Research On The Establishment Of Screening Model And Effectiveness Of Intervention For Population With Impaired Glucose Regulation In Community In Huangpu District

[Objectives]To establish a screening model for population with impaired glucose regulation in community and to verify the effectiveness of the screening model by applying it in normal population. To carry out a comprehensive intervention research to explore a safe, effective and feasible intervention mode for population with impaired glucose regulation in community.[Methods]The screening model for population with impaired glucose regulation in community was established by collecting data from a diabetes epidemiological survey on1769subjects in2006by means of risk factor analysis and risk factor scoring method. The model was applied to screen2120normal residents in another community, and the effectiveness of screening was evaluated. The objects with impaired glucose regulation were randomly divided into4groups:exercise intervention group (58) diet intervention group (57), exercise and diet comprehensive intervention group (59), control group (58). The members of each intervention group were given a personalized guide to prevent diabetes, including physical exercise guide for exercise intervention group, balanced diet guide for diet intervention group, and balanced diet plus exercise guide for exercise and diet intervention group, while the control group members only received health education. The duration of intervention was6months, ranged from Jun2008to Dec2008.[Results]Multivariate unconditional logistic regression analysis showed that age. systolic pressure, family history and waistline were the major risk factors of impaired glucose regulation.The screening model was established by means of risk factor scoring method with the value of OR as variables’scores level and accumulative score of over five as a critical value. In this way, the Youden’s Index of the screening of population with impaired glucose regulation in the model reached the maximum with the sensitivity68.2%and the specificity61.7%. The screening test was carried out in2120normal community residents with the risk factor scoring method.974subjects, which accounted for45.9%of the community residents, were found to have an accumulative score greater than or equal to five. These974subjects were given an OGTT,124subjects of whom were identified as impaired glucose regulation, which accounted for68.9%of the theoretical subjects with IGR.Before intervention, there was a significant difference in fasting blood-glucose and waist-to-hip ratio between the diet intervention group and control group. There was no significant difference in blood glucose, lipids, blood pressure, waist-hip ratio and BMI between the intervention groups and control group.After a6-month sports intervention, the daily average walking amount increased from7432steps to9079steps in the excise intervention group. The difference had a statistical significance (P<0.05). The fasting blood-glucose, glucose tolerance, glycosylated hemoglobin, systolic pressure and diastolic pressure of the excise intervention group decreased to a larger extent than those of the control group, and the difference had a statistical significance (P<0.05). In the excise intervention group, the glycosylated hemoglobin and systolic pressure after intervention decreased significantly compared to those before intervention, and the difference had a statistical significance (P<0.05).After a6-month diet intervention, the intake of energy, fat, cholesterol and percentage of energy from fat of the diet intervention group were significantly less than those of the control group. The intake of dietary fiber and percentage of energy from carbohydrate were significantly more than those of the control group (P<0.01). After intervention, the intake of fat. percentage of energy from fat decreased remarkably. and the intake of dietary fiber and percentage of energy from carbohydrate increased significantly compared to those before intervention. The differences were significant (p<0.01). The reducing amount of cholesterol, fasting blood-glucose, glucose tolerance, glycosylated hemoglobin, systolic pressure, diastolic pressure, body mass index(BMI) and waist-hit ratio(WHR) of the diet intervention group were greater than those of the control group(P<0.05). After intervention, the fasting blood-glucose, glycosylated hemoglobin, systolic pressure and diastolic pressure in the diet intervention group decreased significantly compared to those before intervention(P<0.05). After a6-month comprehensive intervention, the average daily walking amount increased from7876steps’walk before intervention to10118steps’walk, and the difference had a statistical significance (P<0.05). The intake of fat and cholesterol, percentage of energy from fat of the comprehensive intervention group were significantly less than those of the control group. The intake of dietary fiber and carbohydrate, percentage of energy from carbohydrate increased significantly compared to those of control group (P<.01). After intervention, the intake of fat, percentage of energy from fat decreased remarkably and the percentage of energy from carbohydrate increased significantly compared to those before intervention (P<0.01). After intervention, the reduction of cholesterol, triglyceride, fasting blood-glucose, glucose tolerance, glycosylated hemoglobin, systolic pressure and diastolic pressure, BMI and waist-hip ratio of the comprehensive intervention group was greater than those of control group. The difference was significant (P<0.05). After intervention, triglyceride, fasting blood-glucose, glycosylated hemoglobin, systolic pressure and diastolic pressure, waist-hip ratio decreased significantly compared to those before intervention (P<0.05).The four groups were compared. The analysis showed that the intervention effects of cholesterol, triglyceride, waist-hip ratio in diet intervention group and excise intervention group were not evident, but those in comprehensive intervention group were less than those of control group and the difference had a statistically significance (P<0.05).After intervention, fasting blood-glucose, glycosylated hemoglobin, systolic pressure, diastolic pressure and waist-hip ratio of comprehensive intervention group were less than those of excise intervention group significantly (P<0.05). The systolic pressure, diastolic pressure and waist-hip ratio of comprehensive intervention group were less than those of diet intervention group significantly (P<0.05).[Conclusions]The sensitivity was68.2%and the specificity was61.7%with the accumulative score five as diagnosis threshold to screen IGR patients in risk factor scoring method model. The model is an easy, convenient, economical and effective screening tool which was established by the means of risk factor scoring method with the accumulative score of over five points as a critical value, and the model can improve the screening efficiency of IGR in community, promote the management and intervention effects of IGR patients in community. Excise intervention was effective to improve blood glucose and blood pressure of IGR population. Diet intervention was effective to improve blood glucose, blood pressure, physique indexes and dietary nutriment indexes of IGR population. Comprehensive intervention was effective to improve blood glucose, blood lipid, blood pressure, physique indexes and dietary nutriment indexes of IGR population. The plan of comprehensive intervention effectively improved blood biochemical indexes, physique indexes and dietary nutriment indexes of population with impaired glucose regulation. The comprehensive intervention group had the most effective results after intervention.