Comorbidities and Care Practices of Diabetic Patients

Research Article

Austin J Public Health Epidemiol. 2017; 4(2): 1059.

Comorbidities and Care Practices of Diabetic Patients

Rahaman KS¹*, Majdzadeh R², Naieni KH³ and Raza O³

¹School of Public Health, International Campus, Tehran University of Medical Sciences, Iran

²Department of Epidemiology and Biostatistics & Knowledge Utilization Research Center, School of Public Health, Tehran University of Medical Sciences, Iran

³Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Iran

*Corresponding author: Rahaman KS, School of Public Health, International Campus, Tehran University of Medical Sciences, Tehran, Iran

Received: March 16, 2017; Accepted: July 07, 2017; Published: July 14, 2017


Introduction: Diabetes mellitus causes millions of deaths every year around the globe posing serious threat to public health. Death occurs mostly due to co-morbidities and complications resulting from diabetes. Our study was designed with the aim to observe the co-morbidities and practices regarding care of diabetes among patients with type 2 diabetes mellitus.

Methods: In 2016, we conducted this quantitative cross-sectional study by recruiting suitable type 2 diabetic patients conveniently forms the outpatient department of BIRDEM hospital, Dhaka. Patients more than 18 years old have been included in this study. Pre-tested, structured questionnaire was used to gather necessary information. Co-morbidities were identified by patient’s medical history. Univariate and bivariate analysis has been done to identify significant factors associated with practices.

Results: Majority of the patients (75%) were suffering from co-morbidities. Respiratory illnesses, cardiovascular diseases particularly hypertension and renal diseases were the most commonly found co-morbidities. The mean practice score was 16.89 (95% CI for mean 16.25-17.53). Poor practice level were observed among 30% of the respondents. Gender (p=<0.001), marital status (p=<0.001), habitats (p=<0.001), education (p=0.001) and educational program on diabetes (p=<0.001) were the most associated factor with care practices diabetes.

Conclusion: Poor practice levels were found in this cohort with several associated factors. Physicians counselling and motivation as well as robustly designed educational program encouraging self-care of patients can be effective tool to deal with co-morbidities and existing complications of diabetes.

Keywords: Co-morbidities; Practices; Diabetes mellitus; Type 2


Diabetes mellitus is a major public health issue with increase in global prevalence taking place predominantly in developing countries particularly in Southeast Asians [1,2]. It is also counted as major threat of death worldwide [3] and projected to be the 7th leading cause of death in 2030 [4]. Diabetes was the direct cause of 1.5 million deaths and additional 2.2 million deaths occurred due to increased risk of co-morbidities linked with hyperglycemia estimated in 2012 [4,5]. It is estimated that most diabetic adults are suffering from at least 1 chronic illness [6] and 40% of them have at least 3 co-morbidities [7].

The prevalence of diabetes is increasing drastically in Bangladesh during past few years [8]. According to the recent report, 7.1 million adults are suffering from diabetes and within 2040 the projected figure would be nearly two folds [9]. Prevalence is higher in urban areas (8.1%) [10]. Moreover, Bangladesh is among the top ten countries in the world having highest number of diabetic individuals [9]. Diabetes induces many complications (acute or chronic) over time in most cases [11]. Diabetes is the prime cause of many systemic diseases in high-income countries [9] and risk of death among diabetics is twice than non-diabetics. The high prevalence of diabetes in Bangladesh will consecutively increase the number of people with diabetic complications and co-morbid conditions [13,14]. Lack of awareness and definite care will influence patient’s quality of life imposing economic burden [15].

Prominent health care and significant amount of health care cost are required for diabetic patients with multiple chronic conditions [7,16,17]. Necessary intervention is needed otherwise the care expenditure of diabetes will have negative impact on health care system [18]. Therefore, care practices of patients regarding diabetic complications and related co-morbidities are necessary. This primary study can be of help designing future interventional strategies.


This particular study was carried out to figure out about what extent diabetic patients are suffering from other co-morbid conditions, the level of practices regarding complications of diabetes care and its associated factors in Dhaka, Bangladesh.

Materials and Methods

A cross-sectional study was carried out on suitable 425 type two diabetic patients. We recruited patients conveniently from outpatient department of BIRDEM hospital, a referral hospital in Dhaka, Bangladesh particularly for diabetic patients. The study period was from July 2016 to September 2016. Type-2 diabetic patients (both male and female) older than 18 years coming to follow up or seeking general treatment in medicine outpatient departments with at least 1 year past the initial diagnosis of diabetes were included. Exclusion criteria were pregnant women, emergency care patients, and inpatients. Data were collected by experts and trained data collection team. The questionnaire did not have of any questions which can disclose the identity of patients or their treating doctors. Ethical considerations were fulfilled by obtaining verbal consent and maintaining the confidentiality.

Questionnaire design

A pre-tested structured, bilingual questionnaire was developed comprised both open and close ended questions. Patients were interviewed face-to-face by data collection team. The patients were free to choose the language for answering the questionnaire (English and Bengali). The questionnaire was divided into few main categories such as demographic information, socioeconomic information, diabetes and co-morbidity history and practice related information. Medical records were reviewed to identify diagnosed co-morbid conditions, recent Random Blood Sugar (RBS) report and Hemoglobin A1C (HbA1C) levels (within 6 months of the inclusion) retrospectively.

Statistical analysis

Collected data were then entered for analysis to Statistics Package for Social Science (SPSS) version 22 for Windows. Descriptive statistics and frequency distributions were used to describe participant characteristics. Principal Component Analysis (PCA) method was used to determine respondent’s socioeconomic status by calculating patients fixed assets and employment status. One way ANOVA was used to compare means for variables with more than two categories. A ‘p’ value less than 0.05 was taken to define significant relationship among variables.


A total of about 425 diabetic patients were selected randomly in this study. The table below Table 1 shows the total number of participants by age group and number of female with percentage according to the age group. Among the participants attended in the study, males were 234 (55.1%). Most of the participants were between age group of 26-45 years (n=231; 54.4%). The mean ± SD age of the study participants was 43.45 ± 11.81 years (range 21-82 years). The graphical pictures show that males were affected by type 2 diabetes more than females.