The Metabolic Changes And Changed Trends Of Chronic Diabetic Complications In Type 2 Diabetes From 1994 To 2006

Bcakground: According to the WHO's report in 1997, diabetes is one of five diseases with highest incidence and mortality all around the world. With the improvement of pepole's living conditions, the prevalence of type 2 diabetes is rapidly increasing in our country. Type 2 diabetes is the major cause leading to end stage renal disease, blindness, and no trauma amputation, so chronic diabetic complications give important impacts on the quality of life and heaven burden on patients, families and all the society. Therefore, early screening and multi-disciplines treatment have important role in decreasing the chronic diabetic complications.Aim: To evulate biochemical characteristics and the trend of diabetic complications in patients who visit our diabetic center for the first time.Methods: We utilized the database of the diabetes complications assessment finished by our multi-disciplineary team. Diagnostic creiteria of the diabetic complications or other conditions:Obesity: BMI≥25.0 kg/m2, WHR≥0.90 (male), or≥0.85 (female), WC≥90 cm (male), or≥90 cm (female). Control of blood glucose: good if HbA1c < 6.5%, and uncontrol if HbA1c≥6.5%.Dyslipidemia: total cholesterol level≥5.17 mmol/L, triglyceride≥1.7 mmol/L, HDL-C≤0.9 mmol/L for male or≤1.0 mmol/L for female.DR: stage 1 to 3 were background retinopathy, and stage 4 to 6 were proliferous retinopathy. Fundus was examined by direct ophthalmoscope, or by fluoresce in angiography if patients have retinopathy.Neuropathy: abnormal sensation, pathological sign and objective examination not explained by other causes. The sense of touch is checked by10 g monofilament, vibration sense by biothesiometer, and thermal sensory analysis by TSA-2 (Israel). Nephropathy: urine albuminuria excretion>300 mg/day or albuminuria/ creatinine≥30 mg/g .PAD: absence or weakness of dorsalis pedis or and posterior tibial pulses to palpation in at least one leg, or ABI<0.9.Hypertension: systolic blood pressure≥140 mmHg or a diastolic blood pressure≥90 mmHg or being on antihypertensive drugs treatment regardless of the blood pressure values.CDV: Peviously diagnosed CVD or data from in-patient, or the definately of abnormalities in ECG, judged by electrocardiogram.Results :1. The metabolic changes and trends of chronic diabetic complitations in patients screened for the first time The number of the patients increased obviously, the age of the diabetic patients was significantly younger. The mean BMI increased, the abnormal rate of d BMI were increased respe from 50.0% (male) or 49.1% (female) in 1994 to 67.2% (male) and 65.7% (female) in 2006, The abnormal rate of patients with obesity increased after 2000, over three fourth patients was with abnormal WHR , especially in female, the abnormal rate of WHR was over 80.0% in 3 of last 5 years.Compared with 1994, the SBP decreased 9.3 mmHg in 2006(P<0.01), but the DBP unchanged.The fasting blood glucose and HbA1c was decreased from 9.6mmol/L and 10.2% in 1994 to 8.7mmo/L and 7.9% in 2006, respectively.The average TC level decreased from 5.5mmol/L in 1994 to 5.0mmol/L in 2006, and the rate of the patients with hypercholesterolemia decreased from 54.2% to 36.7%; TG level increased from 2.0 mmol/L in 1994 to 2.4 mmol/L in 2006, however no significant changes for the HDL-C and LDL-C level.The diabetic patients with background and proliferative retinopathy decreased respectively from 25.0 % and 3.4% in 1994 to 14.1% and 0.6% in 2006.The prevalence of diabetic nephropathy and neuropathy were not changed. The prevalence of diabetic cardiovascular disease and peripheral arterial disease were not significantly changed.2. The metabolic changes and trends of chronic diabetic complitations in newly diagnosed diabetesThe age of the newly diagnosed diabetic patients was significantly younger。 The number of diabetic patients BMI≥25kg/m2 or WHR≥0.90 (male) or WHR≥0.85 (female) increased. Both SBP and DBP have no significantly changed.The fasting blood glucose, postprandial blood glucose , HbA1c were decreased from 10.3 mmol/L, 15.2 mmol/L, 11.1% in 1994 to 8.1 mmol/L, 12.9 mmol/L, 7.5% in 2006, respectively.The average TG level increased from 1.7 mmol/L in 1994 to 2.3 mmol/L in 2006, however, TC and HDL level have no significant changed.The prevalence of patients with diabetic retinopathy decreased from 28.2% in 1994 to 4.1% in 2006. The prevalence of diabetic nephropathy increased from 17.7% in 1994 to 22.3% in 2006.The prevalence of diabetic cardiovascular disease increased from 14.3% in 1994 to 24.1% in 2006, and the prevalence of peripheral vascular disease were not significantly changed.Compared with the patients without microvascular complications, the patients with microvascular complications have higher SBP, DBP and HbA1c. The patients with nacrovascular complications have higher age, SBP and TG than those without macrovascular complications.Conclusion: The prevalence of obesity was increased, the level of blood glucose, blood pressure and TC decreased, however, the level of TG increased, the prevalence of microvascular disease decreased in patients screened for the first time. The metabolic changes and trends of chronic diabetic complitations in newly diagnosed diabetic patients were similar with patients screened for the first time.Based on those data, it is suggested that weight loss plays important roles in decreasing the incidence of diabetes and improving metabolism control. Further strictly metabolism control is necessary in decreasing diabetic macrovascular complications.