DISABILITY BURDEN OF DIABETES MELLITUS AND ITS COMPLICATIONS

This specific analytical cross-sectional study was conducted at the Out Patient Department (OPD) of BIRDEM hospital to estimate and compare disability burden of Diabetes Mellitus (DM) and its complications during the period of January-June 2003. Data was collected by face-to-face interview with a semi-structured questionnaire and a checklist. To estimate disability burden, Years lived with Disability (YLD) was calculated. Out of total 154 patients, 53% were female while 47% were male and their mean age was 47.02 (± 8.42) years. Around 48% patients claimed the onset age of 40-49 years. Average monthly family income of the patients was TK.16,488.27±6042.40 and 27% of them were illiterate. Out of all, 72% patients had diabetes with complications while the rest 28% had diabetes without complications. With regard to disability burden, total 473.43 YLDs was shared by the patients of which only 20.46% YLD was shared by diabetes itself while major part of YLD (79.54%) was shared by its complications and the discrepancy was statistically significant (‘t’(152) =11.34, p<0.01). It was revealed that the highest YLD was incurred by DM with cardiovascular diseases (37.56%) followed by DM with retinopathy (19.82%) and DM with nephropathy (12.98%). More YLD (52.65%) was shared by the patients with poor compliance with therapy while 34.27% and 13.08% YLD were incurred by the patients with moderate and good compliance with therapy respectively. Older patients shared more YLD than the younger patients and the disparity was statistically significant (‘t’(152)=9.53, p<0.01). More YLD was shared by the patients with long duration of the disease than the patients with short duration and this divergence was statistically significant (‘t’(152)=8.71, p<0.01). The study outcome will recommend for reduction of burden of DM by averting its major complications.


Introduction
Non-communicable diseases has emerged as a challenge for financing the health system globally. 1iabetes mellitus is a recognized major chronic public health problem throughout the world and WHO has targeted major strategies for prevention & control of the disease. 2 It is observed that worldwide prevalence of DM may increase to 5.4% by the year 2025 and major part of this increase will occur in developing countries.4][5] Diabetes mellitus is now recognized as a major public health problem in Bangladesh.It is estimated that the number of diabetics is 2.5 million and is expected to grow dramatically in the country. 6Prevalence DM in a suburban population of Bangladesh in 1995 was estimated 4.1% (men 4.13% & women 3.90%). 7nother study in 1997 among the rural and urban population of Bangladesh revealed a combined prevalence of DM as 5.2% (5.5% men, 4,8% women) of which rural 3.8% and urban 7.8%. 8A recent study in rural population of Bangladesh estimated overall prevalence of diabetes as 4.3% (5.2% men & 3.2% women). 9The overall estimated prevalence of diabetes in Bangladeshi population is 5.6% and more than 96% of which are reported as type 2 DM. 10,11The trend of increase of DM will certainly alarm the health system of the country, which will attract the health policymakers and health professionals at different level. 12- 14The World development report focused that diabetes mellitus accounts for 0.8% YLD of which 1.9% in developed and 0.7% in developing regions. 15,16DM causes different organic or systemic complications, which produces extra disability and economic burden to the patients and society. 17,18Evidences suggest that both the incidence and prevalence of DM are increasing in Bangladesh.The study aims to estimate disability burden of DM and its complications in terms of YLD, which will enable both health care providers and consumers to reduce burden of DM by averting its complications through well management of this chronic disease.

Materials and Methods:
Disability burden of DM was estimated in terms of Years Lived with Disability (YLD) following the methodology used by WHO in estimation of "Global Burden of Disease".Duration of the disease, age weight, disability weight and time preference was considered in this regard.

Conclusion:
The study was conducted among DM patients who attended the OPD of BIRDEM hospital to estimate disability burden of DM and its complications.It was found that more disability burden (YLD) was incurred by complications of DM, which was more among female patients.Nephropathy, cardiovascular disease, retinopathy & neuropathy were the predominant complications.More YLD was directly associated with increase of age and long duration of disease but it was more among middle economic class.Both illiterate and educated patients shared higher YLD.Poor patient compliance with therapy incurred more YLD.To reduce disability burden of DM, its perilous complications should be averted by early diagnosis & prompt treatment along with adherence to therapy.

Study Design:
Cross-sectional type of Analytical study.Study Period: January to June 2003.Place of the Study: Out-Patient Department (OPD) of BIRDEM hospital.Sample Size: The sample size was 154, which was taken conveniently considering the time and other resource constraints.Sampling Technique: Systematic random sampling technique was used for data collection and every third patient was interviewed.Data Collection Tools: A semi-structured questionnaire was used to collect data from the patients and a Checklist was used to collect information from patients' reference book.Data collection techniques: Face to face interview & reviewing patients' reference book.Data Processing and Quality Control: Data was checked for any inconsistency and irrelevancy.Data processing considered categorizing, coding, summarizing and entry of data.Data Analysis: Data was analyzed by computer using SPSS software (Version 15.0).
age there was increase in YLD.It was reflected that with increase in age of the patient, there was increase in duration and complications of the disease and as a result more YLD was incurred.