{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,24]],"date-time":"2026-02-24T10:03:29Z","timestamp":1771927409762,"version":"3.50.1"},"reference-count":46,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,1,26]],"date-time":"2026-01-26T00:00:00Z","timestamp":1769385600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Endocrinol."],"abstract":"<jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>To assess the prevalence and determinants of macrovascular complications (coronary artery disease, stroke, and diabetic foot) among adults living with T2DM in rural Bangladesh.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A population-based cross-sectional study was conducted between December 2023 and September 2024, involving 1094 adults with diagnosed T2DM from rural areas of three regions\/divisions in Bangladesh. Data were collected through household interviews, physical examination, and medical record reviews. Macrovascular complications were identified using clinical criteria and documented diagnosis. The leverage of six machine learning (ML) algorithms were applied in identifying influential variables associated with these complications.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The prevalence of coronary artery disease (CAD), stroke, and diabetic foot was 11.2%, 5.3%, and 9.1%, respectively. The Light Gradient Boosting Machine algorithm performed best for CAD and diabetic foot, with ROC values of 98.8% and 92.6%, respectively, while Random Forest showed the best performance for stroke with a ROC of 99%. These models also outperformed others across accuracy, precision, F1 score, and calibration. Across models, common predictors included older age, longer diabetes duration, diabetes onset at age 45 years or above, and smoking. Hypertension and elevated cholesterol were linked to CAD and stroke. Coexisting microvascular complications were also identified.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>This study identified a substantial burden of macrovascular complications among rural adults with T2DM, with CAD, stroke, and diabetic foot emerging as the most prevalent outcomes. Advanced age, longer duration of diabetes, smoking, hypertension, and elevated cholesterol were consistently associated with these complications, highlighting the need for intensified cardiometabolic risk control within primary care. These findings underscore the urgency of strengthening integrated diabetes\u2013cardiovascular management in rural Bangladesh to reduce the progression and impact of these major vascular outcomes.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fendo.2026.1724957","type":"journal-article","created":{"date-parts":[[2026,1,26]],"date-time":"2026-01-26T05:41:15Z","timestamp":1769406075000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Macrovascular complications in type 2 diabetes: a multiregional study in rural Bangladesh"],"prefix":"10.3389","volume":"17","author":[{"given":"Bodrun Naher","family":"Siddiquea","sequence":"first","affiliation":[{"name":"Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University","place":["Melbourne, VIC, Australia"]},{"name":"Prothikrit Institute of Health Studies (PIHS)","place":["Dhaka, Bangladesh"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dianna J.","family":"Magliano","sequence":"additional","affiliation":[{"name":"Diabetes and Population Health, School of Public Health and Preventive Medicine, Monash University","place":["Melbourne, VIC, Australia"]},{"name":"Baker Heart and Diabetes Institute","place":["Melbourne, VIC, Australia"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Maima","family":"Matin","sequence":"additional","affiliation":[{"name":"Institute of Genetics and Animal Biotechnology of the Polish Academy of Sciences","place":["Jastrzebiec, Poland"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Afsana","family":"Afroz","sequence":"additional","affiliation":[{"name":"Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University","place":["Melbourne, VIC, Australia"]},{"name":"Obstetrics and Gynaecology, Faculty of medicine, Dentistry and health Sciences, The University of Melbourne","place":["Melbourne, VIC, Australia"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Baki","family":"Billah","sequence":"additional","affiliation":[{"name":"Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University","place":["Melbourne, VIC, Australia"]},{"name":"Prothikrit Institute of Health Studies (PIHS)","place":["Dhaka, Bangladesh"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2026,1,26]]},"reference":[{"key":"B1","volume-title":"IDF Diabetes Atlas","year":"2025"},{"key":"B2","doi-asserted-by":"publisher","DOI":"10.2337\/dc11-0442","article-title":"Globalization of Diabetes: The role of diet, lifestyle, and genes","volume":"34","author":"Hu","year":"2011","journal-title":"Diabetes Care"},{"key":"B3","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM199306103282306","article-title":"Long-term complications of diabetes mellitus","volume":"328","author":"Nathan","year":"1993","journal-title":"New Engl J Med"},{"key":"B4","doi-asserted-by":"publisher","DOI":"10.2337\/diaclin.29.3.116","article-title":"Microvascular and macrovascular complications of diabetes","volume":"29","author":"Fowler","year":"2011","journal-title":"Clin Diabetes"},{"key":"B5","doi-asserted-by":"publisher","DOI":"10.1016\/S2213-8587(16)30010-9","article-title":"The changing face of diabetes complications","volume":"4","author":"Gregg","year":"2016","journal-title":"Lancet Diabetes Endocrinol"},{"key":"B6","doi-asserted-by":"publisher","DOI":"10.2337\/dc07-9917","article-title":"Primary prevention of cardiovascular diseases in people with diabetes mellitus: a scientific statement from the American Heart Association and the American Diabetes Association","volume":"30","author":"Buse","year":"2007","journal-title":"Diabetes Care"},{"key":"B7","doi-asserted-by":"publisher","first-page":"75","DOI":"10.1016\/j.jdiacomp.2005.06.013","article-title":"The association between metabolic control and prevalent macrovascular disease in Type 2 diabetes: the VA Cooperative Study in diabetes","volume":"20","author":"Kirkman","year":"2006","journal-title":"J Diabetes its Complications"},{"key":"B8","doi-asserted-by":"publisher","first-page":"150","DOI":"10.1186\/s12933-018-0787-8","article-title":"Vascular complications in patients with type 2 diabetes: prevalence and associated factors in 38 countries (the DISCOVER study program)","volume":"17","author":"Kosiborod","year":"2018","journal-title":"Cardiovasc Diabetol"},{"key":"B9","doi-asserted-by":"publisher","DOI":"10.1016\/j.dsx.2019.07.046","article-title":"Macro-and micro-vascular complications and their determinants among people with type 2 diabetes in Bangladesh","volume":"13","author":"Afroz","year":"2019","journal-title":"Diabetes Metab Syndrome: Clin Res Rev"},{"key":"B10","doi-asserted-by":"publisher","DOI":"10.36347\/sjams.2025.v13i06.010","article-title":"Prevalence of Macrovascular Complications among Diabetic Patients at a Tertiary Care Hospital in Bangladesh","volume":"6","author":"Alam","year":"2025","journal-title":"Sch J App Med Sci"},{"key":"B11","doi-asserted-by":"publisher","DOI":"10.3329\/birdem.v7i2.32453","article-title":"Frequency and risk factors of diabetic complications among selected group of diabetic patients: real-life scenario from a developing country, Bangladesh","volume":"7","author":"Haque","year":"2017","journal-title":"BIRDEM Med J"},{"key":"B12","doi-asserted-by":"publisher","DOI":"10.1016\/S2213-8587(17)30181-X","article-title":"Diabetes in sub-Saharan Africa: from clinical care to health policy","volume":"5","author":"Atun","year":"2017","journal-title":"Lancet Diabetes Endocrinol"},{"key":"B13","doi-asserted-by":"publisher","first-page":"1445","DOI":"10.1186\/s12889-021-11395-3","article-title":"Care-seeking and managing diabetes in rural Bangladesh: a mixed methods study","volume":"21","author":"Jennings","year":"2021","journal-title":"BMC Public Health"},{"key":"B14","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pgph.0000461","article-title":"Prevalence of, and risk factors for, diabetes and prediabetes in Bangladesh: Evidence from the national survey using a multilevel Poisson regression model with a robust variance","volume":"2","author":"Hossain","year":"2022","journal-title":"PloS Global Public Health"},{"key":"B15","doi-asserted-by":"publisher","first-page":"10248","DOI":"10.1038\/s41598-019-46766-9","article-title":"Glycaemic control for people with type 2 diabetes mellitus in Bangladesh-an urgent need for optimization of management plan","volume":"9","author":"Afroz","year":"2019","journal-title":"Sci Rep"},{"key":"B16","doi-asserted-by":"publisher","DOI":"10.2337\/dc22-S006","article-title":"6. Glycemic targets: standards of medical care in diabetes\u20142022","volume":"45","year":"2022","journal-title":"Diabetes Care"},{"key":"B17","doi-asserted-by":"publisher","first-page":"66","DOI":"10.1007\/s10389-006-0024-x","article-title":"Development of the world health organization global physical activity questionnaire (GPAQ)","volume":"14","author":"Armstrong","year":"2006","journal-title":"J Public Health"},{"key":"B18","doi-asserted-by":"publisher","DOI":"10.2337\/diacare.28.3.626","article-title":"Assessing psychosocial distress in diabetes: development of the diabetes distress scale","volume":"28","author":"Polonsky","year":"2005","journal-title":"Diabetes Care"},{"key":"B19","doi-asserted-by":"publisher","first-page":"562","DOI":"10.1038\/s41598-021-04671-0","article-title":"Psychometric validation of diabetes distress scale in Bangladeshi population","volume":"12","author":"Akter","year":"2022","journal-title":"Sci Rep"},{"key":"B20","first-page":"A79","article-title":"Assessing overweight and obesity risk among Korean Americans in California using World Health Organization body mass index criteria for Asians","volume":"3","author":"Cho","year":"2006","journal-title":"Preventing chronic Dis"},{"key":"B21","doi-asserted-by":"publisher","DOI":"10.1038\/ejcn.2009.92","article-title":"The optimal cutoff values and their performance of waist circumference and waist-to-hip ratio for diagnosing type II diabetes","volume":"64","author":"Qiao","year":"2010","journal-title":"Eur J Clin Nutr"},{"key":"B22","doi-asserted-by":"publisher","DOI":"10.1016\/j.clineuro.2005.08.003","article-title":"Validation of Michigan neuropathy screening instrument for diabetic peripheral neuropathy","volume":"108","author":"Moghtaderi","year":"2006","journal-title":"Clin Neurol Neurosurg"},{"key":"B23","doi-asserted-by":"publisher","DOI":"10.1016\/j.jbi.2008.08.010","article-title":"Research electronic data capture (REDCap)\u2014a metadata-driven methodology and workflow process for providing translational research informatics support","volume":"42","author":"Harris","year":"2009","journal-title":"J Biomed Inf"},{"key":"B24","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0219636","article-title":"Predicting long-term type 2 diabetes with support vector machine using oral glucose tolerance test","volume":"14","author":"Abbas","year":"2019","journal-title":"PloS One"},{"key":"B25","doi-asserted-by":"publisher","first-page":"7779","DOI":"10.1038\/s41598-023-34906-1","article-title":"Application of supervised machine learning algorithms for classification and prediction of type-2 diabetes disease status in Afar regional state, Northeastern Ethiopia 2021","volume":"13","author":"Ebrahim","year":"2023","journal-title":"Sci Rep"},{"key":"B26","doi-asserted-by":"publisher","first-page":"8","DOI":"10.1186\/s43067-023-00074-5","article-title":"Diabetes type 2 classification using machine learning algorithms with up-sampling technique","volume":"10","author":"Hama Saeed","year":"2023","journal-title":"J Electrical Syst Inf Technol"},{"key":"B27","article-title":"A unified approach to interpreting model predictions","volume":"30","author":"Lundberg","year":"2017","journal-title":"Adv Neural Inf Process Syst"},{"key":"B28","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0298071","article-title":"Rural and urban differences in the prevalence and determinants of Type-2 diabetes in Bangladesh","volume":"19","author":"Talukder","year":"2024","journal-title":"PloS One"},{"key":"B29","doi-asserted-by":"publisher","first-page":"380","DOI":"10.1186\/1471-2458-12-380","article-title":"Prevalence and trends of the diabetes epidemic in South Asia: a systematic review and meta-analysis","volume":"12","author":"Jayawardena","year":"2012","journal-title":"BMC Public Health"},{"key":"B30","doi-asserted-by":"publisher","first-page":"2327","DOI":"10.1007\/s00125-025-06478-4","article-title":"Variation in type 2 diabetes prevalence across different populations: the key drivers","volume":"68","author":"Gong","year":"2025","journal-title":"Diabetologia"},{"key":"B31","doi-asserted-by":"publisher","first-page":"15","DOI":"10.1007\/s13300-019-00733-9","article-title":"Management of type 2 diabetes in developing countries: balancing optimal glycaemic control and outcomes with affordability and accessibility to treatment","volume":"11","author":"Mohan","year":"2020","journal-title":"Diabetes Ther"},{"key":"B32","doi-asserted-by":"publisher","DOI":"10.1111\/jdi.70015","article-title":"Glycemic control is worse in rural compared to urban type 2 diabetes in Bangladesh, irrespective of food security status","volume":"16","author":"Kamruzzaman","year":"2025","journal-title":"J Diabetes Invest"},{"key":"B33","doi-asserted-by":"publisher","first-page":"2150132720959962","DOI":"10.1177\/2150132720959962","article-title":"Prevalence of vascular complications among type 2 diabetic patients in a rural health center in South India","volume":"11","author":"Govindarajan Venguidesvarane","year":"2020","journal-title":"J Primary Care Community Health"},{"key":"B34","doi-asserted-by":"publisher","DOI":"10.4065\/76.7.707","article-title":"Predictors of macrovascular disease in patients with type 2 diabetes mellitus","volume":"76","author":"Abu-Lebdeh","year":"2001","journal-title":"Mayo Clinic Proc"},{"key":"B35","doi-asserted-by":"publisher","first-page":"252","DOI":"10.1186\/s12902-024-01782-3","article-title":"Time to development of macrovascular complications and its predictors among type 2 diabetes mellitus patients at Jimma University Medical Center","volume":"24","author":"Adare","year":"2024","journal-title":"BMC Endocrine Disord"},{"key":"B36","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(04)17018-9","article-title":"Effect of potentially modifiable risk factors associated with myocardial infarction in 52 countries (the INTERHEART study): case-control study","volume":"364","author":"Yusuf","year":"2004","journal-title":"Lancet"},{"key":"B37","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehac249","article-title":"Cardiovascular disease, mortality, and their associations with modifiable risk factors in a multi-national South Asia cohort: a PURE substudy","volume":"43","author":"Joseph","year":"2022","journal-title":"Eur Heart J"},{"key":"B38","doi-asserted-by":"publisher","first-page":"821","DOI":"10.5603\/KP.2016.0120","article-title":"2016 European Guidelines on cardiovascular disease prevention in clinical practice","volume":"74","author":"Piepoli","year":"2016","journal-title":"Polish Heart J (Kardiologia Polska)"},{"key":"B39","doi-asserted-by":"publisher","first-page":"691","DOI":"10.1161\/CIR.0000000000000230","article-title":"Update on prevention of cardiovascular disease in adults with type 2 diabetes mellitus in light of recent evidence: a scientific statement from the American Heart Association and the American Diabetes Association","volume":"132","author":"Fox","year":"2015","journal-title":"Circulation"},{"key":"B40","doi-asserted-by":"publisher","DOI":"10.1016\/S2213-8587(15)00316-2","article-title":"Relation of active, passive, and quitting smoking with incident type 2 diabetes: a systematic review and meta-analysis","volume":"3","author":"Pan","year":"2015","journal-title":"Lancet Diabetes Endocrinol"},{"key":"B41","doi-asserted-by":"publisher","DOI":"10.1038\/sj.ijo.0803218","article-title":"Body mass index and waist circumference as determinants of coronary artery disease in Taiwanese adults with type 2 diabetes mellitus","volume":"30","author":"Tseng","year":"2006","journal-title":"Int J Obes"},{"key":"B42","doi-asserted-by":"publisher","DOI":"10.3389\/fcvm.2021.768119","article-title":"Obesity and cardiovascular disease: the emerging role of inflammation","volume":"8","author":"Khafagy","year":"2021","journal-title":"Front Cardiovasc Med"},{"key":"B43","doi-asserted-by":"publisher","DOI":"10.1182\/blood-2013-05-427708","article-title":"Inflammation, obesity, and thrombosis","volume":"122","author":"Samad","year":"2013","journal-title":"Blood J Am Soc Hematol"},{"key":"B44","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.321.7258.405","article-title":"Association of glycaemia with macrovascular and microvascular complications of type 2 diabetes (UKPDS 35): prospective observational study","volume":"321","author":"Stratton","year":"2000","journal-title":"bmj"},{"key":"B45","doi-asserted-by":"publisher","DOI":"10.1016\/j.jdiacomp.2017.11.009","article-title":"Age, age at diagnosis and diabetes duration are all associated with vascular complications in type 2 diabetes","volume":"32","author":"Nanayakkara","year":"2018","journal-title":"J Diabetes its Complications"},{"key":"B46","doi-asserted-by":"crossref","DOI":"10.1161\/CIRCULATIONAHA.117.028307","volume-title":"Reverse causality in cardiovascular epidemiological research: more common than imagined","author":"Sattar","year":"2017"}],"container-title":["Frontiers in Endocrinology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fendo.2026.1724957\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,2,24]],"date-time":"2026-02-24T09:11:14Z","timestamp":1771924274000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fendo.2026.1724957\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,1,26]]},"references-count":46,"alternative-id":["10.3389\/fendo.2026.1724957"],"URL":"https:\/\/doi.org\/10.3389\/fendo.2026.1724957","relation":{},"ISSN":["1664-2392"],"issn-type":[{"value":"1664-2392","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,1,26]]},"article-number":"1724957"}}