| [Background]Diabetes mellitus (DM) is a complex of metabolic disorder characterized with chronic hyperglycemia. As the socio-economic development and the improvement of living standards, both developed and developing countries, the prevalent trend of diabetes is upward; it has become one of the major public health issuesworldwide. Impaired glucose regulation (IGR), which is significant to early detection and control of diabetes, is considered as pre-diabetic state. As we know, DM is a clinical syndrome caused by the interaction of genetic and environmental factors. At presents, the number of risk factors of DM has reached a consensus, but the research of the risk factors of IGR is less than DM.Domestic and international study found that due to endocrine and metabolic changes, the surface measurement parameters of patients with DM or IGR have changed, its main feature is the concentric distribution of body fat, using the change trends of these anthropometric indexes to discover DM and its high-risk groups, confirming the cutoff point of these anthropometric indexes for DM screening is of great significance for DM screening and prevention. Basing on the baseline survey data of "Shandong&MOHAction on Salt and Hypertension (SMASH)", we research the epidemiological characteristics of IGR and DM, explore the risk factors of IGR and DM in Shandong province, analyze the relationship between IGR, DM and anthropometric indexes comprehensively,identify the appropriate cut-off point of anthropometric indexes for DM screening in Shandong province, provide scientific data for the DM prevention planning of Shandong province.[Objectives]1.To find outthe epidemiological characteristics of IGR and DM among18to69year-old residents of urban and rural area of Shandong province.2.To analyze the risk factors of IGR and DM in Shandong province.3.To explore the variation of the anthropometric indexes of IGR and DM patients, analyze the relationship between IGR, DM and anthropometric indexes4.To identify the optimal cut-off points of anthropometric indexes which suitable for residents of Shandong province.[Methods]This study is a cross-sectional survey. Multi-stage stratified randomized sampling was used in this study. The sample was stratified according to the geographical distribution, urban-rural and gender. Accounting the dietary habits and geographic distribution of our province,140countries were classified as Jiaodong hilly, central and southern mountainous area, northwest plains of Shandong province. As a result of complex sampling, the probability of each individual was selected is unequal, the sampling weights were used for the complex sampling point value of prevalence and the Taylor series linearization method was adopted to estimate the variance of rate and construct95%confidence interval (CI).The survey included the questionnaire, physical examination and laboratory testing. The diagnosis of IGR and DM was made according to fast plasma glucose concentration, in combination withoral glucose tolerance test (OGTT) and the survey of previous DM diagnosis in local hospital.Fasting venous blood was collected from all subjects, subjects whose FPG values between6.1～7.0mmol/Lshould accept OGTT, subjects whose FPG≥7.0mmol/L were required to do FPG retest.The overall weighted prevalence rates and their95%CIs of IGR and DM amongresidents aged18to69in Shandong province, as well as that among population subgroups divided by age groups,urban and rural areas,geographic distribution, gender and other demographic factors were described, the differences between the prevalence rate was compared and analyzed.The disorderly multi-classification Logistic regression model was determined by the test result of classification of Y value using the parallel test in the risk factors analysis.Suffering IGR and DM arethe dependent variable, determining the independent variables and their assignment. Single-factor analysis was done to screen the meaningful variables and whether there is a linear relationship between all the variables.The linear diagnosis was used to verify and eliminate the linear of all variables in the model. The complex sample design multi-classification SERVEYLOGISTIC regression model was modeled.The prevalence of IGR and DM in different BMI, waist circumference(WC), waist-hip radio(WHR) were described. In order to control the influence of age, gender and other factors as well as the interaction of BMI and WC, calculate prevalenceOR value to compare the relationship between BMI, WC and IGR, DM. Using stratified analysis to analyze the relationship between obesity, central obesity and IGR,DM,controlling the mutual interference of two types obesityto explore the real relationship between obesity, central obesity and IGR, DM.The Receiver Operator Characteristic Curve(ROC) area under the curve (AUC) was used to evaluate the value of BMI, WC, WHR screening DM, optimal cut-off points to screen DM were determined by themaximum of Youden indexes.Dividing the groups by age and height of75%percent, the AUC of different age and height groups were computed to evaluate the screening value of different anthropometric indexes in different age and height groups.In order to evaluate the consistency of the optimal cut-off points of three anthropometric indexes compared the screening results of one optimal cut-off point of one anthropometric index to the other two anthropometric indexes to analyze the consistency.[Results]1. The basic character of the subjects15350people were surveyed actually,15339people participated in blood pressure measuring,15262people had FPG values. The average age was41.5±13.9years, the ratio of male to female is1:1(7683/7667), the ratio of urban to rural population is0.46:1(4804/10546).2. The epidemiological characteristics of DM and IGR.2.1The weighted prevalence rates of IFGJGT and DM are9.34%(95%CI:6.58%-12.10%),1.53%(95%CI:1.09%-1.98%) and5.50%(95%CI:4.51%-6.48%) respectively. All of the DM patients,410patients are confirmed before the survey, accounting for43.57%.2.2The prevalence rates of IGR in rural areas is higher than urban, the prevalence rates of DM in urban areas is5.78%(95%CI:2.33%-9.23%), higher than that in rural areas(5.38%,95%CI:4.00%-6.75%), but there is no statistically significant differences between them (P>0.05).Viewing from the three regions, the prevalence rates of IGR and DM in Northwestern is lowest, which is highest in Eastern Shandong.2.3People aged over40is high-risk population. The DM prevalence rate is significantly higher in the group aged>40years than those aged between18-69, there is significant difference among the group aged>40years and aged18-69years (P<0.05).2.4The prevalence rates of IGR and DM are reduced with the level of education increasing. The prevalence rates for IGR and DM are the lowest in retired population and the highest in school students. The prevalence rate of IGR is reduced with the level of income increasing. The prevalence rate of DM presents "√" distribution with the increase of income, the middle-income population has lowest prevalence rate (4.62%,95%CI:3.58%-5.66%). 3. The risk factors of IGR and DMThe disorderly multi-classification SERVEYLOGISTIC regression model shows that age≥30years, BMI≥24kg/m2, waist circumference excessive and high blood pressure are the common risk factors of IGR and DM; Occupational physical labor more than6hours is protective factors for IFG The risk factors for IFG and DM also include a history of chronic diseases.4. The relationship between the anthropometric indexes and IGR, DMThere is a linear increasing trend between the prevalence rates of IGR, DM and BMI, WC, WHR. Controlling the influential factors by stratified and Logistic regression analysis, the results show that OR value of IGR and DM increased with the rise of the BMI and WC, however, there is more closely relationship between central obesity and DM than systemic obesity.5. The anthropometric indexes screening value and the optimal cut-off points analysis.There is statistically significance between the AUC of BMI,WC and WHR and0.5(T<0.001), the AUC of WHR followed by WC, the AUC of BMI is minimum. There is no different statistically significance between different age and height groups (P>0.05). The Youden index came to maximum when BMI is25.00kg/m2for both males and females, WC is91cm, WHR is0.92for the males and WC is83cm, WHR is0.87for the females respectively. The Kappa value comes to maximum in these optimal cut-off points.[Conclusion]The prevalence rates of IGR and DM is quite high in Shandong province, the huge IFG patients are potential candidates for the occurrence of DM. The awareness of illness in DM patients is low. and the health consciousness is weak. The prevalence of IGR and DM is highest in the group aged>40years. Age≥30years. BMI≥24kg/m". waist circumference excessive and high blood pressure are the common risk factors of IGR and DM; The risk factors for IFG and DM also include a history of chronic diseases such as stroke and coronary heart disease. There is a linear trend between the prevalence of IGR, DM and BMI, WC, WHR,"V" trend between IGR with WC and DM with BMI. Controlling the influential factors by stratified analysis and Logistic regression analysis, the results show that both systemic obesity and central obesity are closely related with IGR and DM, but there is more closely relationship between central obesity and DM. BMI, WC and WHR are effective anthropometric indexes for DM screening, and the WHR has the highest value, this rule also exists in the population of different age and height. The optimal cut-off points for men were BMI25kg/m2,WC91cm and WHR0.92, the corresponding values for women were25kg/m2,83cm and0.87respectively, and they had best consistency for screening DM.[Suggestions]1.To further investigate the epidemiological characteristics of IGR and DM in the follow-up study combined with the problems which need to be perfect in this investigation.2.To strengthen the comprehensive use of DM screening methods, take advantage of the anthropometric cut-off points to consolidate the screening, publicity and education of chronic diseases such as DM, hypertension, coronary heart disease and metabolic syndrome.3.To carry out OGTT in the whole subjects in order to realize the epidemiological characteristics of IGR and the prevalence of DM of the whole crowd.4.To analyze the conversion of IGR and prognosis of DM in the further cohort study, and to study the role of systemic obesity and central obesity in the pathogenesis of IGR and DM.5.To carry out targeted interventions and health education according to the risk factors of IGR and DM, and reduce the prevalence of them.6.To improve the self-test rate and health awarenessof the population, put the anthropometric cut-off points as the key contents of the publicity and education, strengthen self-management of IGR and DM patients. |
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