Vascular Function Assessment And Community Intervention Effect Observation For Patients With Type2Diabetes In Yuyuan Community In Shanghai

BackgroundDiabetes Mellitus (DM) is an important common disorder with a national prevalence of11.6%in2010. However, the treatment and control rate are still low. Among all kinds of DM, the type2DM (T2DM) accounts for90%. T2DM often accompanies with complications, at the same time, it not only seriously affects the physical and mental health of patients, but also overload families and community with tremendous economic burden. Therefore, T2DM is the important object of diabetes prevention.Arteriosclerosis is one of the pathologic changes in cardiovascular system caused by T2MD. It is significant to establish the assessment method of vascular structure and function, and to find the early marker of vascular function, in order to detect and treat the complications of T2DM in the early phase.The treatment of T2DM suggested by International Diabetes Federation includes physical activity, diet control, blood glucose monitor, medication and health education. Accordingly, we evaluate the vascular function and intervention effect of T2DM patients in community, and intend to establish the integrated intervention model of T2DM in community.ObjectivesTo integrate the current management guidelines in the community health service center; to master the assessment method of cardiovascular risk factors, vascular structure and function in type2diabetes (T2D) patients; and to perform comprehensive control model in patient education and management, in order to observe the effect of improving vascular function and elevating the control rate of blood glucose, blood pressure and plasma lipid.MethodsA total of124T2D patients from Yuyuan community health service center were enrolled in this study. It was designed as random, control and intervention study. The risk factors were evaluated by questionnaire, body examination, laboratory test, carotid artery ultrasound, pulse wave velocity (PWV) and ankle brachial index (ABI). After12months of comprehensive treatment, we compared the observed indexes between intervention group and control group.ResultsThere were61males and63females among the124T2D patients, aged64.8±7.8, which were divided into two groups averagely. After one year of intervention, the difference of fasting plasma glucose (FPG),2h plasma glucose (2hPG), total cholesterol (TC) and triglyceride (TG) was significant, and P values were0.023、0.012、0.031和0.027separately. In the intervention group, the systolic blood pressure (SBP) decreased2.95mmHg, the percentage of physical inactivity decreased32.3%,(P<0.001) and the positive rate of urine protein decreased12.9%(P=0.021); the percentage of patients with FPG under7mmol/L increased43.5%(P<0.001),SBP under130mmHg increased17.7%(P=0.019); the pulse wave velocity (PWV) and carotid intra-media thickness decrease67.57cm/s (P=0.001)and0.098(P=0.032); there was a positive correlation between PWV and age (r=0.407), SBP(r=0.302), diastolic blood pressure (r=0.207) and HbAlc(r=0.197)(P<0.05). The improvement of PWV was corrected with intervention (P=0.001).Conclusions and suggestionsT2D patients were always with multiple cardiovascular risk factors. Enhancing the health education and life style intervention, will help to elevate the control rate of plasma glucose, blood pressure and plasma lipid. PWV might act as the early index for arteriosclerosis in T2D patients. Promoting the physical activity, diet control, blood glucose monitor, medication and health education in management of T2D in community hospitals was the only way to control T2D. Other suggestions includes establishing a dynamic electronic information system in the community, taking effective measures to achieve the goals of weight loss, opening a versatile health education platform, introducing the necessary vascular function detection technology in the community and exploring the management measures of chronic disease in the functional community.