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American Journal of   Physical Education 
and Health Science (AJPEHS)

Correlation between Glycemic Control and Cardiovascular Events among Type-2 
Diabetic Patients 

Birupaksha Biswas1*, Umme Sadia2, Md Sazzad Hossain3, Sayonto Kumar Gomosta3, Md Mehedi Hasan4, Simonto Mirza5

Volume 3 Issue 2, Year 2025
ISSN: 2992-9679 (Online) 

DOI: https://doi.org/10.54536/ajpehs.v3i2.5900
https://journals.e-palli.com/home/index.php/ajpehs

Article Information ABSTRACT

Received: August 12, 2025

Accepted: September 15, 2025

Published: November 14, 2025

The aim of  this study is to determine the relationship between cardiovascular events and 
glycemic management in Bangladeshi individuals with type 2 diabetes. A cross-sectional 
study. This study was carried out 400 patients between the ages of  40 and 75 who were 
receiving treatment at two Dhaka tertiary care institutions (Dhaka Medical College and 
Hospital (DMCH) and Mugda General Hospital). Glycated hemoglobin (HbA1c) readings 
were used to measure glycemic management, and patient interviews and medical records were 
used to gather information on cardiovascular events. The demographic and clinical features 
were compiled using descriptive statistics, and the association between HbA1c levels and the 
incidence of  cardiovascular events was investigated using Pearson correlation analysis. The 
results revealed that 45% of  the patients had experienced at least one cardiovascular event, 
such as myocardial infarction, stroke, or heart failure, and 62% had poor glycemic control 
(HbA1c > 7%). Higher HbA1c levels were strongly associated with increased cardiovascular 
risk, as indicated by the moderately favourable correlation (r = 0.39, p < 0.01) between 
HbA1c levels and cardiovascular events. These results implied that among Bangladeshi 
patients with type-2 diabetes; poor glycemic control was a significant contributing factor to 
the emergence of  cardiovascular problems. In order to reduce cardiovascular risks in this 
susceptible group, the study underlined the significance of  efficient diabetes management 
techniques, such as routine monitoring and tailored medication.

Keywords

Cardiovascular Events, Glycemic 
Control, HbA1c, Type-2 Diabetes 
Mellitus 

1 Department of  Public Health, Parul University, Gujarat, India
2 Department of  Medical and Life Science, University of  Chester, Chester, UK
3 Department of  Biochemistry and Molecular Biology, Jagannath University, Dhaka, Bangladesh
4 Department of  Narcotics Control, Security Services Division, Ministry of  Home Affairs, Dhaka, Bangladesh
5 Department of  Physical and Mathematical Sciences, Chattogram Veterinary and Animal Sciences University, Chattogram, Bangladesh
* Corresponding author’s e-mail: pakshabiru2142@gmail.com

INTRODUCTION
One of  the most common chronic illnesses in the world, 
type-2 diabetes mellitus (T2DM) is becoming more 
and more common in low- and middle-income nations 
like Bangladesh (Sara, 2023). Insulin resistance and 
chronic hyperglycaemia are hallmarks of  type 2 diabetes, 
which is linked to numerous problems that drastically 
lower life expectancy and quality. The most common 
cause of  morbidity and death in diabetes people is still 
cardiovascular diseases (CVDs) (Kim, 2021). Compared 
to people without diabetes, people with diabetes have a 
two to four times higher risk of  developing cardiovascular 
problems, including myocardial infarction, stroke, and 
heart failure. Over the past 20 years, diabetes has become 
much more common in Bangladesh due to factors like 
aging, dietary changes, fast urbanization, and physical 
inactivity (Rana, 2024). In 2021, more than 13 million 
people in Bangladesh had diabetes, according to the 
International Diabetes Federation (IDF), and this number 
is expected to increase significantly over the next several 
years. Even with advancements in T2DM diagnosis 
and treatment, a sizable fraction of  diabetics still have 
inadequate glycaemic control, particularly in environments 
with limited resources (Erdin, 2023). One of  the most 
important modifiable risk factors for microvascular 
and macrovascular consequences is poor glycaemic 

control (Sun, 2021). Since glycated hemoglobin (HbA1c) 
represents the average blood glucose levels over the 
previous two to three months, it is commonly recognized 
as the gold standard biomarker for evaluating long-term 
glycaemic management. Elevated HbA1c levels have 
been associated with an increased risk of  cardiovascular 
problems in numerous studies. To lower the risk of  
vascular consequences, it is crucial to keep HbA1c within 
target ranges, according to the UK Prospective Diabetes 
Study (UKPDS) and other seminal trials (Sinha, 2021). 
Despite the rising prevalence of  diabetes in Bangladesh, 
little research has been done on the precise relationship 
between HbA1c and cardiovascular events in that country. 
Additionally, various populations may be affected by 
illness outcomes in different ways by differences in 
food habits, socioeconomic level, health literacy, genetic 
predisposition, and access to healthcare resources (Taylor, 
2022). Understanding the connection between glycemic 
management and cardiovascular outcomes is essential 
for developing effective interventions and policies in 
Bangladesh, where out-of-pocket medical expenses are 
considerable and routine blood glucose monitoring is 
frequently irregular (Farzana, 2024). Thus, the purpose 
of  this study was to look into the relationship between 
cardiovascular events and glycemic control in Bangladeshi 
patients with type-2 diabetes mellitus. This study intends 



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to inform clinical practice and public health strategies 
focused at lowering diabetes-related cardiovascular 
complications in the nation by determining if  inadequate 
glycemic management links with increased cardiovascular 
risk.

LITERATURE REVIEW
The association between glycemic control and 
cardiovascular events in type 2 diabetic patients in 
Bangladesh reflects a complex interplay of  factors 
influencing health outcomes. According to a study, 
people without vascular disease had a 27% increased 
risk of  cardiovascular events for every 1% increase in 
HbA1c, however patients with pre-existing vascular 
disorders did not have a significant risk (Kranenburg, 
2015; Sinha & Sinha, 2021). Atherosclerosis, endothelial 
dysfunction, oxidative stress, and inflammatory responses 
are all accelerated by chronic hyperglycemia, which is a 
major factor in the pathophysiology of  vascular problems 
(Díaz-Flores, 2019). Glycated hemoglobin (HbA1c), 
which is commonly used to measure glycemic control, 
has been extensively researched as a modifiable risk factor 
for cardiovascular outcomes in individuals with diabetes 
(Cavero-Redondo, 2017). Nevertheless, different research 
have shown different levels of  consistency and intensity 
in this connection. Every 1% decrease in HbA1c was 
linked to a 14% decrease in myocardial infarction and 
a 37% decrease in microvascular sequelae, according to 
the study of  (Mostafa, 2018). This seminal study laid 
the groundwork for HbA1c as a crucial clinical aim in 
diabetes treatment. Large cohort studies and recent meta-
analyses have reinforced the notion that poor glycemic 
management is associated with an elevated risk of  
cardiovascular disease (Gilani, 2024). More than 100,000 
individuals were included in a 2022 systematic analysis 
published in Diabetes Care, which found that elevated 
HbA1c levels were independently linked to higher risks 
of  cardiovascular death, coronary heart disease, and 
stroke (Cheng, 2023). More complex findings were found 
in other trials, such as the ACCORD (Action to Control 
Cardiovascular Risk in Diabetes) research. Despite 
improvements in glycemic indices, the ACCORD study, 
which aimed for intensive glycemic control (HbA1c 
target (6.0%), was prematurely stopped because the 
intensive treatment arm experienced higher all-cause 
mortality(Joseph Yeboah, 2018). Intense glycemic control 
also had minimal macrovascular advantages, according to 
the ADVANCE and VADT trials. These results moved 
the emphasis to personalized glycemic goals, particularly 
for individuals with numerous comorbidities or severe 
illness. Few extensive research have specifically looked 
at the relationship between HbA1c and cardiovascular 
events in South Asia, and Bangladesh in particular 
(Shane, 2022). More than 60% of  T2DM patients had 
poor glycemic control (HbA1c >7%), and cardiovascular 
events were more common in this group, according to a 
study by (Morris, 2023). However, the study’s conclusions 
were limited because it did not use correlation analysis 

or account for confounding variables. Although it 
lacked a large sample size and a consistent measure of  
glycemic control, another observational study conducted 
in Dhaka by (Reza, 2021) revealed a considerably greater 
prevalence of  ischemic heart disease among patients 
with uncontrolled diabetes. It has been demonstrated 
that geographical and ethnic characteristics affect the 
course of  diabetes and cardiovascular consequences. For 
example, there is a higher likelihood of  insulin resistance 
and abdominal obesity among South Asians, especially 
Bangladeshis, which are associated with a higher risk of  
cardiovascular disease (Mak, 2021). The necessity for 
country-specific data is highlighted by these metabolic 
and genetic predispositions. Furthermore, the burden 
is made worse by Bangladeshi diabetes individuals’ lack 
of  understanding of  cardiovascular risks, limited usage 
of  HbA1c monitoring, and unequal access to treatment. 
Less than 40% of  T2DM patients in Bangladeshi public 
hospitals had ever received a HbA1c test, and only 28% 
were able to recognize cardiovascular problems as a risk 
associated with diabetes, according to a recent cross-
sectional survey by (Latif, 2017). All of  these results 
suggest a steady, if  occasionally nuanced, correlation 
between cardiovascular outcomes and glycemic 
management. More population-specific research are 
required in low-resource contexts like Bangladesh to 
contextualize clinical guidelines, enhance monitoring 
techniques, and direct resource allocation, even though 
worldwide data supports HbA1c as a significant predictor 
of  cardiovascular risk. The principal objective of  this 
study is to assess the association between glycemic control 
and cardiovascular events in type-2 diabetic patients in 
Bangladesh.

Specific Objectives
• To determine the level of  glycemic control (HbA1c) 

among T2DM patients.
• To assess the prevalence of  cardiovascular events in 

the study population.
• To examine the correlation between HbA1c levels 

and cardiovascular events.

MATERIALS AND METHODS
Between January and June 2024, 400 patients with type-
2 diabetes mellitus who visited the outpatient clinics 
of  two tertiary care institutions in Dhaka, Bangladesh, 
participated in a cross-sectional study. Simple random 
sampling was used to choose participants, who had to 
meet the following inclusion criteria: be between the 
ages of  40 and 75, have had a recorded HbA1c test 
result during the previous three months, and have had a 
diagnosis of  type 2 diabetes for at least a year. Individuals 
with incomplete medical information, type-1 diabetes, 
or gestational diabetes were not included. Structured 
questionnaires and an examination of  medical records 
were used to gather data. These included demographics, 
the length of  diabetes, HbA1c levels, and any prior 
history of  cardiovascular events including heart failure, 



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Am. J. Phys. Educ. Health Sci. 3(2) 65-71, 2025

myocardial infarction, or stroke. HbA1c was used 
as a continuous variable to measure glucose control, 
while binary and frequency data were used to record 
cardiovascular events. All subjects gave their informed 
consent, and the institutional review boards of  the 
cooperating hospitals granted ethical approval. The 
data were analyzed using SPSS version 25, where the 
sample characteristics were summarized using descriptive 
statistics and the association between the frequency of  
cardiovascular events and HbA1c levels was evaluated 
using Pearson correlation analysis, with significance 
established at p < 0.05.

RESULTS AND DISCUSSION
This section summarizes the main conclusions drawn 
from the examination of  data gathered from 400 type-
2 diabetes patients in Bangladesh, with an emphasis on 
the connection between the incidence of  cardiovascular 
events and glycemic control as determined by HbA1c 
levels. The findings are interpreted in light of  the body of  
research to emphasize how important glycemic control 
is in lowering cardiovascular risk in diabetes populations.

Demographic and Clinical Characteristics
At two tertiary care facilities in Dhaka (Dhaka Medical 
College and Hospital (DMCH) and Mugda General 

Hospital), Bangladesh, 400 patients with type-2 
diabetes mellitus (T2DM) were enrolled in the study. 
According to the demographic profile, there were 182 
(45.5%) male participants and 218 (54.5%) female 
participants. With an age range of  40 to 75 years, the 
study population’s mean age was 58.3 years (±9.4). The 
bulk of  participants (60%) were between the ages of  
51 and 65. 68% of  the participants lived in cities, and 
88% of  them were married. 34% of  respondents had 
finished secondary school, whilst 22% lacked literacy. In 
terms of  occupation, 28% were retired, 21% worked in 
various corporate or professional capacities, and 41% 
were stay-at-home moms. Clinically, 46% of  participants 
had diabetes for more than ten years, and the average 
duration of  diabetes was 8.6 years (±5.2). Overall, the 
sample’s mean HbA1c was 8.2% (±1.6), which suggests 
inadequate glycemic control. Only 38% (n = 152) of  
patients maintained controlled glycemic levels (HbA1c 
≤ 7%), whereas 62% (n = 248) of  patients had HbA1c 
levels above 7%. In terms of  body mass index (BMI), 
according to Asian-specific BMI cut-offs, 28% were 
considered obese and 33% were overweight. 52% had 
a history of  dyslipidemia, and 70% reported having 
concomitant hypertension. Of  the individuals, 24% 
reported smoking, and 18% reported leading a sedentary 
lifestyle with little exercise.

Figure 1: Demographic and Clinical Characteristics

In figure 1 there are four factors identified within 
demographic and clinical characteristics. These are: clinical 
parameters, lifestyle habits, demographic characteristics 
and duration of  diabetes. 180 patients (45%) experienced 
cardiovascular events, such as heart failure (7%), stroke 
(11%), and ischemic heart disease (27%). Patients 
with poor glycemic control had a considerably higher 
prevalence of  cardiovascular events than those with 
adequate control (58.5% vs. 23.7%). These results imply 
that among type-2 diabetic patients in the population 

under study, cardiovascular outcomes are significantly 
influenced by both clinical parameters (such as HbA1c 
levels, concomitant diseases, and duration of  diabetes) 
and demographic characteristics (such as age and gender).

Prevalence of  Cardiovascular Events
There was a significant burden of  cardiovascular disease 
(CVD) among the 400 type-2 diabetic patients in this 
study, as 180 of  them (45%) reported having at least 
one cardiovascular event. Ischemic heart disease (IHD), 



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Am. J. Phys. Educ. Health Sci. 3(2) 65-71, 2025

which affected 27% of  patients, was the most commonly 
reported cardiovascular consequence. It was followed by 
stroke (11%) and congestive heart failure (7%). At the 
time of  data collection, 55% of  patients did not disclose 
any cardiovascular events that had been identified. Males 
experienced somewhat more cardiovascular events 
(49%) than females (42%), according to a gender-
based study, however this difference was not statistically 
significant (p > 0.05). Patients with poor glycemic 

control (HbA1c > 7%) had a significantly higher 
prevalence of  cardiovascular events when stratified by 
glycemic control; 58.5% of  these patients reported at 
least one cardiovascular complication, compared to only 
23.7% of  patients with good glycemic control (HbA1c ≤ 
7%). The correlation study, which showed a moderately 
good link between HbA1c levels and the incidence 
of  cardiovascular events (r = 0.41, p < 0.01), further 
corroborated this strong association.

Figure 2: Poor Glycaemic Control Elevates CVD Risk

The figure 2 showed that, numerous international 
investigations that have demonstrated a connection 
between hyperglycaemia and cardiovascular problems 
are in agreement with these findings. In the development 
of  atherosclerosis and cardiovascular events, endothelial 
dysfunction, arterial stiffness, and a pro-inflammatory 
state are all facilitated by chronic hyperglycaemia. 
The findings in this study are corroborated by the UK 
Prospective Diabetes Study (UKPDS) and other large 
cohort studies, which have demonstrated that every 1% 
increase in HbA1c is linked to a considerable increase 
in cardiovascular risk. In Bangladesh, a number of  
coexisting risk factors, including obesity, sedentary 
lifestyle, dyslipidaemia, hypertension, and lack of  access 
to cardiovascular screening or regular follow-up, may 
further contribute to the high prevalence of  CVD among 
diabetic patients. More over half  of  the individuals in 
this trial had dyslipidaemia, and 70% had concomitant 
hypertension, both of  which are significant independent 
risk factors for CVD. Additionally, the observed rates 
of  cardiovascular events may be influenced by delayed 
diagnosis and limited usage of  preventive cardiovascular 
drugs. The results show that cardiovascular risk screening 
and care for diabetic patients, especially those with 
poorly managed blood glucose, urgently need to be 
strengthened. The incidence of  CVDs in this high-
risk group could be significantly decreased by clinical 
interventions that emphasize rigorous glycemic control, 
lifestyle modification, and early diagnosis of  cardiac 
symptoms. To better treat diabetes and associated 
cardiovascular consequences, public health initiatives 

should also prioritize integrated care models, regular 
HbA1c monitoring, and diabetes education.

Correlation Analysis
Using HbA1c levels as a continuous variable and the 
number of  cardiovascular events as a quantitative 
outcome, a Pearson correlation analysis was conducted to 
investigate the association between glycemic control and 
the incidence of  cardiovascular events in patients with 
type-2 diabetes. SPSS version 25 was used to analyze data 
gathered from 400 participants.
The figure 3 showed that the frequency of  cardiovascular 
events and HbA1c levels had a moderately significant 
positive connection (r = 0.41, p < 0.01). This suggests that 
the probability and quantity of  cardiovascular problems 
tended to rise in tandem with elevated HbA1c levels. 
Higher HbA1c readings were associated with an increased 
risk of  heart failure, stroke, and ischemic heart disease, 
among other cardiovascular problems. Further analysis 
of  the correlation across various subgroups revealed that 
the correlation coefficient was slightly higher (r = 0.45) 
among patients over 60, indicating a stronger association 
in older adults; similarly, the correlation between HbA1c 
and cardiovascular events was significantly stronger (r 
= 0.48) among participants who had had diabetes for 
more than ten years, highlighting the cumulative impact 
of  prolonged poor glycemic control. Previous research 
has identified glycemic control as a key determinant of  
cardiovascular health in diabetic populations, with studies 
like the UKPDS and ACCORD trials demonstrating 
that elevated HbA1c levels over time contribute to 



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macrovascular complications. Physiologically, chronic 
hyperglycemia causes endothelial damage, encourages 
atherosclerosis, and increases oxidative stress—all of  
which are essential for the development of  cardiovascular 
disease. The hypothesis that increasing glycemic control 
may lessen the burden of  cardiovascular disease among 
type-2 diabetic patients in Bangladesh is supported by 
the significance level (p < 0.01), which indicates that the 
link found in this study is unlikely to have happened by 
accident. Correlation does not, however, imply causation, 
even when it does show a relationship. To learn more 
about the causal pathways that connect poor glycemic 

control to cardiovascular outcomes in this population, 
future longitudinal or interventional investigations are 
required.

Perception and Awareness
Designing successful public health interventions requires 
an understanding of  how type-2 diabetes patients 
perceive and are aware of  glucose management and its 
relationship to cardiovascular events. Participants in this 
study answered a series of  structured questions designed 
to gauge their attitudes, knowledge, and beliefs on 
cardiovascular risk and diabetes treatment.

Figure 3: Correlation between Glycemic Control and Cardiovascular Risk

Figure 4: Perception and Awareness of  Diabetes and Cardiovascular Disease.

The figure 4 showed that, just 38% of  the 400 
participants knew that cardiovascular problems could 
be directly caused by inadequate glucose control. Many 
people did not clearly link uncontrolled blood sugar to 
hazards like heart attacks, strokes, or heart failure, even 
though 72% of  respondents were aware that maintaining 
normal blood glucose levels was crucial for their general 
health. There is a notable lack of  knowledge on the 
wider systemic effects of  inadequate glycemic control, as 
approximately 41% of  participants thought that diabetes 
mainly affected only the kidneys or eyes. Despite clinical 
guidelines that prescribe routine monitoring at least twice 
a year for patients with stable glycemic control and more 

frequently for those with uncontrolled diabetes, only 
46% of  respondents said they had had a HbA1c test in 
the previous six months. Furthermore, the majority of  
participants were unaware of  how fasting or random blood 
glucose measurements relate to long-term cardiovascular 
risk, even though 60% of  them reported taking these 
measurements at home or in a clinic. Few people (less 
than 20%) said they had ever received official counseling 
on cardiovascular risks from healthcare providers, and 
only 35% of  respondents acknowledged cardiovascular 
symptoms like chest pain, shortness of  breath, or sudden 
weakness as potential signs of  heart-related problems. 
Despite the fact that lifestyle modifications including 



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diet, exercise, and quitting smoking are crucial for 
preventing cardiovascular disease, 58% of  respondents 
stated they only used medication to control their diabetes. 
Furthermore, awareness levels seemed to be influenced 
by socioeconomic characteristics. Higher educated and 
urban-dwelling participants were substantially more aware 
of  the connection between diabetes and heart disease 
(p < 0.05). This raises the possibility of  unequal access 
to health information and emphasizes the significance 
of  focused education for those with lower levels of  
education and those living in remote areas. Overall, 
the results indicate that although there is a fair amount 
of  basic information regarding diabetes as a chronic 
condition, there is still little particular understanding 
regarding the cardiovascular dangers connected to 
inadequate glycemic management. Underutilization of  
preventative health services, poor self-management, and 
delayed diagnosis could all be caused by this ignorance. 
Community-based health education initiatives, culturally 
competent counseling during normal diabetes care, and 
enhanced patient-provider communication about the 
systemic complications of  diabetes are all clearly needed 
to close this gap.

CONCLUSION
In this study, 400 type-2 diabetes patients in Bangladesh 
were examined to determine the relationship between 
glycemic control and the frequency of  cardiovascular 
events. The results showed that 62% of  individuals had 
HbA1c values above the suggested limit of  7%, indicating 
a significant proportion of  poor glycemic control. Of  
the sample group, ischemic heart disease, stroke, and 
heart failure were the most prevalent consequences, 
accounting for 45% of  cardiovascular events. Poor 
glycemic control is moderately linked to increased 
cardiovascular risk, according to a statistically significant 
positive connection (r = 0.41, p < 0.01) between HbA1c 
levels and cardiovascular events. The cumulative effect 
of  uncontrolled blood glucose over time was highlighted 
by this association, which was especially noticeable in 
older persons and those with a longer history of  diabetes. 
Significant gaps in patients’ knowledge and perception of  
the link between diabetes and cardiovascular problems 
were also found by the study. A significant percentage 
of  participants lacked access to routine HbA1c testing 
or thorough diabetes counseling, and many were ignorant 
that long-term hyperglycemia might directly cause heart 
disease and stroke. These results highlight the critical need 
for integrated diabetes and cardiovascular care approaches 
that prioritize patient education, ongoing monitoring, 
and early identification. The study’s conclusions suggest 
that healthcare professionals in Bangladesh should give 
patient education on the connection between poor 
glycemic control and cardiovascular risks top priority. 
They should pay special attention to routine HbA1c 
monitoring and the early identification of  cardiovascular 
symptoms. Public health campaigns should use culturally 
relevant language and resources to increase awareness 

at the community level, particularly among low-literate 
and rural communities. To guarantee early intervention, 
primary care settings should adopt integrated care models 
that incorporate cardiovascular screening and diabetes 
control. In order to promote improved glycemic control 
and lessen the long-term burden of  cardiovascular 
disease among patients with type-2 diabetes, healthcare 
systems should also increase access to diagnostic testing, 
prescription drugs, and lifestyle counselling services.

Acknowledgements
The authors would like to sincerely thank each and every 
participant for kindly providing their time and information 
for this research. Additionally, we thank the participating 
hospitals’ medical staff  for their participation during the 
data collection process. We would also want to thank our 
academic advisors for their invaluable advice during the 
study process.

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