Diabetes in Bangladesh

Diabetes is a major public health problem worldwide and is a leading cause of death in many countries.¹ It is metabolic disorder characterized by presence of high blood sugar due to imperfections in insulin secretion, action, or both.^2,3 Studies have shown a relatively high prevalence of both pre-diabetes and diabetes in Bangladesh.⁴ The prevalence of diabetes has been increasing over time in Bangladesh.^4,5 Some of the risk factors identified include urbanization, increasing age, hypertension, obesity, female gender, and higher socioeconomic status.^4,6  Addressing the diabetes crisis is urgently required in Bangladesh since it can lead to further complications in patients such as stroke, heart attack, chronic kidney disease, neuropathy, visual impairments, and amputations.⁷ Collectively, this can lead to increased healthcare usage, expenses, and burden on the healthcare system.

Mental Health in Bangladesh

Mental health receives little attention in the broad spectrum of health and wellness in Bangladesh. It is a much-neglected area but has significant impact on productivity and quality of life. Studies have shown high prevalence of mental disorders in Bangladesh among different groups.^8-10 However, there is a lack of adequate facilities and mental health practitioners to ­­address this significant health crisis. Additionally, limited government resources and funding are available to support mental health related programs and existing policies do not align well with current needs.¹¹ Adding to the complication is the lack of awareness among patients along with stigma surrounding mental health disorders in Bangladesh.¹²

Diabetes and depression in Bangladesh

Diabetes and depression as a comorbid condition can be a clinical challenge since presence of one condition can worsen the other.¹³ The resulting health condition can increase disability, lead to poor prognosis, and increase healthcare cost.^14-17 Unfortunately, depression is ignored or given lesser attention when present in patients with diabetes. It has been shown that there is a higher risk of developing type 2 diabetes in adults suffering from depression.¹⁸ Conversely, diabetics have a higher risk of developing or having a recurrence of depression which might be attributed to the psychological demands of diabetes management, lifestyle changes, incidence of complications and related consequences.¹⁹

The prevalence of depression with diabetes in Bangladeshis is high and studies have shown ranges between 15.3% to 36%.^20-23 Depression in diabetic patients can play a significant role in nonadherence to treatment including maintaining dietary restrictions and exercise regimen, poor glycemic control, and increased diabetic complications all of which can ultimately lead to poor diabetes management and prognosis.^24-33 Despite these findings, there is limited research on the association between diabetes and depression in Bangladesh.³⁴ More attention needs to be given in understanding the association between diabetes and depression and ways to effectively treat them. Additionally, a patient focused approach should be undertaken where diabetic patients are routinely screened for depression at healthcare facilities and management strategies attuned to resource poor settings should be implemented.³⁵ Healthcare providers should also consider treating both diabetes and depression simultaneously.²³ Effective psychological support can be expected to help reduce not only depression but also metabolic disorders and related complications.²⁷

Reference:

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2.           Kharroubi AT, Darwish HM. Diabetes mellitus: The epidemic of the century. World J Diabetes. 2015;6(6):850-867.

3.           American Diabetes A. Diagnosis and classification of diabetes mellitus. Diabetes Care. 2010;33 Suppl 1(Suppl 1):S62-69.

4.           Akhtar S, Nasir JA, Sarwar A, et al. Prevalence of diabetes and pre-diabetes in Bangladesh: a systematic review and meta-analysis. BMJ Open. 2020;10(9):e036086.

5.           Saquib N, Saquib J, Ahmed T, Khanam MA, Cullen MR. Cardiovascular diseases and type 2 diabetes in Bangladesh: a systematic review and meta-analysis of studies between 1995 and 2010. BMC Public Health. 2012;12:434.

6.           Talukder A, Hossain MZ. Prevalence of Diabetes Mellitus and Its Associated Factors in Bangladesh: Application of Two-level Logistic Regression Model. Sci Rep. 2020;10(1):10237.

7.           Mohiuddin AK. Diabetes Fact – Bangladesh Perspective. International Journal of Diabetes Research.

8.           Ria II, Biswas RK, Alam A, Rakshit PV, Tahsin S. Depressive Symptoms Among Adolescents in Bangladesh. International Journal of Mental Health and Addiction. 2022.

9.           Mridha MK, Hossain MM, Khan MSA, et al. Prevalence and associated factors of depression among adolescent boys and girls in Bangladesh: findings from a nationwide survey. BMJ Open. 2021;11(1):e038954.

10.        Islam MS, Rahman ME, Moonajilin MS, van Os J. Prevalence of depression, anxiety and associated factors among school going adolescents in Bangladesh: Findings from a cross-sectional study. PLoS One. 2021;16(4):e0247898.

11.        Hasan MT, Anwar T, Christopher E, et al. The current state of mental healthcare in Bangladesh: part 1 – an updated country profile. BJPsych Int. 2021;18(4):78-82.

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15.        Golden SH, Lazo M, Carnethon M, et al. Examining a bidirectional association between depressive symptoms and diabetes. JAMA. 2008;299(23):2751-2759.

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17.        Egede LE, Zheng D, Simpson K. Comorbid depression is associated with increased health care use and expenditures in individuals with diabetes. Diabetes Care. 2002;25(3):464-470.

18.        Knol MJ, Twisk JW, Beekman AT, Heine RJ, Snoek FJ, Pouwer F. Depression as a risk factor for the onset of type 2 diabetes mellitus. A meta-analysis. Diabetologia. 2006;49(5):837-845.

19.        Kinder LS, Katon WJ, Ludman E, et al. Improving depression care in patients with diabetes and multiple complications. J Gen Intern Med. 2006;21(10):1036-1041.

20.        Asghar S, Hussain A, Ali SM, Khan AK, Magnusson A. Prevalence of depression and diabetes: a population-based study from rural Bangladesh. Diabet Med. 2007;24(8):872-877.

21.        Roy T, Lloyd CE, Parvin M, Mohiuddin KG, Rahman M. Prevalence of co-morbid depression in out-patients with type 2 diabetes mellitus in Bangladesh. BMC Psychiatry. 2012;12:123.

22.        Bhowmik B, Binte Munir S, Ara Hossain I, et al. Prevalence of type 2 diabetes and impaired glucose regulation with associated cardiometabolic risk factors and depression in an urbanizing rural community in bangladesh: a population-based cross-sectional study. Diabetes Metab J. 2012;36(6):422-432.

23.        Rahman M, Rahman MA, Flora MS, Rakibuz-Zaman M. Depression and associated factors in diabetic patients attending an urban hospital of bangladesh. International Journal of Collaborative Research on Internal Medicine & Public Health. 2011;3(1):64-76.

24.        Eraker SA, Kirscht JP, Becker MH. Understanding and improving patient compliance. Ann Intern Med. 1984;100(2):258-268.

25.        de Groot M, Anderson R, Freedland KE, Clouse RE, Lustman PJ. Association of depression and diabetes complications: a meta-analysis. Psychosom Med. 2001;63(4):619-630.

26.        Kilbourne AM, Reynolds CF, 3rd, Good CB, Sereika SM, Justice AC, Fine MJ. How does depression influence diabetes medication adherence in older patients? Am J Geriatr Psychiatry. 2005;13(3):202-210.

27.        Vickers KS, Nies MA, Patten CA, Dierkhising R, Smith SA. Patients with diabetes and depression may need additional support for exercise. Am J Health Behav. 2006;30(4):353-362.

28.        Bahety P, Agarwal G, Khandelwal D, et al. Occurrence and Predictors of Depression and Poor Quality of Life among Patients with Type-2 Diabetes: A Northern India Perspective. Indian J Endocrinol Metab. 2017;21(4):564-569.

29.        Lin EH, Katon W, Von Korff M, et al. Relationship of depression and diabetes self-care, medication adherence, and preventive care. Diabetes Care. 2004;27(9):2154-2160.

30.        Gonzalez JS, Peyrot M, McCarl LA, et al. Depression and diabetes treatment nonadherence: a meta-analysis. Diabetes Care. 2008;31(12):2398-2403.

31.        Papelbaum M, Moreira RO, Coutinho W, et al. Depression, glycemic control and type 2 diabetes. Diabetol Metab Syndr. 2011;3(1):26.

32.        Lustman PJ, Anderson RJ, Freedland KE, de Groot M, Carney RM, Clouse RE. Depression and poor glycemic control: a meta-analytic review of the literature. Diabetes Care. 2000;23(7):934-942.

33.        Novak M, Mucsi I, Rhee CM, et al. Increased Risk of Incident Chronic Kidney Disease, Cardiovascular Disease, and Mortality in Patients With Diabetes With Comorbid Depression. Diabetes Care. 2016;39(11):1940-1947.

34.        King H, Aubert RE, Herman WH. Global burden of diabetes, 1995-2025: prevalence, numerical estimates, and projections. Diabetes Care. 1998;21(9):1414-1431.

35.        Islam SM, Ferrari U, Seissler J, Niessen L, Lechner A. Association between depression and diabetes amongst adults in Bangladesh: a hospital based case-control study. J Glob Health. 2015;5(2):020406.