OBJECTIVE--To determine the prevalence of non-insulin-dependent diabetes mellitus (NIDDM), impaired glucose tolerance (IGT), and hypertension in a rural community of Bangladesh. RESEARCH DESIGN AND METHODS--A cluster sampling of 1,005 subjects > 15 years of age in the rural community of Dohar was investigated. Capillary blood glucose of fasting and 2 h after 75 g oral glucose (2hBG) were estimated. World Health Organization criteria were used for diagnosis of NIDDM and IGT. Blood pressure, height, and weight were also measured. RESULTS--The crude prevalence of NIDDM was 2.1% (men 3.1, women 1.3%) and IGT was 13.3% (men 14.4, women 12.4%). Age-adjusted (30-64 years of age) prevalence was 2.23% (95% confidence interval [CI] 1.01-3.45) for NIDDM and 15.67% (95% CI 12.59-18.75) for IGT. Prevalence of hypertension with systolic blood pressure (sBP) > or = 140 mmHg was 10.5% and with diastolic blood pressure (dBP) > 90 mmHg was 9.0%. Increased age was the risk factor for NIDDM, IGT, and hypertension; whereas increased BMI showed inconsistent association with them. Relative risk for sBP with higher BMI ( < 22.0 vs. > or = 22.1) was 1.94 with CI 1.55-2.43 and for dBP it was 2.2 with CI 1.40-3.46. Correlation of sBP was significant with age, BMI, and 2hBG. Similar correlation was also observed with dBP. CONCLUSIONS--High prevalences of NIDDM, IGT, and hypertension were observed among rural subjects. Increased age was shown to be an important risk factor for all these disorders, whereas BMI-associated risk was significant with NIDDM and hypertension but not with IGT.

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Cross-sectional studies of the combined intima-media wall thickness (IMT) of the carotid arteries performed in type 1 diabetic patients show partly contradictory results with regard to variables that are associated with the IMT. Therefore, we observed the IMT progression in a longitudinal study with two follow-ups: 1) after 2-3 years (mean 2.5 Ϯ 0.4); and 2) after 4 -8 years (mean 6.3 Ϯ 1.4).A total of 65 type 1 diabetic patients (24 men, 41 women) with Յ40 years of age and a diabetes duration of Ն2 years at baseline were included. Recruitment, characteristics of patients at baseline and the methods used, including ultrasound procedures, have been reported elsewhere (1).The annual progression rate (APR) of each patient was calculated using the difference of the IMT values at the baseline and the follow-up examinations, divided by the time (in years) between these examinations.The IMT was significantly higher at both follow-up examinations (0.65 Ϯ 0.14 and 0.70 Ϯ 0.19 mm, respectively) than the baseline measurement (0.57 Ϯ 0.13 mm; mean Ϯ SD; P Ͻ 0.001). The mean APR was 0.036 mm/year until the first follow-up and 0.020 mm/year until the second follow-up, and it was significantly correlated with these baseline parameters: age, hypertension, systolic blood pressure, ACE inhibitor therapy (all P Ͻ 0.001), albumin excretion rate, nephropathy (stage IV and overall), and smoking (P Ͻ 0.05). In a multiple linear regression analysis, besides age, only hypertension as a categorical variable was an independent predictor of IMT progression. This was also the case for women when both sexes were analyzed separately, but in men the only independent predictor of APR was nephropathy stage IV.Compared with the baseline examination, the HbA 1c value was significantly lower (7.9 Ϯ 1.8 vs. 8.8 Ϯ 2.5%, P Ͻ 0.05) at the time of the second follow-up, and systolic (131 Ϯ 19 vs. 122 Ϯ 16 mmHg, P Ͻ 0.01) and diastolic blood pressure (83 Ϯ 12 vs. 75 Ϯ 11 mmHg, P Ͻ 0.001) were significantly higher. The lipids remained unchanged, except for HDL cholesterol, which increased significantly (63 Ϯ 21 vs. 51 Ϯ 18 mg/dl, P Ͻ 0.05). Significantly more patients presented with hypertension at the second follow-up (34 vs. 13%, P Ͻ 0.05), compared with the baseline examination, and the frequency of nephropathy (35 vs. 25%), retinopathy (49 vs. 31%), and plaques (34 vs. 21%) also increased without reaching significance.For young type 1 diabetic patients, diabetes seems not to be the main risk for IMT progression (while a better metabolic control could have a retarding effect on it). Hypertension plays a major role, especially in women, whereas advanced nephropathy as a diabetes-specific risk was confirmed in men only. These results are in concordance with our previous findings (2) but still have to be regarded with caution because of the relatively small number of included patients.

In recent years, non-communicable diseases (NCD) like obesity, hypertension (HTN) and Type2 diabetes (T2DM) are on the increase, specially in the developing nations. Body mass index (BMI), waist-to-hip ratio (WHR) and Waist-to-height ratio (WHtR) are used as indices of obesity to relate T2DM, HTN and coronary artery disease (CAD). This study addresses whether the risk of obesity for HTN differs between T2DM and non-DM subjects. We investigated 693 diabetic patients from BIRDEM and 2384 from communities. We measured height, weight, waist-girth, hip-girth and blood pressure. All subjects underwent oral glucose tolerance test (OGTT). BMI, WHR and WHtR were calculated. Systolic and diastolic hypertension (sHTN and dHTN)) were defined as SBP >=140 and DBP >= 90 mmHg, respectively. The prevalence of both sHTN and dHTN in T2DM was higher than the non-DM subjects (sHTN: 49.1 vs 14.3%, dHTN 19.6 vs. 9.5%). The comparison of characteristics between subjects with and without hypertension showed that the differences were significant for age, weight, waist-girth, BMI, WHR and WHtR for both T2DM and non-DM subjects (for all p<0.001). The increasing trend of hypertension with increasing obesity was observed more in the non-DM than in the T2DM subjects. The risk (OR) of obesity for hypertension increased with increasing WHR and WHtR in the non-DM than the T2DM subjects. Compared with the non-DM the T2DM participants had two to three folds higher prevalence of HTN. In either group, BMI, WHR and WHtR were significantly higher in the hypertensive than the non-hypertensive subjects. The prevalence of hypertension increased with the increasing BMI, WHR and WHtR but significant only in the non-DM. Further studies may confirm these findings and determine whether there was any altered association between blood pressure and obesity in diabetes possibily, with or without autonomic neuropathy.Ibrahim Med. Coll. J. 2007; 1(1): 1-6 Keywords: obesity, hypertension, diabetes, odds ratio WHR, waist-to-hip ratio; WHtR, waist-to-height ratio.