Kamruzzaman Md, Horowitz Michael, Rahman Muhammad Shafiqur, Deshmukh Harshal, Jones Karen L, Marathe Chinmay S
Adelaide Medical School, University of Adelaide, Adelaide, South Australia, Australia.
Centre of Research Excellence in Translating Nutritional Science to Good Health, University of Adelaide, Adelaide, South Australia, Australia.
J Diabetes Investig. 2025 Jun;16(6):1112-1118. doi: 10.1111/jdi.70015. Epub 2025 Mar 13.
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.
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.
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)).
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.
粮食不安全影响着约25%的孟加拉国人口，发达国家的数据显示2型糖尿病（T2D）患者的粮食不安全率更高，这可能会使血糖控制恶化。在孟加拉国这样的发展中国家，医疗服务可及性存在巨大差异，尤其是城乡之间，粮食不安全对2型糖尿病的影响尚未得到研究。我们评估了孟加拉国2型糖尿病患者中，粮食不安全与居住地区背景下血糖控制之间的关系。
孟加拉国四个地区糖尿病诊所的849名2型糖尿病患者完成了一份经过验证的问卷，以评估粮食不安全情况（得分≥3表明存在粮食不安全），并将其与社会人口统计学和生化数据进行比较。进行了双向方差分析以及多元线性和二元逻辑回归分析。
农村地区的糖化血红蛋白（HbA1c）水平（10.8%对9.5，P<0.001）和粮食不安全患病率（45.8%对31.4%，P<0.001）均较高。根据双向方差分析（平均差异0.87 - 1.78%，P<0.05）和多元线性回归模型（β = 1.4，P<0.001），无论粮食不安全状况如何，农村居民的HbA1c水平也高于城市居民。农村居民血糖控制不佳（HbA1c≥7%）的可能性也比城市居民高出两倍多（调整后比值比：2.26（1.35 - 3.97），P<0.05），无论其粮食安全状况如何（调整后比值比：1.19（0.78 - 1.84，P>0.05））。
在孟加拉国，无论粮食安全状况如何，农村居住与血糖控制不佳相关，因此是糖尿病护理的一个重要社会决定因素，值得进一步探索。
