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

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