Analysis of determinants of pre-diabetes and diabetes among Bangladeshi adults: an application of multinomial logistic regression model

Diabetes and pre-diabetes increase the risk of macrovascular issues, such as heart disease and stroke are the major causes of mortality worldwide. It is projected that 14.2 million adults in Bangladesh will have diabetes by 2045. Therefore, the purpose of this study was to investigate the determinants for diabetes and pre-diabetes among adult’s ≥18 years in Bangladesh. A cross-sectional study was conducted using data from the Bangladesh Demographic and Health Survey (BDHS) 2017–18, which included 11,951 respondents. A fasting plasma glucose level of ≥7.0 mmol/L or taking diabetes medication during the survey was considered “diabetes”, a fasting plasma glucose level of 6.0–6.9 mmol/L was defined “pre-diabetes”, and a fasting plasma glucose level of < 6.0 mmol/L was considered “diabetes free”. The chi-square test was utilized to find the relationship between categorical variables and the multinomial logistic regression model was used to identify the predictors of diabetes and pre-diabetes. Among the respondents, the weighted prevalence of pre-diabetes and diabetes were 17.0% and 10.0%, respectively. Based on the final multiple multinomial logistic regression model, higher BMI was strongly associated with diabetes status, with overweight and obese individuals showing higher odds of both pre-diabetes and diabetes compared to those with normal BMI. Employed individuals had 14.2% lower odds (AOR: 0.858, 95% CI: 0.749, 0.983) of developing diabetes compared to non-employed adults. In addition, there was a statistically significant association found between diabetes and hypertension, but not with pre-diabetes. The risk of diabetes increased with advancing age, higher BMI, high blood pressure, and higher socioeconomic status. This study identified several key determinants of pre-diabetes and diabetes among Bangladeshi adults, including older age, higher BMI, unemployment, hypertension, and higher socioeconomic status. The findings highlight the urgent need for targeted interventions focusing on modifiable risk factors. Policymakers should implement community-based lifestyle programs promoting healthy diets, physical activity, and weight control, especially in urban areas. Additionally, integrating routine blood glucose and blood pressure screening into primary healthcare services could facilitate early detection and prevention of diabetes.