# Macrovascular complications in type 2 diabetes: a multiregional study in rural Bangladesh

## TL;DR

This study examines the prevalence of heart, stroke, and foot complications in people with type 2 diabetes in rural Bangladesh and identifies key risk factors.

## Contribution

The study is the first multiregional analysis of macrovascular complications in rural Bangladesh using machine learning to identify risk factors.

## Key findings

- The prevalence of coronary artery disease, stroke, and diabetic foot was 11.2%, 5.3%, and 9.1%, respectively.
- Advanced age, longer diabetes duration, smoking, hypertension, and elevated cholesterol were consistently linked to complications.
- Machine learning models, particularly Light Gradient Boosting Machine and Random Forest, showed high accuracy in predicting complications.

## Abstract

To assess the prevalence and determinants of macrovascular complications (coronary artery disease, stroke, and diabetic foot) among adults living with T2DM in rural Bangladesh.

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.

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.

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–cardiovascular management in rural Bangladesh to reduce the progression and impact of these major vascular outcomes.