Study On Association Of Diabetes With All-cause Mortality,Economic Burden Of Diabetes And Screening Model For Undiagnosed Diabetes

Objectives: This study aimed to assess the association between different glucose status and all-cause mortality,to investigate the direct economic burden of diabetes,and to develop a diabetes screening model.Methods:(1)A total number of 3016 participants aged 15–95 years enrolled in the Shanghai Diabetes Study have been followed up between November 2016 and April 2017 for all-cause mortality.The causes of deaths were confirmed by the Shanghai Municipal Centre for Disease Control and Prevention.Classification of deaths was defined using the 10 th revision of the International Classification of Diseases.(2)120 patients with diabetes in eight Community Health Centers of Shanghai were interviewed using a semi-structured diabetes vulnerability assessment questionnaire.Interviews were recorded digitally and transcribed verbatim.Qualitative data were coded and analyzed.(3)We selected 15309 individuals,not previously diagnosed with diabetes,and from a survey conducted between April 2013 and August 2014 in Shanghai Nicheng Community.The participants were randomly assigned to either the exploratory group or the validation group.Score points of the model were generated according to the logistic regression coefficients.Results:(1)After a mean follow-up of 13.7 years,the all-cause mortality rates(/1000 person-years)were 12.42,36.72 and 42.19 in participants with normal glucose regulation,patients with prediabetes,and patients with diabetes.The cardiovascular mortality rates(/1000 person-years)were 4.97,16.43,and 18.08 in participants with normal glucose regulation,patients with prediabetes,and patients with diabetes.Diabetes was associated with 1.5-fold increased risks of all-cause mortality and 1.8-fold increased risks of cardiovascular mortality for men compared to participants with normal glucose regulation.(2)The main questions regarding the financial burdens of diabetes covered the following aspects: Expenditure on diabetes was high,coverage ratio of existing health insurance was low and even some commonly used medicines were not covered by health insurance.The economic burden of diabetes became heavier with the presence of complications.The coverage ratio of health insurance in primary health care institutions which were easy to access was low.Unemployment further aggravated these burdens.(1)Age,family history of diabetes,hypertension,overweight/obesity,and central obesity all contributed to the final model,the Shanghai Nicheng Diabetes Screening Score.When applied to the validation group,our model had a similar discriminative ability to the New Chinese Diabetes Risk Score with fewer variables included and simpler categories of variables(AUC: 0.669 vs.0.662,P = 0.187),and performed better than other screening scores for Chinese.However,our model was inferior to fasting plasma glucose,2-hour plasma glucose,and glycosylated hemoglobin in detecting prevalent undiagnosed diabetes(AUC: 0.669(0.653–0.686)vs.0.881(0.868–0.894),0.934(0.923–0.944),and 0.834(0.819–0.848),all P < 0.001).Conclusions: Diabetes can significantly increase the risk of all-cause and CVD mortality.In order to reduce the heavy burden of diabetes,it is of great practical significance to develop diabetes screening models for different populations.