| PART ⅠEpidemiological survey of type 2 diabetes mellitus in Guangxi Nanning community residentsBackground Diabetes Mellitus(Diabetes,DM)is a group of metabolic diseases characterized by chronic hyperglycemia,caused by defects in insulin action and/or insulin secretion.Diabetes has now become the third largest threat to human health,following the malignant tumor and cardiovascular disease.Data from all sides show that the prevalence of DM in most parts of the world is in a state of sustained growth and has become one of the most serious and critical health problems in the 21 st century.According to the epidemiological survey data,Chinese DM population is large,with the prevalence rate increased rapidly,China has become the largest DM country.T2DM could result in multiple complications,accounts for at least 90% of all cases of diabetes,is the key of prevention and treatment of DM.Health care costs for intestinal T2DM has become a great financial burden to the patients,family and the whole society.T2DM is considered to be a result of environmental and genetic risk factors,a large number of studies have been done on T2DM and its risk factors in China and abroad.However,the results are different because of the world wide variety of lifestyle caused by the different regional and ethnic difference.Nanning as the capital of the Guangxi Zhuang Autonomous Region,the political,economic,transportation,science,education,financial and information center,is a multi-ethnic city.With the reform and opening up of China and the held of ASEAN Expo,the material and cultural level of the residents in Nanning has been greatly improved last ten years.At the same time,the situation of the T2DM in Nanning has changed greatly.Datas of the prevalence and control of blood sugar compared with other provinces in guangxi is few.Therefore,it is of great significance to explore the prevalence of T2DM and analyze the risk factors of T2DM in Nanning and Guangxi.The study will provide data for slowing down the spread of T2DM and the prevention and treatment of T2DM and chronic complications.Objective1.To investigate the the prevalence of T2DM and prediabetes,calculate the T2DM awareness rate,drug treatment rate,analysis of the risk factors of T2DM in Nanning community population.2.To investigate the control of blood glucose,calculate the control rate of T2DM and analyze the risk factors affecting blood glucose control in the previously diagnosed T2DM.Methods Adopting the random cluster sampling,13 community were randomly selected in Nanning,and representative ages 40 and older with a residence age ≥ 5 years community residents’ data were collected.The survey includes questionnaire(demographic characteristics,past history,personal history,marriage history,diet,lifestyle,sports,emotional status,etc),physical examination(height,weight,blood pressure,heart rate,waist circumference,hip circumference)And laboratory tests(transaminases,lipids,fasting blood glucose,OGTT-2h blood glucose,etc).To conduct a comprehensive analysis of the prevalence,awareness rate,treatment rate and risk factors of T2DM among ages 40 and older Nanning community population.To study the situation of blood glucose control in previously diagnosed T2DM population,explore the control rate of T2DM and the factors that affect blood glucose levels.Results1.The prevalence of T2DM in Nanning community The prevalence rate of T2DM for the ages 40 and older residents in Nanning community was 11.7%(1052/9022),the awareness rate was 74%(779/1052),and the standard rate was 9.14 %.The prevalence of prediabetes was 29.1%(2624/9022).The male T2DM prevalence rate was 12%,and 11.5%in female,but the difference was not statistically significant(χ2=0.506,P > 0.05).The prevalence rates of type 2 diabetes was significant differences between different ethnic groups(13.8% for Han vs.7.3% for zhuang vs.11.9% for minority)(χ2=76.727,P < 0.001).The prevalence rate of T2DM increased significantly with the age(χ2=451.143,P<0.001).2.Risk factors of T2DM in Nanning community For male: multiple logistic regression analysis showed that the elder(OR=1.639,95%CI:1.805,2.357),living alone(OR=1.892 95%CI: 1.047,3.419),excessive eating frequency(OR=1.745,95%CI:1.221,2.493),do not eat soy products(OR=1.577,95%CI:1.165,2.133),do not drink carbonated beverages(OR=1.994,95%CI:1.304,3.048),abnormal heart rate(OR=1.477,95%CI:1.021,2.137),higher triglyceride(OR=1.606,95%CI:1.155,2.045)were risk factors for T2DM.Zhuang relative to Han(OR=0.626,95%CI:0.457,0.856),non-DM family history(OR=0.63,95%CI:0.429,0.925),do not eat dairy products(OR=0.648,95%CI:0.489,0.858)were protective factors for T2DM.For female: multiple logistic regression analysis showed that the elder(OR=1.509,95%CI:1.509,1.752),excessive eating frequency(OR=1.634,95%CI:1.082,2.467),higher waist to hip ratio(OR=1.486,95%CI:1.131,1.951),do not eat fresh fruit(OR=2.146,95%CI:1.321,1.321),higher GGT(OR=1.665,95%CI:1.208,2.294),do not drink carbonated beverages(OR=1.933,95%CI:1.270,2.942),abnormal heart rate(OR=1.449,95%CI:1.072,1.959),higher TG(OR=1.606,95%CI:1.286,2.005)were risk factors for T2DM.Zhuang relative to Han(OR=0.729,95%CI:0.557,0.953),non-DM family history(OR=0.418,95%CI:0.321,0.545),the control diet(OR=0.627,95%CI:0.432,0.910),the life satisfaction(OR=0.809,95%CI:0.663,0.988)were protective factors for T2DM.3.Blood glucose control in Nanning community In all confirmed T2DM population(1052 people),drug treatment rate was58.1%(611/1052),the control group was 536,Hb A1c(6.10 ± 0.56)%,poor control group was 498,Hb A1c(8.74±1.70)%,blood glucose control rate 51.8%(536/1034),a statistically significant difference in between the two groups(t=33.92,P<0.001).There were 779 previously diagnosed T2DM patients,a total of 586 people were treated with drugs,T2DM treatment rate was 76.7%.According to the level of Hb A1 c was divided into two groups,of which the good control group was 427,Hb A1c(6.10 ± 0.55)%,poor control group wad 337,Hb A1c(8.64 ±1.63)%,blood glucose control rate was 55.9%,there was significant difference in Hb A1 c between the two groups(t=30.14,P<0.001).The value of Hb A1 c was no significant difference between different gender and age(P>0.05).4.Influencing factors of blood glucose control in previously diagnosed T2DM Multiple logistic regression analysis showed that do not eat pickles is a protective factor for blood glucose control(OR=0.620,95%CI:0.459,0.838),higher HOMA-IR was a risk factor for blood glucose control(OR=2.778,95%CI:2.027,3.806).Conclusions1.The prevalence rate of type 2 diabetes for the ages 40 and older community residents in Nanning was paralleled to the national average,and grows rapidly.The prevalence rate of prediabetes was lower than the national average.T2DM and prediabetes increased rapidly in the last ten years,and the prevalence rate increased year by year.2.The total awareness rate,treatment rate and control rate of T2DM in Nanning community was higher compared with the national average.There is still much room for improvement.3.The drug treatment rate and control rate of the patients who had been previously diagnosed with T2DM were higher,which indicated prevention and control of T2DM in Nanning community has achieved initial results.4.4.Elder,excessive eating frequency,abnormal heart rate,higher triglyceride,DM family history were risk factors of T2DM in Nanning community male;Living with spouse and children,Zhuang relative to Han,bean products were protective factors for T2DM in male.Elder,excessive eating frequency,higher waist hip ratio,higher GGT,control diet,abnormal heart rate,higher triglyceride,DM family history were risk factors of T2DM in Nanning community female;Zhuang relative to Han,fresh fruits,satisfaction with life were the protective factors for T2DM in female.5.Eating pickles,higher HOMA-IR were risk factors for blood glucose control in previously diagnosed T2DM.PART ⅡStudy on the relationship between the lowing LDL-C drug target polymorphism and type 2 diabetes mellitusBackground Type 2 diabetes mellitus(T2DM)is a complex disease,which is closely related to the genetic and environmental factors.Similar to diabetes,dyslipidemia in Chinese population increased significantly.Abnormal blood lipid levels,especially elevated levels of LDL-C,is a key factor in the occurrence and development of atherosclerotic cardiovascular disease.Dyslipidemia may lead to increased risk of cardiovascular events in patients without timely intervention.Several guidelines still recommend LDL-C as the main target and evaluation index for dyslipidemia,and all kinds of LDL-C drugs have broad market.With the increase in the prescription of lipid-lowering drugs,some potential and easily overlooked side effects have gradually attracted the attention.The use of statins and the genetic variation of target HMGCR have been shown to be associated with an increased risk of developing T2DM.The relationship between non-statins LDL-C drugs and the genetic variation of the target with T2DM is not clear.The data of the Chinese population in this area are few.Objective Investigate the relationship between the polymorphism of PCSK9 、NPC1L1 and the risk of T2DM in Nanning community population,and to determine whether NPC1L1 and PCSK9 are susceptible to T2DM.Methods Adopting case-control study,randomly selected T2DM and controls from Nanning city communities and the surrounding areas.The general demographic data,physical examination data and clinical biochemical indicators were collected.The peripheral blood samples of 3 ml were collected and the genomic DNA was extracted by the DNA Kit.511 pairs of samples were obtained by propensity score matching.MALDI-TOF-MS was used to detect the polymorphism of r NPC1L1(rs217386,rs2073547)and PCSK9(rs11591147,rs11206510).SPSS 23.0 software was used to describe the general characteristics of the samples and analyze the genotype distribution.Hardy-Weinberg equilibrium,Linkage disequilibrium and Haplotype were analyzed by using shesis software.Gene-environment ineractions were evaluated by using the MDR software and logistic regression analysis.Results1.General overview786 subjects with T2DM and 1015 Controls were recruited in this study,and 980 cases(490 pairs)were detected by genotyping after matching.2.The general characteristics of the subjects Univariate analysis showed that there was no significant difference in age,gender,nationality,smoking,drinking,physical activity,tea drinking,LDL-C,TC,ALT and AST between the two groups(P > 0.05).The difference of systolic blood pressure,diastolic blood pressure,family history,wc,tg,ggt,living situation and educational attainments between the two groups were statistically significant(p < 0.05).Multivariate logistics regression analysis suggested that higher BMI(OR:1.356,95%CI:1.108,1.661),higher GGT(OR:1.873,95%CI:1.190,2.946),higher SBP(OR:1.393,95%CI:1.036,1.872),higher TG(OR:1.759,95%CI:1.315,2.353)were risk factors of T2DM.The protective factors were higher educational attainments(OR:1.356,95%CI:1.108,1.661),non-DM family history(OR:0.832,95%CI:0.392,0.813)and living with offspring(OR:0.548,95%CI:0.343,0.875),(p < 0.05).3.The relationship between NPC1L1,PCSK9 polymorphism and T2DM Compared with wild homozygous AA,the distribution frequency of heterozygous mutant AG of NPC1L1 rs2073547 in T2DM group and Control group was statistically significant(P<0.05),the OR value and 95%CI value were 1.425(1.072,1.893);Compared with AA genotype,the distribution of GG+GA genotype frequency in the two groups was statistically significant(P<0.05),the OR value and 95%CI value was 1.433(1.096,1.874);Compared with A,the frequency of allele G was significantly different between the two groups(P<0.05),the OR value and 95%CI value were 1.275(1.038,1.566).All results were adjusted by educational attainments,BMI,living situation,GGT,SBP,TG,DM family history.There was no significant difference in genotype frequencies between the two groups of NPC1L1 rs217386 and PCSK9rs11206510(P> 0.05).There was no significant difference in the distribution frequency of rs217386 and rs2073547 haplotype of NPC1L1 gene between T2DM group and control group(P>0.05).4.Interaction between environmental factors and NPC1L1 rs2073547 polymorphism The optimal interaction model formed by NPC1L1 rs2073547,educational attainments,BMI and living situation was found to significantly increase the risk of T2DM(OR:3.870,95%CI:2.967,5.047).Conclusions1.Lowing LDL-C target NPC1L1 is associated with increased risk of T2DM in Nanning population,which may be the susceptibility gene of T2DM.Heterozygous mutation of genotype AG vs AA in rs2073547 may increase the risk of T2DM.2.No association was found between PCSK9 rs11591147,rs11206510 polymorphism and T2DM in Nanning population.3.There were interaction between NPC1L1 rs2073547,BMI,living situation and educational attainments,which was significant correlation with the occurrence of T2DM. |
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