Research On Factors Associated With Chronic Complications Of Type 2 Diabetes Mellitus Patients

Objective: Diabetes mellitus (DM) is a chronic metabolic disorder. Lack or relative lack of insulin in vivo leads to persistent hyperglycemia. Diabetic with long-term poor control of blood glucose may develop various complications, especially ophthalmopathy, cardiovascular disease, nephropathy, neuropathy. The high fatality rate and mutilation rate of complications are the major hazards to the DM patients. Therefore, the factors associated with the development of DM chronic complications have been taken seriously. In order to provide evidence for the prevention and control of type 2 diabetes Mellitus(T2DM) chronic complications, the factors associated with the incidence of chronic complications and the time from the diagnosis date of T2DM to the diagnosis date of chronic complications have been investigated。Methods: (1) A hospital-based frequency matching case-control study was conducted. 200 T2DM patients with a kind of DM chronic complication at least(case group) and 200 T2DM patients without DM chronic complication (control group) were recruited at random in the First Central Hospital of Baoding during January 2005 to December 2007. All the patients aged more than 40 years. Frequency of age, sex and ethnic were matched between the two groups. All information was collected by questionnaire in face-to-face interview. Investigator administrated questionnaire was conducted to investigate information including demographic characteristics, previous history, family history, diet, lifestyle, social psychological characteristics, physical and laboratory data. Univariate Logistic regression, Multivariate Logistic regression, Principal component analysis and Factor analysis were used to analyze the risk factors. (2)112 T2DM patients with cardiovascular disease or 108 T2DM patients with ophthalmocace or 103 T2DM patients with neuropathy were treated respectively as cases and the above-mentioned 200 DM patients with no complications were treated as controls. Use multivariate Logistic regression immediately to analyze the factors associated with cardiovascular disease, ophthalmocace and neuropathy. (3) A survival analysis was carried to explore the factors associated with the time from the diagnosis date of DM to the diagnosis date of DM complications. We recruit DM diagnosis date of DM, diagnosis date of first DM complication, demographic characteristics, disease history, disease family history, diet, living and behavioral pattern, social psychological characteristics and clinical data of 194 T2DM patients with a kind of DM chronic complication at least."Survival time"was defined as time between DM diagnosis date and the first DM complication diagnosis date. The end-point was defined as the occurrence of certain kind of T2DM complications. Life-table method was used to calculate complications-free rate. The Log-rank analysis and Cox regression were used to analyze the factors associated with the"survival time".Results: (1) Results from univariate analysis showed that the following factors were associated with the incidence of T2DM chronic complications: farmer, duration of DM, hypertension, dyslipidemia, frequency of hospitalization, time of hospitalization, family history of DM, family history of hypertension, tobacco abuse before developing DM, index of tobacco abuse before developing DM, alcohol intake after developing DM, lack of exercise before developing DM, lack of exercise after developing DM, grease food intake before developing DM, sweat food intake, rice intake, mental stress, living irregular, high systolic blood pressure (SBP), low high density lipoprotein-cholesterol(HDL-C), high low density lipoprotein-cholesterol(LDL-C), high blood urea nitrogen (BUN), high creatinine (Cr), high C-reactive protein (CRP), high glycated hemoglobin A1c (HbA1c %), well control of blood glucose, well control of blood pressure, well control of blood fat, following the doctor's advice, insulin injections, high-quality sleep. Multivariate logistic regression analysis with factors selected by principal component analysis and factor analysis found 15 factors were independently associated with T2DM chronic complications: high CRP (OR=5.568, CI=2.041~15.188), dyslipidemia (OR=4.400,CI=2.092~9.253), high BUN (OR=4.399, CI=1.705~11.350), high LDL-C (OR=3.594, CI=1.229~10.508), time of hospitalization (OR=2.612, CI=1.399~4.878), grease food intake before developing DM (OR= 2.300, CI=1.281~4.128), high HbA1c % (OR=1.747, CI=1.081~2.823), lack of exercise after developing DM (OR=1.672, CI=1.150~2.431), duration of DM (OR=1.509, CI=1.127~2.021), mental stress (OR=1.427, CI=1.041~2.064) are risk factors; high-quality sleep (OR=0.606, CI=0.376~0.977), well control of blood glucose (OR=0.517, CI=0.316~0.844), well control of blood fat (OR=0.299, CI=0.100~0.523), insulin injections (OR=0.155, CI=0.027~0.898) are protective factors. (2) The result of mutifactorial Logistic regression showed that high BUN, high CRP, grease food intake before developing DM, high HbA1c %, hypertension, duration of DM are the risk factors of ophthalmocace; insulin injections, well control of blood glucose are protective factors. The risk factors of cardiovascular disease are high BUN, hypertension, high CRP, high LDL-C, high HbA1c %, duration of DM, mental stress; the protective factors are insulin injections and well control of blood fat. The risk factors of neuropathy are sweat food intake, duration of DM, greasy food intake before developing DM, lack of exercises after developing DM; the protective factors are insulin injections, following the doctor's advice, well control of blood fat. (3) The study showed that over-all DM complications-free rates were 82.1% at 1 year, 73.7% at 3 years, 58.9% at 5 years, 29.5% at 10 years. The median"survival time"is 7.42 years. The positive results found with Log-rank statistics are age, age at diagnosis, dyslipidemia, mental stress. The Cox regression result shows that age (OR=0.434), age at diagnosis (OR=2.967), mental stress (OR=1.394) are the influential factors of the time from the diagnosis date of DM to the diagnosis date of DM complications.Conclusion: (1) The risk factors of T2DM chronic complications are high CRP, dyslipidemia, high BUN, high LDL-C, time of hospitalization, grease food intake before developing DM, high HbA1c%, lack of exercise after developing DM, duration of DM, mental stress. (smallest sort by OR). High Cr indicated that chronic complications had already occurred. The protective factors are insulin injections, well control of blood fat and blood glucose, high-quality sleep.(2)The unique risk factors of cardiovascular disease are high LDL-C and mental stress . The unique risk factors of neuropathy are lack of exercise after developing DM and sweat food intake. The unique protective factor of ophthalmocace is well control of blood glucose. (3) The median"survival time"is 7.42 years. Aged, age at diagnosis and mental stress are independently factors associated with"survival time"of chronic complications.