Establishing Early Warning Systems For Screening Glucose And Lipid Metabolic Disorders

Objective:The unrelenting increase in the prevalence of glucose and lipid metabolism disorders in Shanghai is of great concern.To investigate the associated risk factors and develop a clinical risk index system to screen and predict for adult glucose and lipid metabolism disorders.Methods:The study included the Shanghai 2002-2003 Diabetes Population Survey data(n=14,401)and Baosteel 1995-2001 Healthy cohort study data(n=12,438).Logistic regression models or Cox proportional hazards models were used to develop the Shanghai population risk score for screening and prediction glucose and lipid metabolism disorders,based on those risk factors as significant.Sensitivity,specificity,and the area under the receiver operating characteristic curve(AUC)were used to construct the models.Results:The dyslipidemia prevalence was 36.5%in Shanghai.The diabetes prevalence was significantly higher in hyperlipidemia than the control group(16.9%vs 7.0%,P<0.01).The anthropometric indexes(body mass index,waist circumference,waist-to-hip ratio and waist height ratio)showed positively correlated with fasting blood glucose,postprandial blood glucose,triglycerides and cholesterol,negatively correlated with HDL-C.The AUC was 0.728 predicting diabetes and 0.710 predicting hyperlipidemia with waist height ratio,which was more than waist circumference and body mass index.Hemoglobin showed positively correlated with fasting blood glucose,triglycerides and cholesterol(?=0.084,0.193 and 0.231,P<0.01).The incidence of diabetes,hypertriglyceridemia and fatty liver increased significantly with the hemoglobin at baseline(?~2=11.86,36.29 and 60.07,P<0.01 in trend analysis).During follow-up the new hyperlipidemia cases had significantly higher hemoglobin increasing than the others(hypertriglyceridemia and hypercholesterolemia z=2.91,6.70,P<0.01).Obesity,IFG,hypertriglyceridemia,hypercholesterolemia and fatty liver significantly increased the risk of diabetes(HR=2.41,3.67,2.16,1.43 and4.07).The people with hyperlipidemia or fatty liver had higher diabetes prevalence than those without hyperlipidemia and fatty liver(8.4%or 25.0%vs 3.7%).Four screening risk models were developed.Model 2 including age,fasting glucose,triglycerides and waist height ratio,had a highest AUC(0.952,95%CI 0.944?0.959).Model 4 based on the results of logistic regression analysis,five variables were combined in a simple risk score(age?55=2 points,hypertriglyceridemia=2 points,hypercholesterolemia=2points,waist high ratio?0.5=2 points and abdominal obesity=1).Model 4 had a sensitivity of 70.2%and a specificity of 67.0%in detecting diabetes,with an optimal cutoff of 4.Among three risk prediction models(AUC 0.724?0.752),Model 7 which was a simple risk score with a cutoff of 3,had a sensitivity of 57.9%and a specificity of 67.0%in predicting diabetes within 6years.Conclusion:Patients with hyperlipidemia,obesity and fatty liver most often have diabetes.The diabetes screening and predictive risk models based on Shanghai adult survey data can be used in defining target populations for early prevention programme.