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Articles by T. A. Chowdhury
Total Records ( 2 ) for T. A. Chowdhury
  H. Khan , S. S. Lasker and T. A. Chowdhury

Aims  To determine the prevalence and reasons for refusal to commence insulin in Bangladeshi patients with Type 2 diabetes.

Methods  A survey of 212 Bangladeshi patients seen in a hospital diabetes unit, with poor glycaemic control (HbA1c≥ 8.0%) on maximum oral glucose-lowering therapy, in whom insulin was deemed necessary. Patients who refused insulin were invited to attend focus groups. Data were analysed by thematic content analysis using the constant comparative method.

Results  Of 212 patients offered insulin, 122 (57.5%) commenced insulin immediately, 47 (22.1%) started insulin within 6 months and 43 (20.3%) refused to commence insulin despite repeated counselling. Thirty-six (83.7%) of those who refused insulin agreed to participate in focus groups. Reasons for insulin refusal included: disease severity—perceptions that requirement for insulin was an indicator of a more serious stage of their condition; insulin leading to premature death—common suggestion that commencing insulin led to early death; loss of control—including fear of hypoglycaemia, weight gain, loss of independence and reliance on others to give insulin or look for signs of hypoglycaemia; lack of perception of benefits—poor perception of the benefits of improved glycaemic control on quality of life and cardiovascular risk; needle anxiety—a significant proportion of subjects conveyed concern over frequent injections.

Conclusions  Insulin refusal is common in Bangladeshi subjects with Type 2 diabetes and poor glycaemic control. A number of factors contribute to this, and methods to overcome the barriers to insulin therapy need to be sought.

  T. A. Chowdhury

Diabetes and cancer are common conditions, and their co-diagnosis in the same individual is not infrequent. A link between the two conditions has been postulated for almost 80 years, but only in the past decade has significant epidemiological evidence been amassed to suggest that diabetes and cancer are associated, and the link appears causal. Hyperinsulinaemia, adipocytokines, growth factors and epigenetic changes may be implicated in the pathogenesis of cancer amongst patients with diabetes, and recently, diabetes therapies have also been implicated. There is reasonable circumstantial evidence that metformin may decrease the risk of cancer amongst diabetic patients. Much more research is required to elucidate the link between diabetes and cancer, particularly the potential link with diabetes treatments.

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