Kamruzzaman, Md, Horowitz, Michael, Rahman, Muhammad Shafiqur, Deshmukh, Harshal, Jones, Karen L., and Marathe, Chinmay S. (2025) Glycemic control is worse in rural compared to urban type 2 diabetes in Bangladesh, irrespective of food security status. Journal of Diabetes Investigation, 16 (6). pp. 1112-1118.

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Abstract

Background: Food insecurity (FIS) affects around 25% of Bangladesh's population, and data from developed nations report higher FIS rates among individuals with type 2 diabetes (T2D), potentially worsening glycemic control. The importance of FIS to T2D has not been studied in developing countries such as Bangladesh, with substantial disparities in healthcare access, especially between rural and urban areas. We evaluated the relationships between food insecurity and glycemic control in the context of area of residence among individuals with T2D in Bangladesh. Methods: A total of 849 individuals with T2D attending diabetes clinics in four districts of Bangladesh completed a validated questionnaire to assess the FIS (a score ≥ 3 is indicative of FIS), which was compared with their sociodemographic and biochemical data. Two-way anova and multiple linear and binary logistic regression analyses were performed. Results: Both HbA1c levels (10.8% vs 9.5, P < 0.001) and the prevalence of FIS (45.8% vs 31.4%, P < 0.001) were higher in rural areas. According to two-way anova (0.87–1.78% mean difference, P < 0.05) and multiple linear regression model (β = 1.4, P < 0.001), HbA1c levels were also higher among rural than urban dwellers, irrespective of their FIS status. Rural dwellers were also more than twice as likely to have suboptimal glycemic control (HbA1c ≥7%; AOR: 2.26 (1.35–3.97), P < 0.05), irrespective of their food security status (AOR: 1.19 (0.78–1.84, P > 0.05)). Conclusions: In Bangladesh, rural residence is associated with poor glycemic control, irrespective of food security status, and thus is an important social determinant of diabetes care that warrants further exploration.

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