Reducing Dietary Related Risks associated with Non-Communicable

Diseases in Bangladesh (RDRNCD)

Technical Report

Association between Diabetes and Dietary Habit and Life

Style: A Cross Sectional study among Hospital patients.

Submitted by:

Center for Natural Resource Studies (CNRS)

House-13 (Level 4-6), Road-17, Block-D, Banani, Dhaka-1213

Tel: (+880-2) 9820127-8, E-mail: info@cnrs.org.bd

Web: www.cnrs.org.bd

Reducing Dietary Related Risks associated with Non-

Communicable Diseases in Bangladesh (RDRNCD)

Technical Report

Association between Diabetes and Dietary Habit and Life Style: A Cross

Sectional study among Hospital patients.

Karim MR1, Haque MM2

1. Professor Dr. Md. Rezaul Karim PhD

MBBS, MPH

Professor, Department of Public Health

North South University, Basundhara, Dhaka, Bangladesh

&

Team Leader

RDRNCD Project

E-mail: drr_karim@yahoo.com

2. Professor Dr. Md. Mahmudul Haque

Professor, Department of Community Medicine

National Institute of Preventive and Social Medicine

Mohakhali, Dhaka-1212, Bangladesh

Cell Phone: +8801718532959, E-mail: mhaque59@yahoo.com

Table of Contents Abstract ................................................................................................................................................... 1

Introduction ............................................................................................................................................ 2

Objectives ............................................................................................................................................... 3

Methods and materials ........................................................................................................................... 3

Results ..................................................................................................................................................... 4

Discussion.............................................................................................................................................. 32

Conclusion ............................................................................................................................................. 34

1

Association Between Diabetes and Dietary Habit and Life Style: A Cross

Sectional Study Among Hospital Patients.

Abstract This descriptive cross-sectional study was conducted to attribute of diabetic patients attending

selected hospital, to assess the dietary habits among the respondents, to find out the life styles

among the respondents and to identify the factors affecting glycemic control. A total of 450

purposively selected type 2 diabetic patients from outpatient and inpatient departments of

Shaheed Suhrawady Medical College & Hospital were interviewed face-to-face with a pre-

tested semi-structured questionnaire. Data collection was conducted from April to June 2018.

The study period was from April to December 2018. The selection criteria were adult aged 18

years or older who has been diagnosed as type 2 diabetes mellitus and gave consent to be

included in the study. Women who reported a history of diabetes only during pregnancy were

excluded. Among the respondents 40.9% were male and the rest 59.1% were female. Majority

(43.56%) belonged to age group 46–60 years and 42.2% had family history of diabetes.

Housewives topped the list of all the occupations (51.56%). Majority of them could mention

communicable and non-communicable diseases. Mean duration of suffering from diabetes was

9.70±8.07 years in cases with the male and 6.69±5.72 years in cases with the female. Majority

(68.67%) of the respondents mentioned of taking part in playing or doing exercises. Regarding

tobacco use it was seen that 8.44% smokes and 26.67% used smokeless tobacco (SLT). About

one tenth (9.56%) of the respondents perceived high mental stress and 40.22% perceived

moderate mental stress. One fifth monitor blood glucose regularly. Just more than half (50.7%)

had high adherent to treatment, 15.8% had high blood cholesterol and 70.0% consumed

vegetable almost daily. Among the total 450 respondents 45.8% had controlled diabetes

(RBS<7.8 mmol/l). Respondents having higher education had more controlled of diabetes. No

2

association was found with sex of the respondents (p>0.05), age group (p>0.05) and family

history of diabetes (p>0.05). Tobacco use was found to be associated with diabetes control.

Respondents who used tobacco in any form had less control on diabetes. Statistically

significant association was found between dyslipidemia, adherence to treatment and use of

herbal medicine. Respondents who had dyslipidemia had less controlled diabetes. On the other

hand, respondents who were adherent to treatment and who used herbal medicines were having

more controlled diabetes.

Introduction Diabetes mellitus is now one of the most common non-communicable diseases

globally. It is epidemic in developing and industrializing countries. Its global prevalence was

about 8% in 2011 and is predicted to rise to 10% by 2030 (International Diabetes Federation).

The number of people with diabetes has risen from 108 million in 1980 to 422 million in 2014.

The global prevalence of diabetes among adults over 18 years of age has risen from 4.7% in

1980 to 8.5% in 2014 (Sarwar N et al, 2010). Diabetes prevalence has been rising more rapidly

in middle- and low-income countries. Diabetes prevalence has been rising more rapidly in

middle- and low-income countries. China and India hold the 1st and second position

respectively having 98.4 and 65.1 of total cases of diabetes in adult population (20 to 79 years)

in 2013.

Bangladesh is situated in the South-East Asian region. It is one of the most populous

regions in the world. Nearly one-fifth of all adult diabetics lives in this region. An estimated

10 million people in Bangladesh have diabetes (Chaity AJ, 2017). A similar study reveals a

more shocking fact, almost one in ten adults in Bangladesh was found to have diabetes (Akter

S et al, 2014). According to the latest WHO data published in 2017 Diabetes Mellitus Deaths

in Bangladesh reached 40,142 or 5.09% of total deaths. The age adjusted Death Rate is 40.08

per 100,000 of population ranks Bangladesh 57 in the world (Web World Health Rankings).

3

Objectives General objective of the study was to determine the association between diabetes and

dietary habits and life style among selected hospital patients. Specific objectives were to

determine the socio-demographic characteristics of diabetic patients attending in selected

hospitals, to assess the dietary habits among the respondents, to find out the life styles among

the respondents and to identify the factors affecting glycemic control.

Methods and materials This was a descriptive cross-sectional study conducted among purposively selected 450

type 2 diabetics in Shaheed Suhrawady Medical College & Hospital, a tertiary healthcare

facility in Bangladesh. The study period was from April to December 2018. Both admitted and

out door patients were included. The selection criteria were adult aged 18 years or older who

has been diagnosed as type 2 diabetes mellitus and gave consent to be included in the study.

Women who reported a history of diabetes only during pregnancy were excluded. Face-to-face

interview was the technique of data collection and it was done with a pre-tested semi structured

questionnaire and a check list. Height, weight, blood pressure and random blood glucose of the

respondents were measured using the standard protocol. Data analysis had been performed with

Statistical Package for Social Sciences (SPSS) version 21.0 and Stata 13.0 version.

4

Results A total of 450 respondents were interviewed. Among them 184 (40.9%) were male and the

rest 266 (59.1%) were female.

Figure 1: Distribution of the respondents by gender

Female, 266,

59.1%

Male, 184,

40.9%

Regarding age distribution, it was seen that 47 (10.44%) of the respondents belonged

to age group 20 – 35 years and among them 39 (14.66%) were female and 8 (4.35%) were

male. Age group 36 – 45 years had 113 (25.11%) respondents among whom 85 (31.95%) were

female and 28 (15.22%) were male. Age group 46 – 60 years had 196 (43.56%) respondents

among whom 114 (42.86%) were female and 82 (44.57%) were male. Age group > 60 years

had 94 (20.89%) respondents among whom 28 (10.53%) were female and 82 66 (35.87%) were

male.

5

Table 1: Age and gender distribution of the respondents

Age Group

(years)

Gender Total

Male Female

20 – 35 8 (4.35%) 39 (14.66%) 47 (10.44%)

36 – 45 28 (15.22%) 85 (31.95%) 113 (25.11%)

46 – 60 82 (44.57%) 114 (42.86%) 196 (43.56%)

> 60 66 (35.87%) 28 (10.53%) 94 (20.89%)

Total 184 (100.00%) 266 (100.00%) 450 (100.00%)

* Column percentages

Education of the respondents are shown in table 2. A total of 107 (23.78%) did not have

education. This was 88 (33.08%) among the female and 19 (10.33%) among the male. More

than half 250 (55.56%) had primary to HSC level of education and 93 (20.67%) were graduates

and above.

Table 2: Distribution of the respondents by education and gender

Education Gender

Total Male Female

No education 19 (10.33%) 88 (33.08%) 107 (23.77%)

Primary - HSC 108 (58.70%) 142 (53.38%) 250 (55.56%)

Graduation/ Fazil/ MBBS/ BSc 57 (30.97%) 36 (13.54%) 93 (20.67%)

Total 184 (100.00%) 266 (100.00%) 450 (100.00%)

* Column percentages

6

Among 266 female respondents majority [232 (87.22%)] were housewives, 12 (4.51%)

were service holders and 8 (3.01%) were laborers (work for himself/ herself). On the other

hand, among 184 male respondents 55 (29.89%) were doing small business, 46 (25.00%) were

service holders and 37 (20.11%) were retired.

Table 3: Distribution of the respondents by occupation and gender

Occupation Gender

Total Male Female

Laborers 17 (9.24%) 8 (3.01%) 25 (5.56%)

Small business 55 (29.89%) 2 (0.75%) 57 (12.67%)

Service 46 (25.00%) 12 (4.51%) 58 (12.89%)

Housewife – 232 (87.22%) 232 (51.56%)

Unemployed 9 (4.89%) – 9 (2.00%)

Retired 37 (20.11%) 4 (1.50%) 41 (9.11%)

Others 20 (10.87%) 8 (3.01%) 28 (6.22%)

Total 184

(100.00%)

266

(100.00%)

450

(100.00%)

* Column percentages

7

Cholera, pox, and tuberculosis were mentioned as communicable diseases by 132

(71.74%) of the male and 134 (50.38%) of the female respondents. High blood pressure and

diabetes were identified as non-communicable diseases by 134 (72.83%) male and 137

(51.50%) female respondents. Most [174 (94.57%)] of the male respondents and 236 (88.72%)

of the female respondents mentioned that physical exercise help to decrease high blood

pressure and 149 (80.98%) of the male and 185 (69.55%) of the female respondents opined

that physical labor help to decrease high blood pressure.

Table 4: Distribution of the respondents by perception about CDs and NCDs

Perception about CDs & NCDs Gender

Total (450) Male (184) Female (266)

Cholera, pox, and tuberculosis are

communicable diseases 132 (71.74%) 134 (50.38%) 266 (59.11%)

High blood pressure and diabetes Non-

communicable disease 134 (72.83%) 137 (51.50%) 271 (60.22%)

physical exercise help to decrease high

blood pressure 174 (94.57%) 236 (88.72%) 410 (91.11%)

Physical labor help to decrease high

blood pressure 149 (80.98%) 185 (69.55%) 334 (74.22%)

All of the respondents mentioned that they were suffering from diseases. Most of the

respondents [180 (97.83%) of male and 258 (96.99%) of female] said that they have measured

blood pressure by doctor or health worker. Among the male respondents 77 (41.85%) and

among the female respondents 113 (42.48%) mentioned that they were informed of having high

blood pressure by any doctor or health worker.

8

Table 5: Non-communicable disease (NCD) status of the respondent (Hypertension)

Attribute Gender

Total (450) Male (184) Female (266)

Have ever measured blood pressure

by doctor or health worker 180 (97.83%) 258 (96.99%) 438 (97.33%)

Any doctor or health worker

informed the subject of having high

blood pressure

77 (41.85%) 113 (42.48%) 190 (42.22%)

Majority [175 (92.11%)] of the respondents took medicine regularly to keep control

their blood pressure. This was 73 (94.81%) among the male and 102 (90.27%) among the

female. Among the male respondents 60 (77.92%) and among the female 87 (76.99%) take

extra salt during meal. Among the male 66 (85.71%) and among the female 88 (77.88%) were

following the food habit according to doctor’s advice. Of the male respondents 66 (85.71%)

and 93 (82.30%) of the female respondents were trying to decrease body weight. Most [111

(98.23%)] of the female hypertensives and 66 (85.71%) of male hypertensives were abstaining

from, quitting or decreasing smoking. Majority [55 (71.43%)] of the male and 73 (64.60%) of

females were doing regular physical exercise.

9

Table 6: Respondents’ lifestyle to control hypertension

Practice Gender

Gender (190) Male (77) Male (113)

Taking medication regularly 73

(94.81%) 102 (90.27%) 175 (92.11%)

Avoiding extra salt during meal 7 (9.09%) 12 (10.62%) 19 (10.00%)

Following dietary advices of doctors 66

(85.71%) 88 (77.88%) 154 (81.05%)

Trying to decrease weight 66

(85.71%) 93 (82.30%) 159 (83.68%)

Abstaining, quitting or decreasing

smoking

66

(85.71%) 111 (98.23%) 177 (93.16%)

Doing regular physical exercise 55

(71.43%) 73 (64.60%) 128 (67.37%)

In order to keep control blood glucose 164 (89.13%) of the male and 248 (93.23%) of

the female were taking medicine regularly. Among the male 156 (84.78%) and among the

female 218 (81.95%) were Following the food habit according to doctor’s advice, 144

(78.26%) male and 207 (77.82%) female were trying to reduce their weight, 156 (84.78%) male

and 260 (97.74%) female were abstaining from, quitting or decreasing smoking and 128

(69.57%) male and 177 (66.54%) female were Doing regular physical exercise.

Table 7: Distribution of the respondents by practices to control Diabetes

Attribute Gender

Total (450) Male (184) Female (266)

Taking medication regularly 164 (89.13%) 248 (93.23%) 412 (91.56%)

Following dietary advices of doctors 156 (84.78%) 218 (81.95%) 374 (83.11%)

Trying to decrease weight 144 (78.26%) 207 (77.82%) 351 (78.00%)

Abstaining, quitting or decreasing

smoking 156 (84.78%) 260 (97.74%) 416 (92.44%)

Doing regular physical exercise 128 (69.57%) 177 (66.54%) 305 (67.78%)

10

Among the total 450 respondents 121 could mention their duration of suffering from

diabetes. Of these 121 57 were male and 64 were female. Mean duration was 9.70 years with

standard deviation ±8.07 years were in case of male respondents. The minimum and maximum

were 1.0 year and 40.0 years respectively. In case with the female the mean±SD was 6.69±5.72

years. Minimum and maximum durations were 1.0 year and 30.0 years. Among all respondents

the mean±SD was 8.11±7.06 years. Minimum and maximum durations were 1.0 year and 40.0

years respectively (Table 8).

Table 8: Duration of suffering from diabetes of the respondents (years)

Respondents N Mean Std. Deviation Minimum Maximum

Male 57 9.70 8.07 1 40.00

Female 64 6.69 5.72 1 30.00

All respondent 121 8.11 7.06 1 40.00

As mentioned, out of the total 184 respondents 88 (47.83%) had family history of diabetes

mellitus, 95 (51.63%) did not have and 1 (0.54%) did not know. On the other hand, among 266

female respondents 102 (38.35%) had family history of diabetes, 156 (58.65%) did not have

and 8 (3.01%) respondents mentioned of not knowing about it (Figure 2).

11

88 (47.83%)95 (51.63%)

1 (0.54%)

102 (38.35%)

156 (58.65%)

8 (3.01%)

0

20

40

60

80

100

120

140

160

Male Female

Yes

No

Don't know

Figure 2

* Percentages within category

Among the 450 respondents 149 (33.11%) mentioned that they became upset

sometimes because of something happened unexpectedly. Fairly often was mentioned by 139

(30.89%), never was mentioned by 61 (13.56%), Almost never by 55 (12.22%) and very often

was mentioned by 46 (10.22%) respondents (Table 9).

Table 9: Distribution of the respondents about being upset because of

something happened unexpectedly

Being upset Gender

Total Male Female

Never 22 (11.96%) 39 (14.66%) 61 (13.56%)

Almost never 19 (10.33%) 36 (13.53%) 55 (12.22%)

Sometimes 67 (36.41%) 82 (30.83%) 149 (33.11%)

Fairly often 54 (29.35%) 85 (31.95%) 139 (30.89%)

Very often 22 (11.96%) 24 (9.02%) 46 (10.22%)

Total 184 (100.00%) 266 (100.00%) 450 (100.00%)

12

About one third [153 (34.00%)] respondents felt nervous and stressed sometimes, 112

(24.89%) felt Fairly often, 77 (17.11%) very often, 68 (15.11%) almost never and 40 (8.89%)

felt never (Table 10).

Table 10: Distribution of the respondents by feeling nervous and stressed

Being nervous

and stressed

Gender Total

Male Female

Never 15 (8.15%) 25 (9.40%) 40 (8.89%)

Almost never 24 (13.04%) 44 (16.54%) 68 (15.11%)

Sometimes 72 (39.13%) 81 (30.45%) 153 (34.00%)

Fairly often 46 (25.00%) 66 (24.81%) 112 (24.89%)

Very often 27 (14.67%) 50 (18.80%) 77 (17.11%)

Total 184 (100.00%) 266 (100.00%) 450 (100.00%)

Regarding feeling difficulties that could not overcome, 162 (36.00%) opined that they

felt sometimes, 115 (25.56%) felt fairly often, 72 (16.00%) felt almost never, 55 (12.22%)

never and 46 (10.22%) felt very often (Table 11).

Table 11: Distribution of the respondents by feeling difficulties

that could not overcome

Feeling difficulties

that could not

overcome

Gender

Total

Male Female

Never 18 (9.78%) 37 (13.91%) 55 (12.22%)

Almost never 29 (15.76%) 43 (16.17%) 72 (16.00%)

Sometimes 68 (36.96%) 94 (35.34%) 162 (36.00%)

Fairly often 49 (26.63%) 66 (24.81%) 115 (25.56%)

Very often 20 (10.87%) 26 (9.77%) 46 (10.22%)

Total 184 (100.00%) 266 (100.00%) 450 (100.00%)

13

Majority [160 (35.56%)] of the respondents failed to cope with all the things that had to

do. It was felt Fairly often by 110 (24.44%), Never by 77 (17.11%), Almost never by 70

(15.56%) and Very often by 33 (7.33%) respondents (Table 12).

Table 12: Distribution of the respondents by failing to

cope with all the things that had to do

Failing to cope

with all the things

that had to do

Gender

Total

Male Female

Never 27 (14.67%) 50 (18.80%) 77 (17.11%)

Almost never 25 (13.59%) 45 (16.92%) 70 (15.56%)

Sometimes 78 (42.39%) 82 (30.83%) 160 (35.56%)

Fairly often 40 (21.74%) 70 (26.32%) 110 (24.44%)

Very often 14 (7.61%) 19 (7.14%) 33 (7.33%)

Total 184 (100.00%) 266 (100.00%) 450 (100.00%)

Majority [217 (48.22%)] of the respondents felt confident about ability to handle personal

problems Sometimes, 114 (25.33%) felt Fairly often, 111 (24.67%) felt Very often, 7 (1.56%)

felt almost never and only one (0.22%) felt it never (Table 13).

14

Table 13: Distribution of the respondents by feeling confident

about ability to handle personal problems

Feeling confident about

ability to handle

personal problems

Gender

Total

Male Female

Never 1 (0.54%) 0 (0.00%) 1 (0.22%)

Almost never 2 (1.09%) 5 (1.88%) 7 (1.56%)

Sometimes 93 (50.54%) 124 (46.62%) 217 (48.22%)

Fairly often 48 (26.09%) 66 (24.81%) 114 (25.33%)

Very often 40 (21.74%) 71 (26.69%) 111 (24.67%)

Total 184 (100.00%) 266 (100.00%) 450 (100.00%)

Mental stress of the respondents was measured by a developed adopted stress scale

which is marked 0-20. Among the respondents 225 (50.00%) were suffering from moderate

mental stress for their morbidity. Low stress was perceived by 181 (40.22%) respondents and

43 (9.56%) perceived high mental stress (Figure 3).

Figure 3: Distribution of the respondents by perceived mental stress

181 (40.22%)

225 (50.00%)

43 (9.56%)

0

50

100

150

200

250

Low sterss Moderate stress High stress

15

Table 14 reveals that majority [168 (37.33%)] of the respondents visited doctors once in

2 months, 123 (27.33%) once in 6 months, 80 (17.78%) once in a month, 39 (8.67%) More

than once in a month and 40 (8.89%) visited once in a year.

Table 14: Distribution of the respondents by frequency of

visiting doctor for treatment of diabetes

Frequency of visiting

doctor

Gender Total

Male Female

More than once in a month 10 (5.43%) 29 (10.90%) 39 (8.67%)

Once in a month 38 (20.65%) 42 (15.79%) 80 (17.78%)

Once in 2 months 63 (34.24%) 105 (39.47%) 168 (37.33%)

Once in 6 months 55 (29.89%) 68 (25.56%) 123 (27.33%)

Once in a year 18 (9.78%) 22 (8.27%) 40 (8.89%)

Total 184 (100.00%) 266 (100.00%) 450 (100.00%)

Figure 4 reveals that out of the 184 male respondents 91 (49.46%) were using oral

hypoglycemic agent (OHA), 46 (25.00%) were using insulin and 47 (25.54%) were using both

OHA and insulin. On the other hand, out of the 266 female respondents 156 (58.64%) were

using oral hypoglycemic agent (OHA), 56 (21.05%) were using insulin and 54 (20.30%) were

using both OHA and insulin.

Figure 4: Distribution of the respondents by diabetes treatment modality

16

91 (49.46%)

46 (25.00%) 47 (25.54%)

156 (58.65%)

56 (21.05%)54 (20.30%)

0

20

40

60

80

100

120

140

160

Male (184) Female (266)

OHA

Insulin

OHA & Insulin

OHA: Oral hypoglycemic agent

* Percentages within category

Out of the total 450 respondents 29 (6.44%) consulted with alternative medicine

practitioners (i.e. Unani, Kabiraji of Ayurveda) for treatment of diabetes. Among them 12

(6.52% of category) were male and 17 (6.39% of category) were female (Figure 5).

Figure 5: Distribution of the respondents by consulting with

alternative medicine practitioners

12 (6.52%)

17 (6.39%)

29 (6.44%)

0

5

10

15

20

25

30

Male (184) Female (266) Total (450)

17

Twelve (2.67%) respondents were taking herbal or traditional remedy to control

diabetes. Among them 6 (3.26% of category) were male and 6 (2.26% of category) were female

(Figure 6).

Figure 6: Distribution of the respondents by taking any herbal or

traditional remedy to control diabetes

6 (3.26%) 6 (2.26%)

12 (2.67%)

0

2

4

6

8

10

12

Male (184) Female (266) Total (450)

Only one fifth [90 (20.00%)] respondents monitor blood sugar regularly. Among them

46 (25.00%) were male and 44 (16.54%) were female. Most [404 (89.78%)] of them keep a

record of blood sugar test results in record book though not measure it regularly. Only 31

(6.89%) respondents participated in diabetes health education program arranged by diabetes

hospitals (Table 15).

18

Table 15: Distribution of the respondents by blood sugar monitoring

and participating health education session

Participation Gender

Total (450) Male (184) Female (266)

Regularly monitoring blood sugar 46 (25.00%) 44 (16.54%) 90 (20.00%)

Keeping a record of blood sugar test

results in record book 164 (89.13%) 240 (90.23%) 404 (89.78%)

Participating in diabetes health

education program 14 (7.61%) 17 (6.39%) 31 (6.89%)

Among the 450 respondents 38 (8.44%) developed any complication due to diabetes.

And the rest 412 (91.56%) did not develop any complication (Figure 7).

Figure 7: Distribution of the respondents by presence of

complication due to diabetes

n=450

Absent, 412,

91.56%

Present, 38,

8.44%

Of the 38 respondents who developed complications due to diabetes, 12 (31.57%)

developed neuropathy, 6 (15.79%) developed nephropathy, 9 (23.68%) retinopathy and 11

(28.95%) developed other complications (Figure 8).

19

Figure 8: Distribution of the respondents by type of

complication due to diabetes

n=38

Others, 11, 28.95%

Retinopathy, 9,

23.68%

Nephropathy, 6,

15.79%Neuropathy, 12,

31.58%

Table 16 shows that among the 38 respondents who developed complications due to

diabetes, 22 were male and 16 were female. Among the male respondents 5 (22.73%)

developed diabetic retinopathy, 4 (18.18%) developed diabetic nephropathy, 8 (36.36%)

diabetic neuropathy and 5 (22.73%) developed other complication. On the other hand, among

the female respondents 4 (25.00%) developed diabetic retinopathy, 2 (12.50%) developed

diabetic nephropathy, 4 (25.00%) diabetic neuropathy and 6 (37.50%) developed other

complication.

20

Table 16: Distribution of the respondents by diabetes

related complications and gender

Complication Gender

Total (38) Male (22) Female (16)

Diabetic Retinopathy 5 (22.73%) 4 (25.00%) 9 (23.68%)

Diabetic Nephropathy 4 (18.18%) 2 (12.50%) 6 (15.79%)

Diabetic Neuropathy 8 (36.36%) 4 (25.00%) 12 (31.58%)

Others 5 (22.73%) 6 (37.50%) 11 (28.95%)

One third [153 (34.00%)] respondents forgot to take medicine sometimes, 66 (14.67%)

said that over past 2 weeks, were there any days when medicine was not taken, 105 (23.33%)

mentioned of cutting or stopping medicine without telling doctor because of feeling worse to

take it, 147 (32.67%) forgot to bring along medicine during travel, 112 (24.89%) stopped

medicine when feel symptoms are under control and 159 (35.33%) felt hassle about sticking to

treatment plan (Table 17)

Table 17: Distribution of the respondents by questions on treatment adherence

Participation Gender

Total (450) Male (184) Female (266)

Forget to take medicine sometimes 80 (43.48%) 73 (27.44%) 153 (34.00%)

Over past 2 weeks, were there any days

when medicine was not taken 28 (15.22%) 38 (14.29%) 66 (14.67%)

Cut or stop medicine without telling

doctor 52 (28.26%) 53 (19.92%) 105 (23.33%)

Forget bring along medicine during travel 68 (36.96%) 79 (29.70%) 147 (32.67%)

Did not take all medicines yesterday 15 (8.15%) 13 (4.89%) 28 (6.22%)

Stop medicine when feel symptoms are

under control 54 (29.35%) 58 (21.80%) 112 (24.89%)

Feel hassle about sticking to treatment

plan 70 (38.04%) 89 (33.46%) 159 (35.33%)

Sometimes having difficulty in

remembering to take all medicines

114

(61.96%) 127 (47.74%) 241 (53.56%)

21

Treatment adherence of the respondents was measured with structured Morisky 8-Item

Medication Adherence Questionnaire. It was revealed that 222 (49.3%) had low adherence and

the rest 228 (50.67%) of the respondents had high adherence to the treatment (Figure 9).

Figure 9: Treatment adherence of the respondents

Low adherence,

222, 49.33%

High

adherence, 228,

50.67%

Table 18 opines anthropometry and biochemical measurements of the respondents.

Among the male (n=184) mean height was 166.42 cm with standard deviation ±6.50 cm.

Minimum and maximum height were 149.30 cm and 182.80 cm respectively. On the other

hand, among the female (n=264) mean height was 152.61 cm with standard deviation ±8.72

cm. Minimum and maximum height were 124.90 cm and 170.69 cm respectively. Mean weight

was 64.90 with SD ±8.40 kg in cases with the male and 59.81±10.10 in the cases with the

female. Mean HbA1C was 8.11%±2.77% in cases with the male and 8.07%±2.37% among the

female. It is to be noted that HbA1C was found investigated in 19 male and 29 female

respondents. Mean random blood sugar was 10.16 mmol/dl with SD ±4.73 mmol/dl among the

male and 10.27 mmol/dl with SD ±5.01 mmol/dl among the female.

22

Table 18: Anthropometry and biochemical measurements

Measurements N Mean Std. Deviation Minimum Maximum

Height (cm)

Male 184 166.42 6.50 149.30 182.88

Female 264 152.61 8.72 124.90 170.69

All 448 158.28 10.41 124.90 182.88

Weight (Kg)

Male 184 64.90 8.40 40.10 90.50

Female 266 59.81 10.10 35.50 90.50

All 450 61.89 9.76 35.50 90.50

HbA1c (%)

Male 19 8.11 2.77 6.00 15.90

Female 29 8.07 2.37 4.10 14.20

All 48 8.09 2.50 4.10 15.90

Random Blood Sugar (mmol/l)

Male 184 10.16 4.73 4.00 36.90

Female 266 10.27 5.01 3.70 53.70

All 450 10.22 4.89 3.70 53.70

Among the 450 respondents 239 (53.115) did not know their lipid profile. About one

third [140 (31.11%)] had no dyslipidemia and the rest 71 (15.78%) had dyslipidemia (Figure

10).

Figure 10: Status of lipedema of the respondents

Dyslipidemia,

71, 15.78%

No

Dyslipidemia,

140, 31.11%

Do not Know,

239, 53.11%

23

Table 19 reveals nutritional status of the respondents according to body mass index

(BMI). It was seen that out of the 184 male respondents 125 (67.93%) were having normal

BMI, 44 (23.91%) were Overweight [BMI 25.00 – 29.00], 8 (4.35%) were Underweight [BMI

<18.5] and 7 (3.80%) were Obese [BMI ≥30.00]. On the other hand, among 264 female

respondents, 123 (45.83%) were having normal BMI, 92 (34.85%) were Overweight [BMI

25.00 – 29.00], 40 (15.15%) were Obese [BMI ≥30.00] and 9 (3.41%) were Underweight [BMI

<18.5]. It is to be noted that out of the 266 female respondents, measurement of height was

available for 264 respondents and eventually BMI calculation was possible for these 264

respondents.

Table 19: Body mass index category of the respondents by gender

BMI category Gender

Total (450) Male Female

Underweight [BMI <18.5] 8 (4.35%) 9 (3.41%) 17 (3.80%)

Normal [BMI 18.50 – 24.99] 125 (67.93%) 123 (45.83%) 247 (55.26%)

Overweight [BMI 25.00 – 29.00] 44 (23.91%) 92 (34.85%) 136 (30.43%)

Obese [BMI ≥30.00] 7 (3.80%) 40 (15.15%) 47 (10.51%)

Total 184 (100.00%) 264(100.00%) 448(100.00%)

Majority [309 (68.67%)] of the respondents opined of taking part in playing, exercise

or entertainment. This was 128 (69.57%) among the male and 181 (68.05%) among the female.

However, 44 (23.91%) of the male and 61 (22.93%) of the female said that they sometimes

take part (Table 20).

24

Table 20: Taking part in playing, exercise or entertainment

Participation Gender

Total Male Female

Yes 128 (69.57%) 181 (68.05%) 309 (68.67%)

No 12 (6.52%) 24 (9.02%) 36 (8.00%)

Sometimes 44 (23.91%) 61 (22.93%) 105 (23.33%)

Total 184 (100.00%) 266 (100.00%) 450 (100.00%)

Majority [149 (33.11%)] of the respondents consume vegetables rarely (<once/week).

About a quarter [111 (24.67%)] takes 5-7 days a week, 96 (21.33%) consume vegetables 3-4

days a week and 94 (20.89%) opined to consume vegetable 1-2 days per week (Figure 11).

Figure 11: Distribution of the respondents by vegetable consumption per week

5-7 days, 315,

70.00%

3-4 days, 28,

6.22%

1-2 days, 41,

9.11%

Rarely, 66,

14.67%

Mean number of days per week of performing exercise/work other than regular work

in cases with the male was 5.26±1.94 and 5.40±1.95 in cases with the female. Minimum and

Maximum days were 1 and 7 days respectively for both the groups. It was found that mean

time of performing exercise/work other than regular work per day was 33.73±19.76 minutes

25

among the male and 31.74±24.95 minutes among the female. It is to be noted that this data

were found among 172 male and 242 female respondents (Table 21).

Table 21: Measurements of performing exercise/work

other than regular work

Measurements N Mean Std.

Deviation Minimum Maximum

Days in a week doing exercise

Male 172 5.26 1.94 1 7

Female 242 5.40 1.95 1 7

All 414 5.35 1.95 1 7

Minutes per day doing these exercise/work

Male 172 33.73 19.76 1 110

Female 242 31.74 24.95 1 180

All 414 32.57 22.93 1 180

Table 22 shows Measurements of taking rest by the respondents. Mean time of relaxing

(without sleep) in a day for the male was found to be 59.41±39.94 minutes. It was 60.55±41.25

minutes for the female. Mean hours of sleeping in a day in case with the male was 6.73±1.22

and in case with the female was 6.43±1.43. Mean hours of sleeping in a weekend day in case

with the male was 7.01±11.29 and in case with the female was 6.59±1.49. Mean hours of sitting

at a stretch was 2.06±1.23 among the male and 1.72±1.17 among the female.

26

Table 22: Measurements of taking rest by the respondents

Measurements of

taking rest N Mean

Std.

Deviation Minimum Maximum

Minutes relaxing (without sleep) in a day

Male 175 59.41 39.94 10 180

Female 252 60.55 41.25 8 240

All 427 60.08 40.68 8 240

Hours of sleeping in a day

Male 184 6.73 1.22 4 11

Female 266 6.43 1.43 3 11

All 414 5.35 1.95 1 7

Hours of sleeping in a weekend day

Male 184 7.01 1.29 4 11

Female 266 6.59 1.49 3 11

All 450 6.76 1.42 3 11

Hours of sitting at a stretch

Male 117 2.06 1.23 1 6

Female 190 1.72 1.17 1 10

All 307 1.85 1.20 1 10

Among the 450 respondents 124 (27.56%) opined that they go to workplace by walking

and the rest [326 (72.44%)] did not. Within the male respondents 88 (47.83%) and within the

female 36 (13.53%) said to go to workplace by walking (Table 23).

27

Table 23: Distribution of the respondents on going to workplace by walking

Going to your

workplace by walking

Gender Total

Male Female

Yes 88 (47.83%) 36 (13.53%) 124 (27.56%)

No 96 (52.17%) 230 (86.47%) 326 (72.44%)

Total 184 (100.00%) 266 (100.00%) 450 (100.00%)

Time to go to workplace by walking was 18.06±14.32 minute in cases with the male

and 17.8913.19 minutes with the females. Mean period needed for physical work at workplace

was 2.59±2.59 hours among the male and 1.98±1.68 among the female (Table 24).

Table 24: Time to go to workplace by walking and period needed

for physical work at workplace

Measurements N Mean Std.

Deviation Minimum Maximum

Time to go to workplace by walking (Minutes)

Male 88 18.06 14.32 3 120

Female 36 17.89 13.19 2 60

All 124 18.01 13.95 2 120

Period needed for physical work at workplace

Male 68 3.07 2.59 1 10

Female 94 1.98 1.68 1 10

All 162 2.44 2.17 1 10

Regarding tobacco use it was seen that 38 (8.44%) of the respondents were smokers

and all of them were male. On the other hand, 120 (26.67%) of the respondents used SLT

28

(tobacco/Jarda/Sadapata). Among them 42 (22.83% of the category) were male and 78 (29.32%

of the category) were female (Table 25).

Table 25: Distribution of the respondents by tobacco use status

Tobacco use status Gender

Total (450) Male (184) Female (266)

Smoking 38 (20.65%) 0 (0.00%) 38 (8.44%)

Smokeless tobacco (SLT) use 42 (22.83%) 78 (29.32%) 120 (26.67%)

Mean duration of smoking was 24.26±11.14 years. Number of sticks of cigarette by the

respondents was 11.37 with ±10.07. Mean duration of SLT use by the male respondents was

17.21 years with SD± 10.32 years. In cases with the female it was 16.22±11.81 years.

Regarding frequency of using SLT it was 4.98±4.21 times in the cases with the male and

5.27±4.40 times in cases with the female (Table 26). None of the respondents used alcohol.

29

Table 26: Frequency and duration of tobacco use of the respondents

Tobacco use of the

respondents N Mean

Std.

Deviation

Minimum Maximum

Duration of smoking by the respondents (years)

Male 38 24.26 11.14 5 45

Female – – – – –

All 38 24.26 11.14 5 45

Number of sticks taken in a day

Male 38 11.37 10.07 1 40

Female

All 38 11.37 10.07 1 40

Duration of smokeless tobacco (SLT) use of the respondents (years)

Male 42 17.21 10.32 1 40

Female 78 16.22 11.81 1 50

All 120 16.57 11.28 1 50

Times (Frequency) of using SLT

Male 42 4.98 4.21 1 20

Female 78 5.27 4.40 1 20

All 120 5.17 4.31 1 20

Diabetes control status was found to be associated with Education. Respondents having

higher education had more controlled of diabetes. No association was found with sex of the

respondents, age group and family history of diabetes. Tobacco use was found to be associated

with diabetes control. Respondents who used tobacco in any form had less control on diabetes

(Table 27).

30

Table 27: Association between diabetes control with

sociodemographic attributes and tobacco use

Attributes Controlled [RBS

<7.8 mmol/dl]

Uncontrolled [RBS

≥7.8 mmol/dl] Total Significance

Sex

Male 82 (44.6%) 102 (55.4%) 184 (40.9%) χ2=0.184

p=0.668 (pns) Female 124 (46.6%) 142 (53.4%) 266 (59.1%)

Age group

20-35 years 18 (38.3%) 29 (61.7%) 47 (10.4%)

χ2=0. 6.155

p=0.104 (pns)

36-45 years 45 (39.8%) 68 (60.2%) 113 (25.1%)

46-60 years 91 (46.4%) 105 (53.6%) 196 (43.6%)

60 years & above 52 (55.3%) 42 (44.7%) 94 (20.9%)

Education

No education 25 (23.4%) 82 (76.6%) 107 (23.8%)

χ2=49.696

p=0.000 Primary-HSC 113 (45.2%) 137 (54.8%) 250 (55.6%)

Graduation & above 68 (73.1%) 25 (26.9%) 93 (20.7%)

Family history of diabetes

Has family history 89 (46.8%) 101 (53.2%) 190 (42.2%)

χ2=0.151

p=0.927 (pns) Do not have 113 (45.0%) 138 (55.0%) 251 (55.8%)

Do not know 4 (44.4%) 5 (55.6%) 9 (2.0%)

Tobacco Use

Tobacco user 48 (30.4%) 110 (69.6%) 158 (35.1%) χ2=23.259

p=0.000 Tobacco non-user 158 (54.1%) 134 (45.9%) 292 (64.9%)

31

Statistically significant association was found between dyslipidemia, adherence to

treatment and use of herbal medicine. Respondents who had dyslipidemia had less controlled

diabetes. On the other hand, respondents who were adherent to treatment and who used herbal

medicines were having more controlled diabetes (Table 28).

Table 28: Association between diabetes control with lipidemia,

treatment adherence and herbal medicine use

Attributes Controlled [RBS

<7.8 mmol/dl]

Uncontrolled [RBS

≥7.8 mmol/dl] Total Significance

Dyslipidemia

Dyslipidemia present 9 (12.7%) 62 (87.3%) 71 (15.8%)

χ2=66.260

p=0.000 No dyslipidemia 98 (70.0%) 42 (30.0%) 140 (31.1%)

Do not know 99 (41.4%) 140 (58.6%) 239 (53.1%)

Adherence to treatment

Low adherence 73 (32.9%) 149 (67.1%) 222 (49.3%) χ2=29.352

p=0.000 High adherence 133 (58.3%) 95 (41.7%) 228 (50.7%)

Use of herbal medicine

Herbal medicine user 11 (91.7%) 1 (8.3%) 12 (2.7%) χ2=10.459

p=0.001 Non-user 195 (44.5%) 243 (55.5%) 438 (97.3%)

Among 450 respondents 315 (70.0%) consumed vegetables 5-7 days per week. Of them 170

(54.0%) were with controlled diabetes and 145 (46.0%) were with uncontrolled diabetes.

Twenty-eight (6.2%) consumed vegetable 3-4 days per week and among them 15 (53.6%) had

their diabetes controlled. Among 41 (9.1%) respondents who consumed vegetables 1-2 days,

32 (78.0%) had uncontrolled diabetes and among the rest 66 (14.7%) respondents who

consumed vegetables rarely (<once per week) 54 (81.8%) had their diabetes uncontrolled.

Vegetable consumption was found to be significantly associated with diabetes controlled

(p<0.000) (Table 29).

32

Table 29: Association between diabetes control with vegetable consumption

Weekly consumption

of vegetables

Controlled [RBS

<7.8 mmol/dl]

Uncontrolled [RBS

≥7.8 mmol/dl] Total Significance

5-7 days 170 (54.0%) 145 (46.0%) 315 (70.0%)

χ2=38.825

p=0.000

3-4 days 15 (53.6%) 13 (46.4%) 28 (6.2%)

1-2 days 9 (22.0%) 32 (78.0%) 41 (9.1%)

Rarely 12 (18.2%) 54 (81.8%) 66 (14.7%)

Total 206 (45.8%) 244 (54.2%) 450 (100.0%)

Discussion The aim of the study was to determine the association between diabetes and dietary

habits and life style amongst selected Medical College Hospitals in Dhaka city. The study

population were admitted along with outdoor patients who suffered from Diabetes type-2.

Studies revealed that only 20% respondents monitor blood sugar regularly. Very few

(6.89%) respondents participate in health education programme on diabetes. For a better

control in diabetes, the respondents should involve themselves with education programme.

Respondents should be encouraged to monitoring the blood sugar level regularly for a control

diabetes and to combat complication of diabetes.

Regarding treatment adherent 61.96% male and 47.44% female respondents said that

they have difficulty in remembering to take all medicines sometimes. To overcome these

situation, counselling programme should be continued.

Usage of tobacco, it was evident that 8.44% respondents were smokers and all of them

were male. In case of female respondents twenty-seven percentage usage of tobacco was in the

form of smokeless tobacco (jarda/ sadpata).

Research findings revealed that diabetic control was found to be associated with

education and tobacco use in any form. The research done in different country by Asgharzadeh

33

M. et al, Saeed M. et al and Chen J et al their results are consistent with our findings (Saeed

M,2019; Chen J, 2019; Asgharzadeh M,2016).

In relation to association between control of diabetes with dyslipidemia, adherent to

treatment and use of herbal medicine, studies show that they were statistically found to have a

better control of diabetes.

Research reveals that only 17.78% of the respondents visit doctor once in a month.

Diabetes is chronic disease and control of blood sugar prevent complication of diabetes. So,

service should be provided door to door effectively.

In this research, complications due to diabetes were alarming. Amongst the male

respondents, 22.73% developed diabetic retinopathy, followed by diabetic nephropathy,

diabetic neuropathy and developed other complication was 18.18%, 36.36%, 22.73%

respectively.

On the other hand, amongst the female respondents developed diabetic retinopathy, followed

by diabetic nephropathy, diabetic neuropathy and other complication was25.00%, 12.50%,

25.00%, 37.50%. To overcome diabetes complications, patients’ awareness should be

developed to monitor blood sugar regularly, take medicine, physical exercise, control diet habit

and visit doctor frequently.

34

Conclusion Diabetes currently is an emerging pandemic especially in developing countries like

Bangladesh. In this study, it was evident that the diabetes control status was found to be in a

more controlled and better state on respondents with education and those with a mild smoking

habit. Statistically significant association was found between dyslipidemia, adherence to

treatment and use of herbal medicine. Respondents who had dyslipidemia had less controlled

diabetes. On the other hand, respondents who were adherent to treatment and who used herbal

medicines were having more controlled diabetes.

Therefore, prevention is only possible by minimizing the significant risk factors and by

changing life styles by taking specific measures which involves mass media (radio, television),

message through mobile, YouTube, rally, install bill board in important places. Diabetes can

easily be prevented by changing life style, regular physical exercise, controlling anxiety and

by leading a regular life.

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