Abstract
Introduction: The World Health Organization (WHO) in 1985 and 1999 recommended the use of fasting plasma glucose (FPG) and 2-h post glucose load with a 75 gm oral glucose (OGTT) for identification of diabetic cases. The American Diabetes Association (ADA) published new
diagnostic criteria for diabetes in 1997. They were introduced to facilitate wider recognition of diabetes and to minimize the need for oral glucose tolerance test for epidemiological studies. The
appropriateness of these diagnostic criteria has been debated. These recommendations necessitate a critical review on the day to day variability of FPG and 2 hr OGTT. Further diabetes mellitus is a major cardiovascular risk factor associated with increased prevalence of coronary artery disease (CAD). Patients with diabetes often have numerous concomitant cardiac risk factors with a higher incidence of acute myocardial infarction (AMI) and congestive heart failure (CHF). Poor glycemic control and insulin resistance are associated with significant endothelial cell dysfunction, procoagulability, and diffuse multi-vessel cardio vascular disease. Identification of cardiovascular disease status among the newly diagnosed type 2 diabetes patients may indicate the stage of diabetes mellitus at first diagnosis and the importance of early diagnosis in order to take necessary steps to control and thereby avoid serious complication.
Objectives: To assess the day to day variability of fasting blood glucose test and 2-h oral glucose tolerance test in order to examine the internal consistency to indicate reliability of test results and
to describe the demographic characteristics and cardiovascular diseases among the newly diagnosed type 2 diabetes patients in Bangladesh. Further associated risk factors for cardiovascular
disease among the newly diagnosed type 2 diabetes patients were also examined including HbA1c.
Method and materials: Fasting blood glucose, oral glucose tolerance test and HbA1c were preceded in two consecutive days among the 218 (107 men and 111 women) newly diagnosed type 2 diabetes patients in a diabetic hospital, Dhaka, Bangladesh. Electro Cardio Graph (ECG)
and blood pressure measurements were also carried out among them. Further bio-physical and anthropometrical examinations were performed and a structured interview for the collection of demographic information.
Result: The mean BMI, systolic blood pressure and diastolic blood pressure were 23.9(±3.70)kg/m2, 126.5(±19.70) mmHg and 84.6(±13.70) mmHg respectively. The mean differences for glucose values from day 1 to day 2 was found significant for FBG 0.01, 95% CI (-0.604to-
0.077), but against for oral glucose tolerance test. It was observed that there were higher concordance between 1st day and 2nd day in the lower levels of FBG values whereas OGTT showed higher concordance among individuals with higher values. However, the observed
difference in the FBG values was restricted among one specific age and sex group. Further, a total 57 (25.3%) patients had abnormal ECG among 218 newly diagnosed type 2 diabetes mellitus subjects. Among the all subjects 10.6% had sinus trachycardia, 5.1% had sinus
bradycardia,0.5% had leaft ventricular hypertrophy, 3.7% had old myocardial infraction and 6% had ischemia. No significant association were found between abormal ECG and cardio-vascular
risk fators like Age, sex, BMI, hypertension etc.
Conclusion: It appears that the internal consistency at the lower levels of FBG values and at higher level of OGTT is dependable. The reported fasting state of the participants needs to be
verified in a more controlled study. High number of abnormal ECG findings (cardiovascular diseases) were observed among the newly diagnosed type 2 diabetes patients. This high number of cardiovascular diseases among the newly diagnosed type 2 diabetes patient may indicate the late diagnosis of the condition. By identifying risk factors for cardio-vascular diseases among the
newly diagnosed type 2 diabetes mallitus may allow us to delay or prevent early onset of complications. We suggest further studies are needed to investigate the observed difference in a specific sex and age group including lipid profiles in the assessment for the risk factors of cardiovascular diseases