An unexpectedly high level of unrecognized depressive symptoms was found in the general rural population of Bangladesh. These are among the first data to suggest that depressive symptoms in this culture are common, especially in women. Depression is particularly common in those with diabetes. Psychiatric intervention may be necessary in addition to lifestyle changes to prevent the exponential increase in the occurrence of Type 2 diabetes. In addition, a common approach including psychiatric treatment in diabetes care may be necessary to achieve improved glycaemic control in this population.

OBJECTIVE -To determine the prevalence of type 2 diabetes and impaired fasting glycemia (IFG) in a rural population of Bangladesh.RESEARCH DESIGN AND METHODS -A cluster sampling of 4,923 subjects Ն20 years old in a rural community were investigated. Fasting plasma glucose, blood pressure, height, weight, and girth of waist and hip were measured. BMI and waist-to-hip ratio (WHR) were calculated. Total cholesterol, triglycerides, and HDL cholesterol were also estimated. We used the 1997 American Diabetes Association diagnostic criteria.RESULTS -The crude prevalence of type 2 diabetes was 4.3% and IFG was 12.4%. The age-standardized prevalence of type 2 diabetes (95% CI) was 3.8% (3.12-4.49) and IFG was 13.0% (11.76 -14.16). The subjects with higher family income had significantly higher prevalence of type 2 diabetes (5.9 vs. 3.5%, P Ͻ 0.001) and IFG (15.6 vs. 10.8%, P Ͻ 0.001) than those with lower income. Employing logistic regression in different models, we found that wealthy class, family history of diabetes, reduced physical exercise, and increased age, BMI, and WHR were the important predictors of diabetes. Total cholesterol, triglycerides, and HDL cholesterol showed no association with diabetes and IFG.CONCLUSIONS -The prevalence of diabetes and IFG in the rural population was found to be on the increase compared with the previous reports of Bangladesh and other Asian studies. Older age, higher obesity, higher income, family history of diabetes, and reduced physical activity were proved significant risk factors for diabetes and IFG, whereas plasma lipids showed no association with diabetes and IFG. Further study may address whether diabetes is causally associated with insulin deficiency or insulin resistance.

A higher prevalence of diabetes mellitus (DM) in the urban population was observed compared with rural subjects despite similar body mass indexes (BMI). Differences in obesity, waist/hip ratio or hypertension failed to explain the increasing occurrence of T2DM in the urban population.

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Low prevalence of type 2 diabetes and relative high impaired fasting blood glucose was observed. The factors associated with the occurrence of diabetes in this population appeared to differ than its known relations with BMI. This may indicate that the risk factors for type 2 diabetes are likely to differ in different population. Our results are likely to be in line with the Indian data suggesting that a revised guideline for anthropometric measures in the South Asian population is called for, in order to classify people at risk.