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TRACK Implementation: a 

Bangladesh Scenario 

 

Abdul Kader Mohiuddin1 
 
1Dr. M. Nasirullah Memorial Trust, 
Tejgaon, Dhaka, Bangladesh 

 

Vol. 9, No. 1 (2020)   |   ISSN 2166-7403 (online)  

DOI 10.5195/cajgh.2020.416 |   http://cajgh.pitt.edu 

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MOHIUDDIN 

 

 

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Abstract 

With the increasing burden of non-communicable diseases in low-income and middle-income countries (LMICs), biological risk 

factors, such as hyperglycemia, are a major public health concern in Bangladesh. Optimization of diabetes management by positive 

lifestyle changes is urgently required for prevention of comorbidities and complications, which in turn will reduce the cost. Diabetes 

had 2 times more days of inpatient treatment, 1.3 times more outpatient visits, and nearly 10 times more medications than non- 

diabetes patients, as reported by British Medical Journal. And surprisingly, 80% of people with this so called “Rich Man's Disease” 

live in low- and middle-income countries. According to a recent study of American Medical Association, China and India 

collectively are home of nearly 110 million diabetic patients. The prevalence of diabetes in this region is projected to increase by 

71% by 2035. Bangladesh was ranked as the 8th highest diabetic populous country in the time period of 2010-2011. In Bangladesh, 

the estimated prevalence of diabetes among adults was 9.7% in 2011 and the number is projected to be 13.7 million by 2045. The 

cost of diabetes care is considerably high in Bangladesh, and it is primarily driven by the medicine and hospitalization costs. 

According to Bangladesh Bureau of Statistics, in 2017 the annual average cost per T2DM was $864.7, which is 52% of per capita 

GDP of Bangladesh and 9.8 times higher than the general health care cost. Medicine is the highest source of direct cost (around 

85%) for patients without hospitalization. The private and public financing of diabetes treatment will be severely constrained in 

near future, representing a health threat for the Bangladeshi population. 

Keywords: Blood sugar Screening; Compliance; Overweight; Lifestyle; Regular health checkup; Ramadan fasting; Climate 

issue of diabetes 

TRACK (by NEHEP) Implementation: 

a Bangladesh Scenario 

 

Abdul Kader Mohiuddin1 
 
1Dr. M. Nasirullah Memorial Trust, Tejgaon, 
Dhaka, Bangladesh 

News: research and practice 

Bangladesh was ranked as the 8th highest 

diabetic populous country in the time period of 2010-

2011 [1]. In Bangladesh, the estimated prevalence of 

diabetes among adults was 9.7% in 2011 and the number 

is projected to be 13.7 million by 2045. The cost of 

diabetes care is considerably high in Bangladesh, and it 

is primarily driven by the medicine and hospitalization 

costs. According to Bangladesh Bureau of Statistics, in 

2017 the annual average cost per T2DM was $864.7, 

which is 52% of per capita GDP of Bangladesh and 9.8 

times higher than the general health care cost [2].  

In Bangladesh, specifically, the IDF projects the 

prevalence of diabetes will increase to more than 50% in 

the next 15 years [3,4]. About 129,000 deaths were 

attributed to diabetes in Bangladesh in 2015, as reported 

by leading research organization ICDDR, B [5]. 

According to the WHO-Diabetes country profile of 

Bangladesh in 2016, the physical inactivity was 

prevailing among 25.1% of population [6]. Around 85% 

population of age group 25-65 never checks for diabetes 

[7]. A recent study by British Medical Journal says, 1 in 

10 Bangladeshi adults aged ≥18 years have 

hyperglycemia (among urban residents) [8]. Even in rural 

Bangladeshi community, undiagnosed diabetes was high, 

7.2% found in a 2016 and 10% in 2019 [9,10]. Roughly 

20%–30% of adults in rural areas of Bangladesh have 

abnormal fasting glucose or impaired glucose tolerance, 

with the prevalence of diabetes (mostly type 2 diabetes) 

expected to reach 24%–34% by 2030 [10-12]. And IDF 

says, there are 7.1 million people with undetected 

diabetes in Bangladesh and this number will be double  

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Figure 1. TRACK, a program of National Institute of Health (NIH), England to memorize the factors that can 

contribute to health while living with diabetes [14]. 

by 2025 [13]. Prevalence of dyslipidemia was over 70% 

to both male and female subjects, which indicates the 

urgency of lifestyle intervention strategies to prevent and 

manage this important health problem and risk factor 

[15]. Among 8400 stroke patients from different 

hospitals in Bangladesh over a period of sixteen years, 

diabetic patients were nearly 25% [16].  

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Risk Factors Prevalence 

Physical inactivity (overall) 25.1% 

Physical inactivity (among adults) 35% to 38% 

Young adults among capital who unmet recommended physical activity 80% 

Adults who never checks diabetes 85% 

Undiagnosed diabetes among rural population 7.2% 

Adults with hyperglycemia 10% 

Abnormal fasting glucose among rural population 20%-30% 

People over the age of 35 having diabetes under control 12% 

People over 35 

had abnormal fasting glucose 

25% 

Stroke among diabetic patients 25% 

Non-compliance with medication 87% 

Prevalence of dyslipidemia More than 70% 

Obesity among young adults 22% to 27% 

Obesity among school going children 40% 

Mothers unaware of consequences of childhood obesity 70% 

Obesity among urban women 34% 

Obesity among married women 30% 

Obesity increase among women in 15 years study 17.5% 

Higher prevalence of diabetes among males 7.4% 

Overall consumption of fast food consumption among youth and children Around 54% 

Prevalence of self-reported depression 47% 

Smokers (male) 37% 

GDM 15% 

Adulterated food in daily consumption 50% 

Child marriage 30% 

Undernourished women 33% 

Underweight among children aged less than five years 40% 

Low health literacy (among urban people) 60% 

Table 1. Summary of Diabetic Risk Factors in Bangladesh 

ICDDR, B, estimated 150 food items in the country. 

More than 50% of the food samples they tested were 

adulterated reported by the Institute of Public Health 

(IPH) [17]. Undoubtedly human health is now under the 

domination of formalin, in Bangladesh about 400 tons of 

formalin is being imported which are goes to human 

stomach, creates deadly mistreats on long term exposure 

[18]. Several studies highlighted formaldehyde-induced 

neurodegeneration, diabetes risk and diabetes-associated 

cognitive impairments [19-21]. Even more unfortunate is 

the fact that nefarious practice of food adulteration 

increases exponentially during the month of Ramadan in 

Bangladesh [22]. 

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A Netherlands based study in CNN Health says, 

"a 1-degree Celsius rise in environmental temperature 

could account for more than 100,000 new diabetes cases 

per year in the USA alone" [23]. A similar study says 

Bangladesh will exceed 35-degree Celsius before the end 

of the century [24]. Consuming arsenic contaminated 

food grains could be another reason of high diabetes 

prevalence [25].  In sex-stratified analyses with 641 

subjects from rural Bangladesh, a study reported arsenic 

exposure (50.01-150 μg/L) showed a clearer pattern of 

dose-dependent risk for hyperglycemia in females than 

males [26]. Again, 15% of expecting women are 

diagnosed with gestational diabetes among these 60% 

contribute to permanent diabetes within 10 years, says Dr 

Samsad Jahan (professor of Obstetrics and Gynecology, 

BIRDEM) [27]. 

According to a 2018 BBC record, insulin 

availability found supplies were low in six countries - 

Bangladesh, Brazil, Malawi, Nepal, Pakistan and Sri 

Lanka [28,29]. Also, huge gap between the number of 

diabetic patients and doctors are well-known [30]. The 

Diabetic Association of Bangladesh (DAB) record 

shows, except Dhaka and Chittagong, there are no 

tertiary facilities in Bangladesh to preventing blindness 

due to diabetic retinopathy. Children with diabetes are 

still managed by adult physicians or occasionally by adult 

diabetologists, except in institutions like BIRDEM, and 

Dhaka Shishu Hospital [31].  

Around 22% to 27% Bangladeshi youth were 

recorded as obese with different stages of obesity [32]. 

Another study says nearly 40% Bangladeshi youth, 

taking fast foods were recognized as overweight where 

32% were noted as obese with different phases of obesity 

and overall prevalence of fast food consumption was 

about 53.8% [33]. In a newspaper interview, Professor 

AK Azad Khan, President, Diabetic Association of 

Bangladesh said 40% school going children of Dhaka 

city were either obese or overweight [34]. “Children with 

type 2 diabetes is rising “alarmingly” in Bangladesh. A 

300% raise in the last five years”, according to the 

Changing Diabetes in Children Program of the BIRDEM 

hospital [35]. A community level study shows 35% of 

mothers perceived that childhood overweight/obesity 

could be a health problem and nearly 70% were not aware 

of any health consequences of childhood obesity [36]. 

Another study shows 97.4% students consume fast food 

contain Monosodium Glutamate which causes obesity 

and other body discomforts [37]. In a similar study 

among students of 4 private universities of Dhaka, 98% 

of the students were well informed about the negative 

effects associated with excessive fast food consumption, 

they were still profoundly addicted to it [38]. Prevalence 

rates of overweight and obesity are higher in urban 

peoples compared to rural peoples living in Bangladesh 

[39]. 

According to the WHO-Diabetes country 

profile of Bangladesh in 2016, the physical inactivity was 

prevailing more than 25% of population. Bangladeshi 

women more at health risk than men due to inactivity. 

Two big reasons to diabetes among Bangladeshi people 

are carbohydrate-dependent food pattern and sedentary 

lifestyle [40-42]. Evidence shows that prevalence of 

physical inactivity 35% to 38% in Bangladeshi adults 

aged 25 years and older [43]. 

 Despite the high levels of diabetes and 

intermediate hyperglycemia, awareness and control of 

the condition is low [44]. In a cross- sectional study in 

urban population of Bangladesh, more than 60% of the 

diabetic patients had inadequate functional health literacy 

of them and nearly 90% had inadequate glycemic control 

(HbA1c>8%) [45]. Also, another study says that 

diabetes-related health literacy in rural Bangladesh is a 

major factor associated with diabetic retinopathy (DR) 

screening [46]. 

The IDF atlas estimated the incidence of type 1 

diabetes in Bangladesh as 4.2 new cases of 

T1DM/100,000 children (0–14 years)/year, in 2013 [31]. 

The social challenges faced by T1DM children are 

numerous. Many of them are poor, with little access to 

education. They are often considered a burden on the 

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family, especially girls; they have little prospect of 

getting married or being employed. According to 

UNICEF, Bangladesh has the fourth highest prevalence 

rate of child marriage in the world, and the second highest 

number of absolute child brides – 4.5 million. Around 

30% of girls in Bangladesh married before the age of 15 

and nearly 80% got married before the age of 18 [47-49]. 

The prevalence of nutritional deficiency was relatively 

higher among rural, illiterate and early married women 

and among those with a low standard of living. Child 

marriage, low-birthweight, mother nutrition and diabetes 

closely related to each other [50]. 

Recently, Telenor Health and DAB have 

launched the first- ever diabetes management service, 

Dia360, to help people with diabetes manage their blood 

sugar levels and reduce risks of complications. People 

can enroll in three DAB centers in Dhaka—Bangladesh 

Institute of health and Sciences, Bangladesh Institute of 

Research and Rehabilitation in Diabetes, Endocrine and 

Metabolic Disorders (BIRDEM) General Hospital, and 

the National Health Network Hospital. It has more than 

400,000 diabetics registered at its tertiary center, 

BIRDEM in Dhaka. However, the most important thing 

is patient education, that the modern world is giving the 

highest priorities. Rich or poor, privileged or 

unprivileged, all segment of population should be 

brought under the arena of compliance through patient 

education, at least by health campaign. Both government, 

profit taking NGOs and pharmaceutical companies 

should take initiatives in this regard. 

 

Abbreviations 

Low- And Middle-Income Countries (LMICs); 

International Diabetes Federation (IDF); National Eye 

Health Education Program (NEHEP); Bangladesh 

Demographic and Health Survey (BDHS); Bangladesh 

Institute of Research and Rehabilitation in Diabetes, 

Endocrine and Metabolic Disorders (BIRDEM); Institute 

of Public Health (IPH). 

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Central Asian Journal of Global Health 

Volume 9, No. 1 (2020) |  ISSN 2166-7403 (online) | DOI 10.5195/cajgh.2020.416|http://cajgh.pitt.edu 

 

 

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