The Study On The Trends Of Diabetes Prevalence And Self-management And The Correlation Between RANTES And Its Receptor CCR5 And Diabetes Mellitus Among The Naxi Ethnic Population In Yunnan Province

ObjectiveThis project is to study the prevalence of diabetes,the prevalence of self-management and variation trend of diabetes in unique Naxi nationality of Yunnan province.To analyze the influence of life behavioral factors on diabetes,RANTES and its receptor CCR5 and diabetes.To explore whether there is any interaction between lifestyle behavioral factors,target gene polymorphism and expression level in the occurrence of diabetes and prediabetes.MethodsA repeated cross-sectional study was used to select residents aged 35 and above of Naxi nationality in Yulong County of Yunnan Province as research objects in 2013 and 2018 by multi-stage stratified random sampling method.This study was divided into the following three parts:Part 1 The study on the trends of diabetes prevalence and self-management among the Naxi ethnic population in Yunnan ProvinceThe date of demographic characteristics,information about the self-management of blood glucose,and diabetes-related lifestyle date were collected by on-site questionnaire combined with physical examination.The research objects' height,weight,waist circumference,hip circumference and blood pressure were measured,and their blood glucose(fasting blood glucose or 2h post-prandial blood glucose or random glucose)were measured by capillary fingertip blood sample.The prevalence of diabetes and prediabetes,the awareness,treatment,control and self-management of diabetes among the Naxi population were analyzed by the ?2 tests.The ?2 tests were also used to contrastively analyze the variation trend of prevalence of diabetes and prediabetes,the awareness,treatment,control and self-management of diabetes.The logistic regressions were used to investigate the risk factors for self-management of diabetes in Naxi population.Part 2 The study on the trend of life behavior pattern and its relationship with diabetes among the Naxi ethnic population in Yunnan ProvinceThe data of diabetes-related lifestyle were collected by on-set questionnaire.The prevalence of diabetes-related lifestyle and the aggregation of diabetes risk factors among the Naxi population were analyzed by the ?2 tests,the variation trend of diabetes-related lifestyle and aggregation of related risk factors among the Naxi population was also analyzed by the ?2 tests;The logistic regressions were used to investigate the influence of life behavioral factors on the incidence of diabetes in Naxi population.Part 3 The study on the relationship between RANTES and its receptor CCR5 and diabetes among the Naxi ethnic population in Yunnan ProvinceThe fasting or 2 hours postprandial blood glucose or random blood glucose of subjects were measured by fingertip capillary blood.Peripheral venous blood of patients diagnosed with diabetes and prediabetes and age-and gender-matched normal controls at a ratio of 1:2 were collected.A total of 133 cases in the normal blood glucose group,60 cases in the prediabetes group,and 61 cases in the diabetes group were collected finally.Biochemical indicators were detected by automatic biochemical analyzer.The levels of CCR5 on monocytes and lymphocytes and plasma RANTES were detected by flow cytometry,and the genotypes of RANTES gene rs2280788 and CCR5 gene rs 1799987 were detected by Taqman real-time fluorescence quantitative PCR.The chi-square test was used to compare whether the genotypes and allele frequencies of RANTES rs2280788 and CCR5 rs1799987 between the diabetes group,the pre-diabetes group and the healthy control group were different;the One-Way ANOVA was used to compare the clinical and biochemical indicators,plasma RANTES level and the expression of CCR5 on lymphoid and monocyte surface between the three groups,the biochemical indicators and CCR5 expression between the different CCR5 gene rs1799987 genotype groups,using the LSD-t test for pairwise comparison.Use two independent sample t-test or two independent sample rank test to compare the biochemical indicators,plasma RANTES level between RANTES rs2280788 CC group and CG+GG group and the level of plasma RANTES and the expression of CCR5 on leukocyte surface between diabetic patients with or without hypoglycemic drugs.Use disordered multiple Logistic regression to analyze the influencing factors of prediabetes and diabetes among survey population of Yunnan Naxi nationality.Multifactor Dimensionality Reduction(MDR)was used to analyze whether there is any interaction between the gene polymorphism and expression level of RANTES and CCR5 and lifestyle behavior factors in the occurrence of diabetes and prediabetes by MDR 3.0.2.P<0.05 was considered statistically significant(p<0.017 was considered statistically significant when taking pairwise comparison in chi-square test).ResultsPart 1 The study on the trends of diabetes prevalence and self-management among the Naxi ethnic population in Yunnan ProvinceA total of 1,402 cases were screened in 2013,including 644 males and 758 females,A total of 1,426 cases were screened in 2018,including 657 males and 769 females.1.Investigation on diabetes of Naxi nationality in Yunnan Province in 2018.L1 The prevalence rates of prediabetes and diabetes among Naxi populations were 19.5%and 8.6%,respectively.The prevalence rates of prediabetes in research objects who were men,with education level of junior high school or above,?65 years old and with Per capita annual income>8000 yuan were higher than that of women,with education level of primary school or below,<65 years old and with Per capita annual income?8000 yuan(all P<0.05),and?65 years old group had the highest prevalence of diabetes.The awareness,treatment and control rates of diabetes among Naxi residents in Yunnan Province were 52.8%,89.2%and 29.2%,respectively.Among all the age groups,?65 years old group had the highest diabetes treatment rate(95.5%)(P<0.01),there was no significant difference among different gender,age,per capita annual income,living conditions and medical service accessibility groups.(all P>0.05).1.2 The self-management of diabetes among Naxi population in Yunnan Province included compliance to anti-diabetic drugs,self-monitoring blood glucose and taking hypoglycemic measures in the last 2 weeks,with the rates of 87.7%,49.2%and 100.0%,respectively.The rate of self-monitoring blood glucose in diabetics with an education level of junior high school or above was higher than in diabetics with an education level of primary school or below.The hypoglycemic measures in the last 2 weeks included weight control or weight loss,diet control,exercise increase and smoking cessation,with the rate of 69.2%,92.3%,84.6%and 12.3%,respectively.The rate of weight control or weight loss was higher in population between 55-64 years old,with Per capita annual income>8000 yuan,with education level of junior high school or above,and the rate of quitting smoking was higher in men.2.The variation trend of diabetes prevalence and self-management among Naxi population2.1 There was no significant difference between 2018 and 2013 in the prevalence of prediabetes in Naxi population,while the standard prevalence of diabetes rose from 4.1%to 8.6%.The standard awareness rate of diabetes decreased from 66.4%to 53.1%(P<0.05),there were statistical decreases in awareness rates in those who used tap water,had a toilet at home,with Per capita annual income of>8000 yuan and had good access to medical services(P<0.05),but there were no significant changes in the treatment rate and control rate of diabetes(all P>0.05).2.2 The rates of compliance to anti-diabetic drugs and taking hypoglycemic measures in the last 2 weeks among Naxi diabetic patients increased significantly from 2013 to 2018(P<0.05).The rates of compliance to anti-diabetic drugs in diabetic patients who were men,with Per capita annual income of>8000 yuan,had a toilet at home and had poor access to medical services increased significantly(P<0.05),but there was no significant variation in the rate of self-monitoring blood glucose(P>0.05).The standard rates of taking hypoglycemic measures in the last 2 weeks including weight control or weight loss,diet control and increased exercise in the two years were 28.1%and 71.2%,72.7%and 92.7%,28.1%and 84.9%,respectively,showing upward trends(all P<0.05),but there was no statistical difference in the rate of quitting smoking(P>0.05).3.The influence factors of self-management of diabetesMultivariate logistic regression showed that high education level among diabetic patients was a protective factor for adopting measures to lower blood glucose.Part 2 The study on the trend of life behavior pattern and its relationship with diabetes among the Naxi ethnic population in Yunnan Province1.Investigation of Naxi people's life behavior patterns in 20181.1 The prevalence rate of hypertension and the rates of overweight,obesity,central obesity,smoking,current smoking,drinking,lack of physical activity,family history of diabetes,eating oily or fatty food(?3 days a week),eating salted food(?3 days a week)among Naxi population were 38.1%,34.2%,15.5%,60.4%,36.9%,29.3%,15.7%,25.5%,5.3%,31.8%and 41.4%,respectively.1.2 The rates of central obesity and family history of diabetes were higher in women than in men(P<0.01 and P<0.05),the rates of smoking,drinking and eating oily or fatty food(?3 days a week)were higher in men than in women(P<0.01),and men were less physically active than women(P<0.05).1.3 Among all the age groups,?65 years old group had the highest rates of hypertension,physical inactivity and central obesity,35-44 years old group had the highest rates of eating oily or fatty food(?3 days a week)and eating salted food(?3 days a week),the highest rates of overweight and current smoking were founded in the 45-54 years old group.1.4 The older the Naxi people were,the higher the rate of three or more risk factors aggregation was.2.The changing trend of life behavior patterns among survey population of Naxi nationality2.1 The prevalence rate of hypertension and the rates of overweight,obesity,central obesity,family history of diabetes increased significantly compared with 2013(P<0.01),the smoking rate increased compared with 2013(P<0.05),but the rates of drinking,lack of physical activity,eating oily and fatty food(?3 days a week),and eating salted food(?3 days a week)decreased compared with 2013(P<0.01),showing downward trends.2.2 The rate of three or more risk factors aggregation in 2018 was higher significantly than that in 2013(P<0.05).3 The relationship between life behavior factors and diabetes in Naxi populationMultivariate logistic regression showed that hypertension,family history of diabetes and physical inactivity were the risk factors for diabetes among Naxi population.Part 3 The study on the relationship between RANTES and its receptor CCR5 and diabetes among the Naxi ethnic population in Yunnan Province1.The waist circumference,the level of TG,FPG and HbAlc of the diabetes group were higher than those of the healthy control group(P<0.05),the level of TC,TG,FPG and HbAlc of the diabetes group were higher than those of the prediabetes group(P<0.05),and the HbAlc level of the prediabetes group was higher than that of the healthy control group(P<0.05).There were no statistically significant differences in other indicators between the prediabetes group and the healthy control group(P>0.05)2.RANTES rs2280788 CC,CG+GG genotype frequency and RANTES rs2280788 C/G allele frequency was not statistically different among diabetic group,pre-diabetic group and healthy control group(P>0.05).RANTES rs2280788 CG+GG genotype frequency and G allele frequency in male prediabetes group were higher than healthy control group(P<0.017),the RANTES rs2280788 CC,CG+GG genotype frequency and C/G allele frequency were not statistically different among the other male groups and the three groups in female(P>0.017).3.The frequency of CCR5 rs 1799987 AA genotype and A allele frequency in the prediabetes group are higher than those in the healthy control group(P<0.017),and the frequency of CCR5 rs 1799987 AA genotype and A allele in the diabetic group were lower than the pre-diabetic group(P<0.017),the results were consistent with those of women.In the male population,there was no statistical difference in the genotype frequency and allele frequency of CCR5 rs 1799987 among the diabetes group,pre-diabetes group and healthy control group(P>0.05).4.There were no statistically significant differences in plasma RANTES levels and expression levels of CCR5 on mononuclear and lymphocyte surfaces among diabetes group,prediabetes group and healthy control group(P>0.05).There were no statistically significant differences in plasma RANTES levels and the expression levels of CCR5 on mononuclear and lymphocyte surfaces between hypoglycemic drugs used and hypoglycemic drugs unused groups(P>0.05).5.There was no significant difference in self-expression level and plasma LDL,HDL,TC,TG,FPG,HbAlc among different RANTES rs2280788 genotype groups and different CCR5 rs 1799987 genotype groups(P>0.05).6.MDR showed that the CCR5 genotype,age,BMI is the best prediction model,the model training balance accuracy was 0.651,the model testing balance accuracy was 0.492,the cross validation consistency was 7/10(P<0.0001),in which CCR5 rs 1799987 genotype and BMI had a strong synergistic effect:with the increase of the BMI,the risk of pre-diabetes or diabetes with CCR5 rs1799987 AA genotype residents was increased.Conclusion1.The prevalence of pre-diabetes and diabetes among Naxi people in Yunnan province is lower than the national level;The treatment rate of diabetes was at a high level,the awareness rate was slightly more than half,followed by control rate was less than one-third.2.Self-management of Naxi diabetics including compliance to anti-diabetic drugs,controlling blood glucose by weight control or weight loss,diet control and increased exercise were at a good level,while the level of self-monitoring blood glucose was near a middle level,and diabetic patients with higher education level had a better self-management.3.The prevalence rates of diabete among Naxi residents was on the rise,the awareness rate was on the decline,and the treatment and control rates had no significant change.The rates of compliance to anti-diabetic drugs,controlling blood glucose by weight control or weight loss,diet control and increasing exercise also showed significant upward trends,but there was no significant variation in the rate of self-monitoring blood glucose.4.The rates of smoking,drinking and eating oily or fatty food were higher in men than in women among Naxi residents,men were less physical activity than women,but the rate of central obesity was higher in women.The younger the Naxi people were,the higher the rates of eating oily and fatty foods,eating salted food,smoking and overweight.The older the Naxi people were,the higher the rates of hypertension,physical inactivity and central obesity.5.Although the Naxi population in Yunnan Province showed a trend of improvement in drinking,physical inactivity,eating oily or fatty foods,and eating salted foods,the rates of hypertension,overweight,obesity,and central obesity was still on the rise,and there was still a long way to go to strengthen the management of lifestyle.6.Hypertension,family history of diabetes and physical inactivity were the risk factors for diabetes in Naxi people in Yunnan province.7.The level of plasma RANTES and CCR5 on monocyte and lymphocyte surface may not be significantly correlated with pre-diabetes and diabetes in Naxi residents of Yunnan Province,The use of hypoglycemic drugs does not affect the level of plasma RANTES and CCR5 expression on monocyte and lymphocyte surface in the Naxi diabetes patients in Yunnan Province.8.RANTES rs2280788 gene polymorphism and CCR5 rs 1799987 gene polymorphism had no significant effect on their self-expression and plasma level of LDL,HDL,TC,TG.9.CCR5 rs 1799987 genotype,age and BMI have interactive effects on the development of prediabetes and diabetes,and the combination of these three variables is the best prediction model of pre-diabetes and diabetes,in which CCR5 rs 1799987 genotype and BMI has a strong synergistic effect:with the increase of the BMI,the risk of pre-diabetes or diabetes in residents with CCR5 rs1799987 AA genotype will increase.