Survey of random blood sugar levels amongst leprosy-disabled people in Bangladesh

People with leprosy-related disability in north west Bangladesh were surveyed for diabetes. According to patient reports,97 (27.1/1000) already knew they suffered from diabetes mellitus. Amongst 3573 subjects who underwent a random blood sugar test, anyone with random blood sugar level above 11.0 mmol/l was referred for confirmation of diabetes and advice (111). Unexpectedly, we also found that 30.1% asymptomatic people without a previous diagnosis of diabetes had random blood sugar in the “impaired glucose tolerance” range (i.e. 7.8- 11.0 mmol/l). These people were asked to have a second blood test for fasting blood sugar level, and if this was high (above 7.0 mmol/l) they were advised to have a review with a doctor, preferably at the local diabetic clinic. A sample of people (5%) with Blood sugar levels in the normal range were also invited to have a second test for fasting blood sugar; amongst them only 2 had elevated fasting blood sugar levels (>7.0). Thus another 14 were referred with high fasting blood sugar levels. Of those125 people (considered to be Diabetes suspects) newly-detected with hyperglycaemia, 121 attended a suitable service provider for confirmation/exclusion of diabetes, within 1month of their abnormal blood test. Of them 47 (37.6%) were diagnosed with diabetes. However, 4 people did not take action as advised, and 2 died before attending clinic. Taking into account new diagnoses and old, we estimate a minimum prevalence of 40.3/1,000 amongst leprosy-disabled people in NW Bangladesh. These findings indicate the advisability of routine screening for diabetes amongst people affected by leprosy during routine clinic reviews, and that the ability and motivation to manage their own self-care of people with leprosy related disability and diabetes should be assessed. Appropriate follow up and advice for those with blood sugar in impaired glucose tolerance (IGT) range needs consideration, to minimise their future risk.