| Background: Diabetes Melitus(DM)is an endocrine and metabolic disease with high blood glucose as the main indicator caused by various factors such as genetic factors,environment and behavior.With the socio-economic development and the improvement of the material level,the incidence of diabetes in both developed and developing countries is increasing year by year.Diabetes has become a worldwide public health problem.Pre-diabetes mellitus(PDM)is a high-risk group of people with diabetes.It is an abnormal state of glucose metabolism between normal glucose metabolism and diabetes.The prevalence of PDM also shows a rapid increase,which has greatly exceeded the prevalence of DM.Large-scale randomized controlled trials at home and abroad show that early detection of diabetes and its high-risk populations in the general population using diabetes screening methods and effective intervention can reduce the rate of diabetes mellitus,which is to prevent diabetes and contain Accelerated diabetes epidemic is of great significance.The diabetes risk assessment tools constructed by domestic and international research institutes are mostly used to screen diabetics and have less attention to the prediabetic population.Most of the assessment tools are based on urban population surveys,with less attention to residents in rural areas.Therefore,the establishment of a simple and effective early screening method and strategy for the prediabetic population has become an increasingly hot topic.Objective:(1)To understand the prevalence of new T2 DM and PDM among residents aged 18-65 in urban and rural areas in Jiangsu Province.(2)To analyze the characteristics and main influencing factors of new-onset T2 DM and PDM in residents of Jiangsu Province.(3)Explore pre-diabetic population screening methods suitable for the community and establish a screening model for prediabetic populations in Jiangsu Province.(4)Evaluate the screening effectiveness of the screening model established in this study and the existing two diabetes risk rating scales to provide reference and basis for seeking risk score tools applicable to pre-diabetic populations in Jiangsu Province.Methods: This study is a cross-sectional survey,including questionnaires,physical examination and laboratory tests.A multi-stage stratified randomized cluster sampling method was adopted.Six districts and counties in Yancheng,Zhenjiang,Suzhou,Huai’an,and Nantong were selected as survey sites.Each district and county selected three townships or streets.8 to 9 administrative villages are selected in townships or streets,and about 100 residents aged 18 to 65 years are selected from each village to exclude those who have diabetes.Descriptive research methods were used to calculate the prevalence of newly diagnosed T2 DM and PDM among residents aged 18-65 years in Jiangsu Province,and to compare the prevalence and differences between populations with different demographic and sociological characteristics.Based on the baseline survey information,a multi-classified Logistic regression model was established to analyze the influencing factors of newly diagnosed T2 DM and PDM in urban and rural residents in Jiangsu Province.Using the baseline survey data of the 2016 diabetes screening project in Jiangsu Province,training samples(70%)and validation samples(30%)were established according to random sampling methods.Through the analysis of risk factors of PDM,a 10-fold independent regression coefficient was used as a risk factor score to construct a risk factor score method.According to the cumulative score value to determine the individual’s risk of disease,a prediabetic population screening model was established and verified.At the same time,the existing China Diabetes Risk Rating Scale and Qingdao Diabetes Risk Integral Self-assessment Scale were applied to the study population to evaluate the screening effects of three different scales.The area under the ROC curve(AUC)was used as the evaluation index of the model screening value,and the maximum value of the Youden index was used as the best cut-off value for screening the prediabetic population.Results:(1)The basic characteristics of the survey population: In this study,7,859 inhabitants actually participated,and the effective number of participants was 7689.The effective rate was 97.84%.The average age of the surveyed population was 43.75±11.92 years old,of which 3380(43.96%)were men,and the average age was 43.49±12.31 years;4309(56.04%)were women,and the average age was 43.95±11.61 years.There were statistically significant differences in the results of the population and blood biochemical indicators between different regions.(2)The epidemiological characteristics of newly diagnosed T2 DM and PDM: The crude prevalence rates of newly diagnosed T2 DM,IFG,IGT and PDM in Jiangsu Province were 6.52%,4.59%,12.15% and 16.74%,respectively,and the standardized prevalence was 6.65%.4.81%,12.19%,and 16.99%.In the survey area,the prevalence of newly diagnosed T2 DM and PDM in Jurong City was the highest(8.01%,23.33%).The prevalence of newly diagnosed T2 DM and PDM in different regions was different.The prevalence rates of T2 DM and PDM in people over 45 years of age were significantly higher than those in 18-24 years of age;the prevalence of newly diagnosed T2 DM and PDM was higher in those with higher education;the difference on prevalence of newly diagnosed T2 DM and PDM in people with different occupations and family annual income was larger;the prevalence of new diagnoses of T2 DM and PDM in families with a family history of diabetes was significantly different.There was a difference in the prevalence of newly diagnosed T2 DM and PDM among people with different BMI,waist circumference and waist-to-hip ratio.Except supper habits,there were differences in the prevalence of newly diagnosed T2 DM and PDM among the population with other dietary habits.There were statistically significant differences in the prevalence of newly diagnosed T2 DM and PDM among residents with different drinking habits and whether they exercised vigorously for one week.(3)The influencing factors of newly diagnosed T2 DM and PDM: age ≥ 45 years,family history of DM,BMI ≥ 24.0,excessive heart rate,high waist-to-hip ratio,high blood pressure are risk factors for PDM prevalence in urban and rural residents in Jiangsu Province;Slow heart rate is a protective factor for PDM prevalence among urban and rural residents in Jiangsu Province.Age ≥ 55 years old,DM family history,heart rate hypervelocity,BMI ≥ 28.0,excessive waistto-hip ratio,high blood pressure are risk factors for newly diagnosed T2DM;low heart rate,BMI <24.0 is the protection of newly diagnosed T2 DM factor.Age ≥ 55 years old,family history of diabetes,excessive heart rate,excessive waist-to-hip ratio,and high blood pressure are common risk factors for newly diagnosed T2 DM and PDM.(4)Establishment and validation of a prediabetic screening model: Logistic regression analysis of prediabetes risk factors revealed that gender,age,family history of diabetes,resting heart rate,waist-to-hip ratio,and blood pressure were pre-diabetes(PDM)the main factor of influence.When the discriminatory threshold was set to 31 and 30,the Yodon index of the prediabetes screening was highest in the modeled population and the validated population.The sensitivity and specificity of the training and validation samples were 70.21%/61.50% and 69.04%,respectively.56.50%,AUC(95% CI)were 0.643(0.623-0.662),0.612(0.582-0.642).(5)Screening evaluation of different risk factors for subscales: The pre-diabetic screening model and two different screening methods(China Diabetes Risk Scale and Qingdao Diabetes Risk Integral Self-assessment Table)for the target established in this study The risk scores of the population were evaluated.The AUC(95% CI)of the best scoring cut-points for the three scoring tools were 0.632(0.616-0.648),0.626(0.609-0.642),and 0.586(0.569-0.604),respectively.The effect of checking the model is better than the other two scales.Conculusion: The prevalence of new diagnoses of T2 DM and PDM in urban and rural residents in Jiangsu Province is high,and those over 45 years of age are high-risk groups for newly diagnosed T2 DM and PDM.The prevalence of newly diagnosed T2 DM and PDM increased with BMI,waist circumference,and waist-to-hip ratio.Eating habits,smoking,and alcohol consumption affected the prevalence of newly diagnosed T2 DM and PDM.Age ≥ 55 years old,family history of diabetes,excessive heart rate,excessive waist-to-hip ratio,and high blood pressure are common risk factors for newly diagnosed T2 DM and PDM.A good lifestyle can reduce the risk of diabetes,which is the fundamental method of preventing diabetes.Individualized diabetes prevention measures should be adopted for different groups of people.T2 DM and PDM populations should form a good lifestyle,pay attention to regularly check blood lipids,blood glucose,blood pressure,heart rate,weight and waist and hip circumference,etc.,in order to monitor the effect of disease progression and control.The prediabetic population screening model in this study was established based on the risk factors of PDM analysis.It is a scientific,effective,simple and practical screening method that can be used for self-assessment of diabetes risk and health education.In order to improve the effectiveness of the model screening PDM,the impact of different screening cut-points on the screening effect should also be considered to improve the screening efficacy and practicality of the screening model.In view of the severe situation of China’s current T2 DM and PDM,it is important to use the screening model to perform risk assessment of diabetes risk factors in the general population.It is of great practical significance to discover patients with T2 DM and PDM as soon as possible.The three risk factors scores are simple,easy,and effective.They can be used to screen PDM patients for healthy physical examination.Overall,the screening model established in this study was superior to the China Diabetes Risk Rating Scale(CDRS)and the Qingdao Diabetes Risk Integral Self-assessment Checklist,which is more suitable for pre-diabetic screening in the general population.However,due to differences in the characteristics of different populations,the risk of various risk factors leading to disease is also not the same.Therefore,to establish a first-line method for screening PDM in Jiangsu Province and even in the whole country,we need to conduct in-depth research on different population characteristics,diabetes epidemic trends and related risk factors,optimize the risk rating scale and population suitability,and further improve its screening.efficacy. |
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