| Objective:China has the largest number of diabetic patients in the world.The current status of diabetes in China is high prevalence,low treatment rate and low control rate.High glycemic variability is associated with diabetes mortality and complications.1.Understand the health management status of type 2 diabetes mellitus in the community.2.Construct trajectory models of fasting glucose fluctuation in type 2 diabetic patients in community,explore their long-term blood glucose change patterns,and analyze the influencing factors of different blood glucose change patterns.3.Explore the relationship between blood glucose fluctuation and the adverse outcome of type 2 diabetes and determine other major factors affecting the adverse outcome of type 2 diabetes,so as to provide new clues for developing personalized health management strategies for diabetes population and preventing the adverse outcome of diabetes.Methods:1.Based on Shuangbei Community Health Service Center in Shapingba District,Chongqing,demographic characteristics,disease history and follow-up data of patients were obtained through the chronic disease management system of community health service center.Descriptive epidemiological methods were used to describe the health management status and change characteristics of type 2 diabetes patients in the community from 2013 to 2021.2.This study identified and constructed trajectory of fasting glucose fluctuation of diabetes patients based on Latent Class Trajectory Modeling(LCTM),and compared the differences in demographic characteristics,health status,medical history,lifestyle,medication compliance,etc among different categories.Multinomial logistic regression was used to explore the related factors of different fluctuation trajectories.3.Based on the identified and constructed fasting blood glucose fluctuation trajectories of type 2 diabetes patients,the subjects were divided into different groups.The Kaplan Meier method and Log rank test were used for univariate analysis.Multivariate cox proportional hazard regression model or restricted mean survival time was used to explore the relationships between blood glucose fluctuation trajectories and death,diabetes chronic complications.Results:1.A total of 2269 patients with type 2 diabetes who joined community management from 2013 to 2021 were included.More than half(51.6%)were 65 years of age or older.42.2% of the patients had junior high school education.From 2013 to2021,the standard management rate of type 2 diabetes patients in the community increased year by year(from 78.7% to 85.2%),and the blood glucose control rate of the management group also showed an overall rising trend(from 58.2% to 92.6%).By providing individualized treatment programs,the referral rate of type 2 diabetes patients in the community has shown an increasing trend year by year.The incidence of hypoglycemia reaction showed an increasing trend,and intermittent medication increased year by year。2.The 769 patients with type 2 diabetes were divided into three different fluctuation trajectory subgroups by LCTM,defined as the low-level steady group(n=622),the moderate-level fluctuation group(n=69),and the high-level fluctuation group(n=78).Patients in the low-level steady group had a low blood glucose level with insignificant fluctuations.The fasting blood glucose of type 2 diabetes in the moderate-level fluctuation group showed a fluctuating trend from low level to high level and then to low level.The fasting blood glucose of type 2 diabetes in the high-level fluctuation group showed a fluctuating trend from high level to medium level,and then rose to high level.Compared with the low-level steady group,the results of multinomial logistic regression analysis showed that patients with occasional or no exercise and intermittent medication were more likely to be classified as the moderate-level fluctuation group,which were more likely to show a low level rising to a high level and then falling to a low level(OR for occasional or no exercise: 1.95,95%CI 1.15 to 3.29,P=0.013;OR for intermittent medication: 3.90,95%CI 2.10 to 7.25,P<0.001).The patients with other medical insurance types were more likely to be classified into the moderate-level fluctuation group,that is,the patients with diabetes whose medical insurance types are other medical insurance types were more likely to show a rapid decline in fasting blood glucose from a high level and then rise to a high level(OR for other medical insurance types: 1.94,95%CI1.15 to 3.27,P=0.012).The patients who did not take medication were less likely to be classified into the group of high-level fluctuation group,that is,the patients with diabetes who did not take medication were less likely to show a rapid decline in fasting blood glucose from a high level and then rise to a high level(OR for did not take medication: 0.26,95%CI 0.10 to 0.67,P=0.005).3.There were 61 deaths and 77 chronic complications of diabetes by July 2022.Among the all-cause death objects,the proportions of age ≥ 65 years old,working,other marital status,hypertension were higher than that of the survivors(P<0.05).Among the patients with chronic complications of diabetes,the proportions of age ≥65 years old and hypertension were higher than those without chronic complications of diabetes(P<0.05).The results of RMST analysis showed that the mean survival time of diabetic patients in the high-level fluctuation group was 1.52 years shorter than that of patients in the low-level steady group(95%CI-2.73 to-0.32,P=0.013),and 2.78 years shorter than that of patients in the moderate-level fluctuation group(95%CI-3.67 to-1.89,P<0.001).The RMST analysis of follow-up time for chronic complications of diabetes showed that the mean follow-up time of complication of patients who in the high-level fluctuation group was 2.97 years shorter than those in the moderate-level fluctuation group(95%CI-3.90 to-2.64,P<0.001).This suggested that people with type 2 diabetes who have high levels of glucose fluctuations were at higher risk of mortality and chronic complications of diabetes.Conclusions:1.From 2013 to 2021,the standard management rate of type 2 diabetes patients in Shuangbei Community Health Service Center of Shapingba District,Chongqing was basically higher than the national level,and the blood glucose control rate of the management group also showed a good trend.The next step for the community is to increase awareness and health education to improve medication compliance while avoiding hypoglycemic reactions.2.The fasting blood glucose trajectories of community type 2 diabetes patients showed different dynamic changes.Exercise frequency,medication compliance and medical insurance type may be the related influencing factors of different fasting blood glucose fluctuation trajectories of patients.3.The high fluctuation of fasting glucose may lead to an increased risk of death in type 2 diabetes patients,as well as accelerate the progression of chronic complications of diabetes. |
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