bangladesh is divided into 64 administrative districts and has a population of 149.7 million , area of 147,570 km , and population density of approximately 1015 people / km2 .
the country has a total fertility rate of 2.3/capita gdp of $ 772 , life expectancy of 69.5 years .
the government 's expenditure on health is the third largest in the country , after education and defense .
the paradox of bangladesh lies in its gdp and its achievements in the health , education , and socio - economic sectors .
the latest international diabetes federation ( idf ) atlas estimated the incidence of type 1 dm ( t1 dm ) in bangladesh at 4.2 new cases of t1dm/100,000 children ( 014 years)/year , in 2013 .
the highest incidence of t1 dm ( children 014 years ) is estimated to be in europe and north america , with south - east asia closely following the trend at third position .
a series of studies have reported a constant global increase in the incidence of t1 dm , and multifactorial process might be involved . at the bangladesh institute of research and rehabilitation in diabetes , endocrine and metabolic disorders ( birdem ) , there has been an upward trend in the number of newly diagnosed children , from 112 cases in 2008 to 319 cases in 2013 , as documented by the changing diabetes in children ( cdic ) program at birdem .
the question , however , remains whether this upward trend is because of a real increase in the incidence of childhood dm or increased awareness and a decrease in prevalence of communicable diseases , brought about by hygienic practices , immunization against common infectious diseases , with a concomitant rise in non - communicable diseases ( ncd ) .
recent studies show that it is likely that multifactorial reasons are responsible for the increasing incidence e.g. , hygienic practices , feeding regimens ( autoimmunity to cow 's milk ) .
badas has contributed massively to educating the public about diabetes , such that the hitherto unaccepted notion that children could get and die from dm , has been translated into a relatively low threshold for testing for dm in children with polyuria , loss of weight , unconsciousness etc .
they are often considered a burden on the family , especially girls ; they have little prospect of getting married or being employed .
dm is likely to be hidden from teacher , prospective spouse and employer , often with far - reaching consequences .
lack of motivation , inability to manage common complications e.g. , hypoglycaemia , sick day management , drop out from the clinic ( which may be due to lack of motivation or extra cost involved in travel ) , psychological issues , are other common problems .
the diabetic association of bangladesh ( badas ) , which was established in 1956 , is the largest of its kind in the world , with 68 affiliated associations in 64 districts of the country .
it has more than 400,000 diabetics registered at its tertiary centre , birdem in dhaka .
prior to badas , there was no care available for patients with dm needing insulin under the government health services , so poor patients faced certain death !
episodic care was the only kind available , and patients with chronic diseases , faced an uncertain and grim future .
the motto was that  no diabetic shall die untreated , unfed or unemployed , even if poor. starting of as an opd , badas has grown into a network of 64 affiliated associations , one in as many districts , and a chain of small hospitals and opds , as well as medical and nursing schools .
all patients , irrespective of socio - economic status , are entitled to free consultation and certain tests .
treatment , including insulin , is available to patients free of cost if entitled , or according to income .
badas operates on a cross - financing model , such that services for the poor are subsidized from the income earned from the well - to - do , who come to seek care or be investigated .
badas is a member of the idf and was a who collaborative centre until recently .
children with diabetes are still managed by adult physicians or occasionally by adult diabetologists , except in institutions like birdem , where paediatricians took over the care of children , and adolescents with diabetes in 1997 , as well as in dhaka shishu hospital .
children and adolescents have special needs at different stages e.g. , nutrition , schooling , growth , puberty etc .
initially , when the department of paediatrics started , the majority of patients were classed as mrdm , and classical t1 dm were a minority . however , the situation is reversed now , with an increase across all socio - economic groups of t1 dm . the burden of providing for the care of diabetic patients places a huge demand on the stretched resources of badas . t1
two programs need special mention , the changing diabetes in children ( cdic ) program , and the life for a child ( lfac ) program , the former sponsored by novo nordisk and the latter by the international diabetes federation ( idf ) .
the central one is located in dhaka and the peripheral ones are located in 2 district headquarters ; chittagong and faridpur .
the number of patients enrolled in dhaka is 1477 , in faridpur 216 and 200 in chittagong .
age of the children range from 0 - 18yrs . under the lfac program , there are 2200 registered ( 1yr-23yrs ) .
there is a slight preponderance of females over males . with the launch of these 2 programs ,
the intensity of motivation and education increased and as a result , glycaemic control has improved over time from a hba1c of more than 9% to a gradual fall to < 7.5% amongst the cdic patients .
both the programs are providing support by providing free consultation , free insulin , education , machines for measurement of hba1c , microalbumin on spot urine sample , and retinal camera .
some blood tests , annual check - up and screening for complications , growth and pubertal monitoring are done free of cost .
cdic has constructed the clinic within the premises of the women 's and children hospital ( birdem2 ) and has been providing funds for running the clinic including doctors and supporting staff salary . under its umbrella , cdic supports some health care staff , including a psychologist . and runs an enviable education programme .
the education program was set up with the help of cdic , and employs diabetes educators , a cadre specially trained in a structured diabetology course , training patients and caregivers in injection and testing techniques , and advising patients about any issues related to diabetes .
however , now diabetes educators are being paid for by patients using the cross  financing model .
also certain components of the chec -up are available on payment by the well - to - do .
the lfac program is carrying out a multi - centred epidemiological study of t1 dm , which will give us an insight into the risk factors , trends etc .
it also brought to the world 's notice that dm is increasing alarmingly and every nation has a responsibility to prevent the onward march of this threat , which culminates in 14 november being declared the un world diabetes day .
diabetes in children and adolescents is increasing in bangladesh , and comprehensive diabetes care is essential to achieve good glycaemic control .
diabetes education combined with appropriate motivation of the patients and caregivers is the cornerstone of dm management .
sustainability of the programs will ensure that the child with diabetes can lead a normal life .
 diabetes mellitus ( dm ) is a common endocrine disorder among children and adolescents in bangladesh . 
 the latest international diabetes federation atlas estimated the incidence of type 1 dm ( t1 dm ) in bangladesh as 4.2 new cases of t1dm/100,000 children ( 014 years)/year , in 2013 . 
 diabetes , being a lifelong disease , places a huge burden on the economy of the most densely populated , and resource - poor country of the world . 
 the diabetic association of bangladesh ( badas ) , the largest of its kind in the world , provides comprehensive care to the biggest number of diabetics at any one centre and is engaged in advocacy . 
 although sounding grandiose , it 's aims that  no diabetic shall die untreated , unfed or unemployed , even if poor is pursued with a passion . 
 recently badas has been supported in its endeavor for children and adolescents by two programmes ; viz the changing diabetes in children program ( a joint initiative of badas , the world diabetes foundation and novo nordisk ) , and the life for a child programme ( lfac ) supported by the idf . 
 numerous studies from the prosperous countries have demonstrated the incidence of t1 dm is increasing . 
 data from the cdic clinic at birdem shows a rising trend in patients presenting with classical t1 dm . 
 in addition , the pattern of dm is changing . 
I
S