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Response: Increasing Prevalence of Type 2 Diabetes in a Rural Bangladeshi Population: A Population Based Study for 10 Years (Diabetes Metab J 2013;37:46-53)
Bishwajit Bhowmik1, Faria Afsana2, Lien My Diep1,3, Sanjida Binte Munir4, Erica Wright5, Sharif Mahmood6, A. K. Azad Khan2, Akhtar Hussain1
Diabetes & Metabolism Journal 2013;37(2):153-154.
Published online: April 16, 2013
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1Department of Community Medicine, Institute of Health and Society, University of Oslo Faculty of Medicine, Oslo, Norway.

2Department of Endocrinology, Bangladesh Institute of Research and Rehabilitation in Diabetes, Endocrine and Metabolic Disorders (BIRDEM), Dhaka, Bangladesh.

3Unit for Biostatistics and Epidemiology, Oslo University Hospital, Oslo, Norway.

4Executive Diabetes Care Centre, NHN, Diabetic Association of Bangladesh, Dhaka, Bangladesh.

5ACT Diabetes Service, Division of Medicine, Canberra Hospital, Canberra, Australia.

6Institutes of Statistical Research and Training, University of Dhaka, Dhaka, Bangladesh.

Corresponding author: Bishwajit Bhowmik. Department of Community Medicine, Institute of Health and Society, University of Oslo Faculty of Medicine, P.O. Box 1130, Blindern, N-0317 Oslo, Norway.

Copyright © 2013 Korean Diabetes Association

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

We sincerely appreciate the interest and comments regarding our study, "Increasing prevalence of type 2 diabetes in a rural Bangladeshi population: a population based study for 10 years" which was published in Diabetes & Metabolism Journal 2013;37:46-53. Our responses to Nan Hee Kim's comments follow:
We agree with reviewer's comment that it may be more convincing if we included all the mentioned factors (like dietary data, smoking habits, and physical activity, etc.). We should keep in mind that this is a rural agricultural society where manual labour is the only means for farming. Therefore, other than the land lords (few indeed) people work manually for 8 to 10 hours. Therefore questions like "leisure time physical activity" may not be relevant. In addition, variables like dietary data and smoking habits were not included in previous two studies (1999 and 2004). It should be noted that in 2009 study, we did not find any significant association of body mass index (BMI), socioeconomic condition, education level, family history of diabetes, smoking habits, and physical inactivity as risk indicators for diabetes [1]. This is possibly owing to the fact that almost no women in culture smoke and physical activity is high with a low BMI.
Second, we used the same cutoff level for waist-hip ratio (WHR) to maintain the flow of our previous two studies [2]. We have also attempted with 3 cutoff level for WHR but did not get any significant findings possibly due to low statistical power in each stratum. This may also be mentioned that previous cross-sectional and prospective studies in Bangladesh have found WHR a better predictor of type 2 diabetes than waist circumference [1-4].
Third, decreasing prevalence of hypertension is noteworthy. Landmark study like WHO MONICA [5] is in agreement with our findings. It is true that antihypertensive is only used when diagnosed with hypertension and therefore should not affect the prevalence of hypertension in ideal situation. In this context people can buy almost any drugs over the desk in a pharmacy. People often use these antihypertensive drugs with increasing age and obesity without any prescription. Therefore we cannot rule out the possibility for such unexplained observations. However, we cannot ignore the possibility of measurement error but the measurement of blood pressure was conducted by trained physicians in all studies.
We again thank the reviewer for providing very thoughtful comments.

No potential conflict of interest relevant to this article was reported.

  • 1. Bhowmik B, Binte Munir S, Ara Hossain I, Siddiquee T, Diep LM, Mahmood S, Mahtab H, Khan AK, Hussain A. Prevalence of type 2 diabetes and impaired glucose regulation with associated cardiometabolic risk factors and depression in an urbanizing rural community in bangladesh: a population-based cross-sectional study. Diabetes Metab J 2012;36:422-432. ArticlePubMedPMC
  • 2. Rahim MA, Hussain A, Azad Khan AK, Sayeed MA, Keramat Ali SM, Vaaler S. Rising prevalence of type 2 diabetes in rural Bangladesh: a population based study. Diabetes Res Clin Pract 2007;77:300-305. ArticlePubMed
  • 3. Hussain A, Rahim MA, Azad Khan AK, Ali SM, Vaaler S. Type 2 diabetes in rural and urban population: diverse prevalence and associated risk factors in Bangladesh. Diabet Med 2005;22:931-936. ArticlePubMed
  • 4. Asghar S, Khan AK, Ali SM, Sayeed MA, Bhowmik B, Diep ML, Shi Z, Hussain A. Incidence of diabetes in Asian-Indian subjects: a five year follow-up study from Bangladesh. Prim Care Diabetes 2011;5:117-124. ArticlePubMed
  • 5. Kuulasmaa K, Tunstall-Pedoe H, Dobson A, Fortmann S, Sans S, Tolonen H, Evans A, Ferrario M, Tuomilehto J. Estimation of contribution of changes in classic risk factors to trends in coronary-event rates across the WHO MONICA Project populations. Lancet 2000;355:675-687. ArticlePubMed

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      Response: Increasing Prevalence of Type 2 Diabetes in a Rural Bangladeshi Population: A Population Based Study for 10 Years (Diabetes Metab J 2013;37:46-53)
      Diabetes Metab J. 2013;37(2):153-154.   Published online April 16, 2013
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