cigarettes . Despite the reduction in overall tobacco use, the male smoking prevalence in Bangladesh is still high at 37% . Although, government is taking initiatives from administration, more than one fourth (25.5%) of the police personnel in Bangladesh are currently smokers and this should be intervened .
F. Other Issues
(a) Climate and Environment: Not only food and lifestyle, global warming also plays an important role in diabetes prevalence. A Netherlands based study in CNN Health says, a 1-degree Celsius rise in environmental temperature could account for more than 100,000 new diabetes cases per year in the USA alone . A similar study says Bangladesh will exceed 35-degree Celsius before the end of the century . Consuming arsenic contaminated food grains could be another reason of high diabetes prevalence . In sex-stratified analyses with 641 subjects from rural Bangladesh, Paul, et al., 2019 reported arsenic exposure (50.01-150 μg/L) showed a clearer pattern of dose-dependent risk for hyperglycemia in females than males . Again, 15% of expecting women are diagnosed with gestational diabetes among these 60% contribute to permanent diabetes within 10 years, says Dr Samsad Jahan (professor of Obstetrics and Gynecology, BIRDEM) .
(b) Skipping Meals: Breakfast skipping is highly prevalent among urban adult population with significant association of obesity in Bangladesh [67,68]. Kabir, et al., 2018 reported skipping breakfast by public university students for cost saving  and Bipasha, et al., 2014 reported the same by private university students due to late sleep and rush for classes in the morning . Either way, skipping breakfast hikes both obesity and diabetes risk .
(c) Fatty and Fried Food after Religious Fasting: It is common knowledge that fasting has myriad health benefits. Fasting during Ramadan is significantly associated with decrease in blood lipid profile, blood pressures, glucose, and HbA1c level among diabetic patients [71-77]. The total energy intake decreases during Ramadan, whereas the dietary fat consumption increases because of an augmentation of fatty food that does not occur during other periods . Following Prophetic tradition, it is customary to open the fast with dates, which is unique in its nutrient content (β-D-glucan, a soluble fiber) that gives the stomach a full feeling .
(d) Food Adulteration: ICDDR, B, estimated 150 food items in the country. More than 50% of the food samples they tested were adulterated reported by the Institute of Public Health (IPH). Undoubtedly human health is now under the domination of formalin, in Bangladesh about 400 tons of formalin is being imported which are goes to human stomach, creates deadly mistreats on long term exposure . Several studies highlighted formaldehyde-induced neuro-degeneration, diabetes risk and diabetes-associated cognitive impairments [81-84]. Even more unfortunate is the fact that nefarious practice of food adulteration increases exponentially during the month of Ramadan in Bangladesh, according to a study of European Journal of Sustainable Development Research, 2019 . The number of patients suffering from cancer, diabetes, and kidney diseases is on the rise due to food adulteration [86-89].
(e) Child Marriage: According to United Nations Childrens Emergency Fund (UNICEF), Bangladesh has the fourth highest prevalence rate of child marriage in the world, and the second highest number of absolute child brides-4.5 million. Around 30% of girls in Bangladesh married before the age of 15 and nearly 80% got married before the age of 18 [90-92]. The prevalence of nutritional deficiency was relatively higher among rural, illiterate and early married women and among those with a low standard of living . Child marriage, low-birth-weight, mother nutrition and diabetes closely related to each other [46,93-96].
(f) Low Health Literacy (LHL): In low-income countries such as Bangladesh, the less than optimum use of services could be due to LHL. Emphasis on health literacy has been inadequate. And also, health service delivery is pluralistic with a mix of public, private and informally trained healthcare providers . Despite the high levels of diabetes and intermediate hyperglycemia, awareness and control of the condition is low . In a cross- sectional study in urban population of Bangladesh, more than 60% of the diabetic patients had inadequate functional health literacy of them and nearly 90% had inadequate glycemic control (HbA1c>8%). Therefore, Mehzabin, et al., 2019 concluded that LHL is consistently associated with inadequate glycemic control . LHL also indicates that the health promotion techniques are not used appropriately and it is linked to the declining health status of the people and results in low compliance to disease prevention programs.
Also, Islam, et al., 2018 concluded that diabetes-related health literacy in rural Bangladesh is a major factor associated with Diabetic Retinopathy (DR) screening . Diabetes prevention and control efforts in this population must include large-scale awareness initiatives which focus not only on high-risk individuals but the whole population. Innovations in increasing diabetes knowledge and health behavior change are recommended specially for females, those with lower education and less income .
Table 1: Summary of Diabetic Risk Factors in Bangladesh- To view visit PDF.
(g) Malnutrition & other Social Challenges: Mother Nutrition and diabetes situation is already discussed. Very little is known about the occurrence of Type 1 diabetes mellitus (T1DM) in resource-poor countries and particularly in their rural hinterlands. Bangladesh is among the 20 countries where 80% undernourished children are living.
Underweight (weight-for-age z-score <-2) among children aged less than five years is more than 40% and nearly one-third of women are undernourished with body mass index of <18.5 kg/m2 in Bangladesh . The IDF atlas estimated the incidence of type 1 diabetes in Bangladesh as 4.2 new cases of T1DM/100,000 children (0-14 years)/year, in 2013 . The social challenges faced by T1DM children are numerous.
Many of them are poor, with little access to education. They are often considered a burden on the family, especially girls; they have little prospect of getting married or being employed. This has a direct association of physical inactivity, drinking, smoking, drug/alcohol abuse and depression among youth. Diabetes is likely to be hidden from society, prospective spouse and employer, often with far-reaching consequences. Lack of motivation, inability to manage common complications e.g., hypoglycemia, sick day management, drop out from the clinic (which may be due to lack of motivation or extra cost involved in travel), psychological issues, are other common problems.
(h) Negative Attitude and Unemployment: Negative attitudes toward physical activity were more likely among girls, adolescents who slept ≤ 8 h/night and adolescents, who were overweight or obese, found in a study among eight secondary schools in Dhaka . Earlier stated that, four out of five young adults in Dhaka City did not meet the Physical activity recommendations . In Bangladesh, a nearly 80% unemployed are youth; more than 46% unemployed youths are university graduates . This has a direct association of physical inactivity, drinking, smoking, drug/alcohol abuse and depression among youth.
The prevalence of type 2 diabetes showed an increasing trend in both urban and rural population in Bangladesh. People with no education, lower socio-economic status, and those who lived in disadvantaged regions in terms of education and economic profile are found lacking of diagnosis, treatment, and control of diabetes. Emphasizing medication adherence with multiple comorbid diseases should be strongly considered in future diabetes management programs to improve glycemic control in patients with type 2 diabetes. Recently, Telenor Health and DAB have launched the first- ever diabetes management service, Dia360, to help people with diabetes manage their blood sugar levels and reduce risks of complications. People can enroll in three DAB centers in Dhaka-Bangladesh Institute of health and Sciences, BIRDEM General Hospital, and the National Health Network Hospital. It has more than 400,000 diabetics registered at its tertiary center, BIRDEM in Dhaka. However, the most important thing is patient education, that the modern world is giving the highest priorities. Rich or poor, privileged or unprivileged, all segment of population should be brought under the arena of compliance through patient education, at least by health campaign. Both government, profit taking NGOs and pharmaceutical companies should take initiatives in this regard.
I am thankful to Dr. Afsana Afroz, Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia for her valuable time to audit my paper and for her thoughtful suggestions. Im also grateful to seminar library of Faculty of Pharmacy, University of Dhaka and BANSDOC Library, Bangladesh for providing me books, journal and newsletters.
1. Ali N, Akram R, Sheikh N, Sarker AR and Sultana M. Sex-specific prevalence, inequality and associated predictors of hypertension, diabetes, and comorbidity among Bangladeshi adults: results from a nationwide cross-sectional demographic and health survey (2019) Bio Med J 9: 9 https://doi.org/10.1136/bmjopen-2019-029364
2. Mohiuddin AK. Diabetes Fact: Bangladesh Perspective. Int J of Diabetes Res (2019) 2: 14-20. https://doi.org/10.17554/j.issn.2414-2409.2019.02.12
3. Afsana A, Karim A, Alramadan MJ, Habib SH, Ali L, et al. Type 2 diabetes mellitus in Bangladesh a prevalence based cost-of-illness study (2019). Bio Med Care health serv res 19: 1. http://doi.org/10.1186/s12913-019-4440-3
4. Islam JY, Zaman MM, Bhuiyan MR, Haq SA, Ahmed S, et al. Prevalence and determinants of hyperglycaemia among adults in Bangladesh: results from a population-based national survey (2019) Bio Med J open 9: 7. http://doi.org/10.1136/bmjopen-2019-029674
5. Salahuddin T. The rising threat of NCDs in Bangladesh (2019). The Daily Star, Bangladesh, January 06.
6. Salahuddin T. Obesity is increasing among the younger generation in Bangladesh (2018). The Daily Star, Bangladesh, September 23.
7. Star Online Report. 80 lakh Bangladeshis suffering from diabetes: State minister (2016). The Daily Star, Bangladesh, April 06.
8. Islam FM, Chakrabarti R, Islam MT, Wahab M, Lamoureux E, et al. Prediabetes, diagnosed and undiagnosed diabetes, their risk factors and association with knowledge of diabetes in rural Bangladesh: The Bangladesh Population-based Diabetes and Eye Study (2016) J Diabetes 8: 260-8. http://doi.org/10.1111/1753-0407.12294
9. Fottrell E, Ahmed N, Morrison J, Kuddus A, Shaha SK, et al. Community groups or mobile phone messaging to prevent and control type 2 diabetes and intermediate hyperglycaemia in Bangladesh (DMagic) a cluster-randomised controlled trial (2019) The lancet Diabetes & endocrin 7: 200-212. http://doi.org/10.1016/S2213-8587(19)30001-4
10. Islam SMS, Lechner A, Ferrari U, Laxy M, Seissler J, et al. Healthcare use and expenditure for diabetes in Bangladesh (2017) BMJ global health 2: 1 http://doi.org/10.1136/bmjgh-2016-000033
11. Das H and Banik S. Prevalence of dyslipidemia among the diabetic patients in southern Bangladesh: A cross-sectional study (2019). Diabetes Metab Syndr. 13: 252-257. http://doi.org/10.1016/j.dsx.2018.09.006.
12. Mohammad QD, Habib M, Mondal BA, Chowdhury RN, Hasan MH, et al. Stroke in Bangladeshi patients and risk factor (2014). Mymensingh Med J. 23: 520-9.
13. Afroz A, Zhang W, Wei Loh AJ, Jie Lee DX, and Billah B. Macro- and micro-vascular complications and their determinants among people with type 2 diabetes in Bangladesh (2019) Diabetes Metab Syndr. 13: 2939-2946. http://doi.org/10.1016/j.dsx.2019.07.046.
16. Mohiuddin AK. Domination of Nephrotic Problems among Diabetic Patients of Bangladesh (2018) Archives of Nephro and Urology 1: 009-016. http://doi.org/10.26502/anu.2644-2833002
17. Vanderlee L, Ahmed S, Ferdous F, Farzana FD, Das SK, et al. Self-care practices and barriers to compliance among patients with diabetes in a community in rural Bangladesh 2016) Int J Diabetes Dev Ctries 36: 320. http://doi.org/10.1007/s13410-015-0460-7
18. Azad A. How climate change will affect your health (2018). CNN health, October 12.
20. Azad and Kishwar. Type 1 diabetes: The Bangladesh perspective Indian journal of endocrinology and metabolism (2015) Indian J Endocri and Met 19: 9-11. http://doi.org/10.4103/2230-8210.155344
21. Alam MM, Hawlader MDH, Wahab A, Hossain MD, Nishat SA,et al. Determinants of overweight and obesity among urban school-going children and adolescents: a case-control study in Bangladesh (2019) Int J Adolesc Med Health http://doi.org/10.1515/ijamh-2018-0034
22. Al Muktadir MH, Islam MA, Amin MN, Ghosh S, Siddiqui SA, et al. Nutrition transition - Pattern IV: Leads Bangladeshi youth to the increasing prevalence of overweight and obesity (2019) Diabetes Metab Syndr 13: 1943-1947. http://doi.org/10.1016/j.dsx.2019.04.034
23. Goon S, Bipasha MS and Islam S. Fast food consumption and obesity risk among university students of Bangladesh (2014) Eur J Prev 2: 99. http://doi.org/10.11648/j.ejpm.20140206.14
24. World Diabetes Day. Access to insulin is a human right in conversation with Professor AK Azad Khan, President, Diabetic Association of Bangladesh. The Daily Star, Bangladesh November 14, 2018.
25. Hasib NI. Children getting type 2 diabetes alarmingly in Bangladesh (2016) bdnews 24.com, Bangladesh, 06 April.
26. Hossain MS, Siddiqee MH, Ferdous S, Faruki M, Jahan R, et al. Is Childhood Overweight/Obesity Perceived as a Health Problem by Mothers of Preschool Aged Children in Bangladesh? (2019) A Community Level Cross-Sectional Study Int J Environ Res Public Health. 16: 202. http://doi.org/10.3390/ijerph16020202.
27. Chaity AJ. Obesity blamed for alarming rise in childhood diabetes (2017) Dhaka Tribune, Bangladesh, November 13.
28. Bipasha M and Goon S. Fast food preferences and food habits among students of private universities in Bangladesh (2014) South East Asia J of Pub Health 3: 61-64. http://doi.org/10.3329/seajph.v3i1.17713
29. Hoque ME, Long KZ, Niessen LW and Al Mamun A. Rapid shift toward overweight from double burden of underweight and overweight among Bangladeshi women: a systematic review and pooled analysis (2015) Nutr Rev 73: 438-47. http://doi.org/10.1093/nutrit/nuv003.
30. Sultana TT, Syed H, Chakrabartyal S, Saltmarsh S and Winn S. Socioeconomic correlates of overweight and obesity among ever-married urban women in Bangladesh (2019) BMC pub health 19: 842. http://doi.org/10.1186/s12889-019-7221-3
31. Banik S and Rahman M. Prevalence of Overweight and Obesity in Bangladesh: a Systematic Review of the Literature (2018) Curr Obes Rep 7: 247-253. http://doi.org/10.1007/s13679-018-0323-x
32. Biswas T, Garnett SP, Pervin S and Rawal LB. The prevalence of underweight, overweight and obesity in Bangladeshi adults (2017) Data from a national survey PloS one 12: 5. http://doi.org/10.1371/journal.pone.0177395
33. Chowdhury MAB, Adnan M and Hassan Z. Trends, prevalence and risk factors of overweight and obesity among women of reproductive age in Bangladesh: a pooled analysis of five national cross-sectional surveys (2018) BMJ open 8: 1-12. http://doi.org/10.1136/bmjopen-2017-018468
34. Biswas T, Uddin MJ, Mamun AA, Pervin S and P Garnett S. Increasing prevalence of overweight and obesity in Bangladeshi women of reproductive age (2017) PLoS One 12: 1-12 http://doi.org/10.1371/journal.pone.0181080
35. Guthold R, Stevens GA, Riley LM and Bull FC. A pooled analysis of 358 population-based surveys with 1.9 million participants (2018) Lancet Glob Health 6: 1077-1086. http://doi.org/109X(18)30357-7
37. Tareq S. Obesity is increasing among the younger generation in Bangladesh (2018) The Daily Star, Bangladesh, September 23.
38. Uddin R, Khan A and Burton NW. Prevalence and socio demographic patterns of physical activity among Bangladeshi young adults (2017) J Health Popul Nutr 36: 31. http://doi.org/10.1186/s41043-017-0108-y
39. Moniruzzaman M, Mansur MSA and Zaman MM. Physical activity levels and associated socio-demographic factors in Bangladeshi adults: a cross-sectional study (2017) BMC public health 17: 59. http://doi.org/10.1186/s12889-016-4003-z
40. Vancampfort D, Firth J, Schuch F, Rosenbaum S, De Hert M, et al. Physical activity and sedentary behavior in people with bipolar disorder A systematic review and meta-analysis (2016) J Affect Disord 201: 145-52. http://doi.org/10.1016/j.jad.2016.05.020
41. Bishwajit G, OLeary DP, Ghosh S, Yaya S and Tang Shangfeng. Physical inactivity and self-reported depression among middle- and older-aged population in South Asia World health survey (2017) BMC geriatrics 17: 100. http://doi.org/10.1186/s12877-017-0489-1
43. Aowsaf SMA. Diabetes management service launched in Bangladesh (2018) Dhaka Tribune, Bangladesh, September 25.
44. Fottrell E, Ahmed N, Shaha SK, Jennings H, Kuddus A. Diabetes knowledge and care practices among adults in rural Bangladesh: a cross-sectional survey (2018) BMJ global health 3: 891. http://doi.org/10.1136/bmjgh-2018-000891
45. Fottrell E, Ahmed N, Shaha SK, Jennings H, Kuddus A, et al. Distribution of diabetes, hypertension and non-communicable disease risk factors among adults in rural Bangladesh a cross-sectional survey (2018) BMJ global health 3: 787. http://doi.org/10.1136/bmjgh-2018-000787
46. Palma P. A worrying picture of diabetes in Bangladesh (2018) The Daily Star, Bangladesh, November 14.
47. Health Tips. Screening reduces mortality for detectable type 2 diabetics (2017) The Daily Star, Bangladesh, August 27.
48. Hasan MK. WHO Tobacco responsible for 1 in 5 deaths in Bangladesh (2018) Dhaka Tribune, Bangladesh, June 01.
49. Bergman BC, Perreault L, Hunerdosse D, Kerege A, Playdon M, et al. Novel and reversible mechanisms of smoking-induced insulin resistance in humans (2012) Diabetes 61: 3156-66. http://doi.org/10.2337/db12-0418
50. Kong C, Nimmo L, Elatrozy T, Anyaoku V, Hughes C, et al. Smoking is associated with increased hepatic lipase activity, insulin resistance, dyslipidaemia and early atherosclerosis in Type 2 diabetes (2001) Atherosclerosis 156 :373-8.
51. Schofield JD, Liu Y, Balakrishna PR, Malik RA and Soran H. Diabetes Dyslipidemia. Diabetes therapy: research, treatment and education of diabetes and related disorders (2016) 7: 203-19. http://doi.org/10.1007/s13300-016-0167-x
52. Facchini FS, Hollenbeck CB, Jeppesen J, Chen YD and Reaven GM. Insulin resistance and cigarette smoking. Lancet (1992) May 339: 1128-30. http://doi.org/10.1016/0140-6736(92)90730-q
53. Mandeep B. Nicotine and insulin resistance: when the smoke clears (2012) Diabetes vol. 61: 3078-3080. http://doi.org/10.2337/db12-1100
54. Kindred KH, Zopey M and Friedman TC Metabolic effects of smoking cessation (2016) Nat rev Endocrinology 12: 299-308. http://doi.org/10.1038/nrendo.2016.32
55. Calcaterra V, Winickoff JP, Klersy C, Schiano LM, Bazzano R, et al. Smoke exposure and cardio-metabolic profile in youth with type 1 diabetes (2018). Diabetol Metab Syndr 10: 53. http://doi.org/10.1186/s13098-018-0355-0
56. Srinivasa Ch and Subash YE. The effect of chronic tobacco smoking and chewing on the lipid profile. Journal of clinical and diagnostic research (2013) JCDR 7: 31-4. http://doi.org/10.7860/JCDR/2012/5086.2663
57. Gossett LK, Johnson HM, Piper E, Michael CF,Timothy B. Smoking intensity and lipoprotein abnormalities in active smokers (2009) Journal of clinical lipidology 3: 372-378. http://doi.org/10.1016/j.jacl.2009.10.008
59. Nigar Nargis N, Hussain AKMG, Goodchild M, Quahd CKA and Fongd GTA. Decade of cigarette taxation in Bangladesh: lessons learnt for tobacco control (2019) Bulletin of the WHO 97: 221-229. http://doi.org/10.2471/BLT.18.216135
60. Alam DS, Jha P, Ramasundarahettige C, Streatfield PK, Niessen LW. Smoking-attributable mortality in Bangladesh: proportional mortality study (2013) Bulletin of the World Health Organization 91: 757-64. http://doi.org/10.2471/BLT.13.120196
61. Nigar Nargis N, Hussain AKMG, Goodchild M, Quahd CKA and Fongd GTA. Prevalence and Patterns of Tobacco Use in Bangladesh from 2009 to 2012. (2015) Evidence from International Tobacco Control (ITC) Study, PloS one 10: 1-16. http://doi.org/10.1371/journal.pone.0141135
62. Khan MK, Hoque HE and Ferdous J. Knowledge and Attitude Regarding National Tobacco Control Law and Practice of Tobacco Smoking among Bangladesh Police (2019) Mymensingh Med J 28 :752-761.
63. Tribune Desk. Temperature in Bangladesh to raise to deadly heights by end of century (2017) Dhaka Tribune, Bangladesh, August 03.
64. Mohiuddin AK. Domination of Pollutant Residues among Food Products of South-East Asian Countries (2019) South Asian Res J Agri Fish 1: 50-53. http://doi.org/10.36346/sarjaf.2019.v01i02.003
65. Paul SK, Islam MS, Hasibuzzaman MM, Hossain F, Anjum A, et al. Higher risk of hyperglycemia with greater susceptibility in females in chronic arsenic-exposed individuals in Bangladesh (2019) Sci Total Environ 668: 1004-1012. http://doi.org/10.1016/j.scitotenv.2019.03.029
66. Chaity AJ. 15% pregnant women diagnosed with diabetes. Dhaka Tribune, Bangladesh, November 14.
67. Goon S and Islam MS. Breakfast skipping and obesity risk among urban adults in Bangladesh (2014) Int J Public Health Sci 3: 15-22. http://doi.org/10.11591/ijphs.v3i1.5653
68. Khan A, Khan SR and Burton NW. Missing breakfast is associated with overweight and obesity in Bangladeshi adolescents (2019) Acta Paediatr 108: 178-179. http://doi.org/10.1111/apa.14553 .
69. Kabir A, Miah S and Islam A. Factors influencing eating behavior and dietary intake among resident students in a public university in Bangladesh: A qualitative study (2018) PLoS One 13: 801. http://doi.org/10.1371/journal.pone.0198801.
70. Mohiuddin A. Skipping Breakfast Everyday Keeps Well-Being Away (2019) Acta Medica 50: 26-33. http://doi.org/10.32552/2019.ActaMedica.331.
71. Bener A and Yousafzai MT. Effect of Ramadan fasting on diabetes mellitus a population-based study in Qatar (2014) J Egypt Public Health Assoc 89: 47-52. http://doi.org/10.1097/01.EPX.0000451852.92252.9b .
72. Yeoh EC, Zainudin SB, Loh WN, Chua CL, Fun S, et al. Fasting during Ramadan and Associated Changes in Glycaemia, Caloric Intake and Body Composition with Gender Differences in Singapore (2015) Ann Acad Med Singapore 44: 202-6.
73. Bener A, Abdulla OAA, Öztürk M, Çatan F, Haris PI, et al. Effect of Ramadan fasting on glycemic control and other essential variables in diabetic patients (2018) Annals of African medicine 17: 196-202. http://doi.org/10.4103/aam.aam_63_17
74. Bener A, Hamaq AOA, Öztürk M, Çatan F, Haris Pi, et al. Effect of ramadan fasting on glycemic control and other essential variables in diabetic patients (2018) Ann Afr Med 17: 196-202. http://doi.org/10.4103/aam.aam_63_17 .
75. Ahmed MH, Husain ME, Elmadhoun WM, Noor SK,KhaliL AA, et al. Diabetes and Ramadan: A concise and practical update (2017) J of family med and pri care 6: 11-18. http://doi.org/10.4103/2249-4863.214964
76. Malinowski B, Zalewska K, Węsierska A, Sokołowska MM, Socha M, et al. Intermittent Fasting in Cardiovascular Disorders-An Overview (2019) Nutrients 11: 673. http://doi.org/10.3390/nu11030673
77. Siaw MYL, Chew DEK, Toh MPHS, Seah DEJ,Chua R, et al. Metabolic parameters in type 2 diabetic patients with varying degrees of glycemic control during Ramadan: An observational study (2016) J of diabetes inves 7: 70-5. http://doi.org/10.1111/jdi.12374
78. Khaled, Méghit B and Belbraouet S. Effect of Ramadan fasting on anthropometric parameters and food consumption in 276 type 2 diabetic obese women (2009) Int J of diabetes in dev countries 29: 62-8. http://doi.org/10.4103/0973-3930.53122
79. Ali SA, Parveen N and Ali AS. Links between the Prophet Muhammad (PBUH) recommended foods and disease management: A review in the light of modern super foods (2018). Int Journal of health sci 12: 61-69.
80. Mohiuddin A. The Mysterious Domination of Food/Drinking Water Contaminants and Adulterants in Bangladesh (2019) Pharma Tutor 7: 42-58. http://doi.org/10.29161/PT.v7.i1.2019.42
81. Tan T, Zhang Y, Luo W, Lv J, Han C, et al. Formaldehyde induces diabetes-associated cognitive impairments (2018) FASEB J 32: 3669-3679. http://doi.org/10.1096/fj.201701239R
82. Alan RH. Depression, Diabetes and Dementia: Formaldehyde May Be a Common Causal Agent, Could Carnosine, a Pluripotent Peptide, Be Protective? (2017) Aging and disease 8: 128-130. http://doi.org/10.14336/AD.2017.0120
83. Tulpule K are Dringen R. Formaldehyde in brain: an overlooked player in neurodegeneration (2013) J Neurochem 127: 7-21. http://doi.org/10.1111/jnc.12356
84. Grotton C. Research Update Protect Against Formaldehyde Exposure (2019) Life Extension Magazine, January.
85. Mohiuddin AK. Chemical Contaminants and Pollutants in the Measurable Life of Dhaka City (2019). European J of Sustainable Dev Res 3: 83. https://doi.org/10.29333/ejosdr/5727
86. Ullah A. Sale of Adulterated Spice Powder: Public health at risk (2019) The Daily Sun, Bangladesh, October 16.
87. Staff Correspondent. Food adulteration rings alarm bell: STAR-RDRS roundtable told most food items adulterated, pose lethal risks to public health (2019) The Daily Star, Bangladesh, August 11.
88. Majed N, Real MIH and Azam HM Food Adulteration and Bio-Magnification of Environmental Contaminants: A Comprehensive Risk Framework for Bangladesh (2016) Front Environ Sci 4: 34 http://doi.org/10.3389/fenvs.2016.00034
89. Chowdhury MFI. Evaluating Position of Bangladesh to Combat Adulterated Food Crisis in Light of Human Rights. OSR Journal of Humanities and Social Science (2014) IOSR J Of Hum And Social Sci 19: 45-54.
90. Child Marriage in Bangladesh. Marry before Your House is Swept Away (2019). Human Rights Watch USA, June 9.
91. Kamal SM, Hassan CH, Alam GM and Ying Y. Child marriage in Bangladesh: trends and determinants (2015) J Biosoc Sci.Jan 47:120-39. http://doi.org/10.1017/S0021932013000746.
92. Hossain MG, Mahumud RA and Saw A. Prevalence Of Child Marriage Among Bangladeshi Women And Trend Of Change Over Time (2016) J Biosoc Sci 48: 530-8. http://doi.org/10.1017/S0021932015000279 .
93. Zahangir MS, Hasan MM, Richardson A and Tabassum S Malnutrition and non-communicable diseases among Bangladeshi women: an urban-rural comparison (2017) Nutri & diabetes 7: 250. http://doi.org/10.1038/nutd.2017.2
94. Silva-Zolezzi I, Samuel TM and Spieldenner J. Maternal nutrition opportunities in the prevention of gestational diabetes (2017) Nutrition rev 75: 32-50. http://doi.org/10.1093/nutrit/nuw033
95. Tunçer M. Fetal malnutrition in infants born to diabetic mothers. (1982) Turk J Pediatr. 24: 245-9.
96. Independent Online Desk. Malnutrition major cause of premature child birth in Bangladesh (2018) The Independent, United Kingdom, 23 March.
97. Das S, Mia MN, Hanifi SM, Hoque S and Bhuiya A. Health literacy in a community with low levels of education, findings from Chakaria, a rural area of Bangladesh (2017) BMC Public Health 17 :203. http://doi.org/10.1186/s12889-017-4097-y
98. Mehzabin R, Hossain k, Moniruzzaman M and Sayeed SKJ. Association of Functional Health Literacy With Glycemic Control: A Cross Sectional Study in Urban Population of Bangladesh (2019) J of Med, 20: 19-24. http://doi.org/10.3329/jom.v20i1.38816
99. Islam FMA, Kawasaki R and Finger RP. Factors associated with participation in a diabetic retinopathy screening program in a rural district in Bangladesh (2018) Diabetes Res Clin Pract 144: 111-117. http://doi.org/10.1016/j.diabres.2018.08.012.
100. Siddique KB, Islam SMS, Banik PC and Rawal LB. Diabetes knowledge and utilization of healthcare services among patients with type 2 diabetes mellitus in Dhaka, Bangladesh (2017) BMC health services research 17: 586. http://doi.org/10.1186/s12913-017-2542-3
101. Ahmed T, Ireen S, Ahmed AMS, Rahman S, Islam MM, et.al. Nutrition of children and women in Bangladesh: trends and directions for the future (2012). J of health, population and nutri 30: 1-11. http://doi.org/10.3329/jhpn.v30i1.11268
102. Burton NW, Kadir MA and Khan A. Physical activity attitudes among adolescents in Bangladesh (2019) Pub Health 179: 59-65. http://doi.org/10.1016/j.puhe.2019.10.004
103. Rawlings GH, Williams RK, Clarke DJ, English C, Fitzsimons C, et al. Exploring adults experiences of sedentary behaviour and participation in non-workplace interventions designed to reduce sedentary behaviour: a thematic synthesis of qualitative studies (2019) BMC Pub Health 19: 1099. http://doi.org/10.1186/s12889-019-7365-1
104. Neyazi SN. The Rise Of Joblessness Among The Youths In Bangladesh (2019). Fin Tech, July 15.
105. Aravinda J. Risk factors in patients with type 2 diabetes in Bengaluru: A retrospective study (2019). World J Diabetes 10 :241–248. http://doi.org/10.4239/wjd.v10.i4.241
106. Foucaut AM, Faure C, Julia C, Czernichow S,Levy R, et al.Sedentary behavior, physical inactivity and body composition in relation to idiopathic infertility among men and women (2019) PLoS One 14 : 1-15. http://doi.org/10.1371/journal.pone.0210770
107. Pati S, Lobo E, Pati S, Desaraju S and Mahapatra P. Type 2 diabetes and physical activity: barriers and enablers to diabetes control in Eastern India (2019) Prim Health Care Res Dev 20: 44. http://doi.org/10.1017/S146342361800097X
108. Kirk JK and Stegner J. Self-monitoring of blood glucose practical aspects (2010) J Diabetes Sci Technol 4: 435–439. http://doi.org/10.1177/193229681000400225.
109. Janapala RN, Jayaraj JS, Fathima N, Kashif T, Usman N, et al. Continuous Glucose Monitoring Versus Self-monitoring of Blood Glucose in Type 2 Diabetes Mellitus: A Systematic Review with Meta-analysis (2019) Cureus 119: 5634. http://doi.org/10.7759/cureus.5634
110. Chawla A, Chawla R and Jaggi S. Microvasular and macrovascular complications in diabetes mellitus: Distinct or continuum? (2016) Indian J Endocrinol Metab 20: 546–551. http://doi.org/10.4103/2230-8210.183480
111. St Onge EL, Motycka CA, and Miller SA. A review of cardiovascular risks associated with medications used to treat type-2 diabetes mellitus (2009) Pharm and Therapeutics 34: 368–378.
112. Monte S. Insulin Resistance and Neurodegeneration Progress Towards the Development of New Therapeutics for Alzheimers Disease (2017) Drugs 77: 47–65. http://doi.org/10.1007/s40265-016-0674-0
113. Jingi AM, Tankeu AT, Ateba NA and Noubiap JJ. Mechanism of worsening diabetic retinopathy with rapid lowering of blood glucose: the synergistic hypothesis (2019) BMC Endocr Disord 17 :63. http://doi.org/10.1186/s12902-017-0213-3
114. Kiziltoprak H, Tekin K, Inanc M and Goker YS. Cataract in diabetes mellitus (2019) World J Diabetes 10: 140-153. http://doi.org/10.4239/wjd.v10.i3.140
116. Mendes AL, Miot HA and Junior HV. Diabetes mellitus and the skin (2017) An Bras Dermatol 92: 8–20. http://doi.org/10.1590/abd1806-4841.20175514
117. Al Wahbi A. Auto amputation of diabetic toe with dry gangrene a myth or a fact? (2018) Diabetes Metab Syndr Obes 11: 255–264. http://doi.org/10.2147/DMSO.S164199
118. Fekadu G, Chelkeba L and Kebede A. Risk factors, clinical presentations and predictors of stroke among adult patients admitted to stroke unit of Jimma university medical center, south west Ethiopia: prospective observational study (2019) BMC Neurol 19: 187. http://doi.org/10.1186/s12883-019-1409-0
119. Lau LH, Lew J, Borschmann K, Thijs V and Ekinci EI. Prevalence of diabetes and its effects on stroke outcomes: A meta-analysis and literature review (2019) J Diabetes Investig 10: 780–792. http://doi.org/10.1111/jdi.12932
120. Chowdhury MZI, Yeasmin F, Rabi DM, Ronksley PE and Turin TC. Predicting the risk of stroke among patients with type 2 diabetes: a systematic review and meta-analysis of C-statistics (2019) BMJ Open 9: 1-22. http://doi.org/10.1136/bmjopen-2018-025579
121. LN Aminde, Tindong M, Ngwasiri CA, Aminde JA, Njim T, et al. Adherence to antidiabetic medication and factors associated with non-adherence among patients with type-2 diabetes mellitus in two regional hospitals in Cameroon (2019) BMC Endocr Disord 19 :35. http://doi.org/10.1186/s12902-019-0360-9
122. Alqarni AM, Alrahbeni T, Qarni AA and Qarni HMA. Adherence to diabetes medication among diabetic patients in the Bisha governorate of Saudi Arabia - a cross-sectional survey (2018) Patient Prefer Adherence 13: 63-71. http://doi.org/10.2147/PPA.S176355 .
123. Brown T, Moore TH, Hooper L, Gao Y, Zayegh A, et al
Blood sugar screening, Patient compliance, Overweight, Sedentary lifestyle, Regular health checkup, Ramadan fasting, Climate issues of diabetes.