Application Of Interpretative Structure Model To Diabetes Integrated Rehabilitation Treatment And NAFLD And Diabetic Nephropathy

Objective:1.To explore The relationship of the related factors of diabetes mellitus integrated rehabilitation treatment.2.To explore the relationship between nonalcoholic fatty liver disease (NAFLD) and diabetic nephropathy in patients with T2DM.Methods:1. descriptive research:The method of interpretative structure model(ISM) was adopted to investigate the relationship of the influence factors of diabetes mellitus integrated rehabilitation treatment. First of all, organized the ISM group, and established the core problem about "diabetes integrated rehabilitation factors", on the basis of consulting a large number of literature material and the analysis of the ISM group, to determine the effect factors of diabetes integrated rehabilitation treatment and their mutual relations. And according to the correlation of the factors established the adjacency matrix and reachability matrix, then established the interpretation structure model after the reachability matrix decomposition.2. analytical research:The method of retrospective cohort study was adopted to investigate the correlation between NAFLD and diabetic nephropathy in T2DM patients.Retrospectively reviewed the cases of T2DM patients who repeated hospitalization in endocrinology department of Tianjin Third Central Hospital in recent10years (two intervals of7years), selected the T2DM patient without diabetes acute and chronic complications.According to whether with NAFLD, they were divided into the group with NAFLD (group A) and without NAFLD (group B), and according to the fat content of liver.group A was divided into Al, A2and A3sub groups. We compared the incidence of diabetic Nephropathy in the group A, group B and group Al, A2and A3for the second time in the hospital, and calculated the relative risk (RR), attributable risk (AR) and attributable risk percent(ARP), and analysed the relevance of urinary albumin to creatinine ratio and other variables. Based on additive interaction model,analyzed additive interaction of NAFLD and other factors on the effect of DN, calculated the interaction of the relative excess risk (RERI), attributable proportion of interaction (AP) and interaction index (S), and application of correlation analysis and multivariate stepwise regression to analyze the correlation between Aurinary albumin to creatinine ratio, AGFRand NAFLD additive interaction factors in group Al, A2and A3.Results:1.descriptive research results:Through extensive literature search and ISM group discussion, finally determined diabetes mellitus integrated rehabilitation model including education, sports, food, medicine, non mainstream medicine, T2DM, NAFLD,obesity, sleep disorders, osteoporosis, diabetic retinopathy, diabetic nephropathy, diabetic neuropathy, diabetic macroangiopathy factors. ISM analysis yielded a hierarchical structure model of four layers. The basic layer was education.The second layer were the movement, western medicine, non mainstream medicine and die. Third layer and the fourth layer was diabetes mellitus and its complications, diabetes mellitus and complications were closely related, and the complications of diabetes mellitus were closely related with each other. And through the diabetes mellitus integrated rehabilitation treatment structure model,we found the research between NAFLD and diabetic neuropathy was very little, and controversial, which Needs further study.2.analytical research results:Group A and group B had the same baseline. The cumulative incidence of diabetic nephropathy in group A was58.58%,whic h in group B was37.22%,x2=15.94(P<0.01).The relative risk (RR) of NAFL D was1.57, and the attributable risk (AR) was21.36%, and the attributable ri sk percent(ARP) was36.46%. In group Al, the cumulative incidence of DN w as46.43%(mass proteinuria cumulative incidence rate was8.93%, the cumulati ve incidence of microalbuminuria was37.50%).in group A2,the cumulative inci dence of DN was57.14%(mass proteinuria cumulative incidence rate was10.71%, trace protein urinary cumulative incidence was46.43%,in group A3,the cu mulative incidence of DN was71.93%(mass proteinuria cumulative incidence r ate was15.79%, microalbuminuria cumulative incidence rate was56.14%).NAF LD and HOMA-IR,FFA, TNF-α, omention-1, visceral fat area, HCY,UA existe d additive interaction, the relative excess risk (RERI) were4.980、3.794、3.353、 2.399、2.169、2.357and1.695, attributable proportion of interaction (AP) were0.617、0.409、0.433、0.372、0.193、0.348and0.399,the interaction index were3.384、1.845、1.991、1.786、1.269、2.421and2.093. In subgroups Al, ΔFF A, ΔHOMA-IR were the independent risk factor for ΔUrinary albumin/creatinin e, ΔFF A, ΔHOMA-IR, ΔUrinary albumin/creatinine were the independent risk fa ctor for ΔGFR; In subgroups A2, ΔHOMA-IR, ΔTNF-α, Δomentin-1were inde pendent risk factors of ΔUrinary albumin/creatinine, AHOMA-IR, ΔTNF-α, ΔUr inary albumin/creatinine were independent risk factors of ΔGFR; in the subgro up A3, ΔTNF-α,ΔHOMA-IR,ΔHCY were the independent risk factor for AUrin ary albumin/creatinine, ΔTNF-α,ΔHOMA-IR,Δomentin-1were the independent ri sk factor for ΔGFR.Conclusion:1.Type2diabetes integrated rehabilitation therapy is a system management philosophy,ISM belongs to a conceptual model, it scientifically constructed the integrated rehabilitation model of diabetes.2.1n T2DM patients,NAFLD is a risk factor in the pathogenesis of DN,and with the increase of fat content in liver,the cumulative incidence of DN is gradually increased.3. In T2DM patients, the effect of NAFLD and visceral fat area, HOMA-IR, FFA, TNF-α,HCY,UA, omentin-1are interacted,suggesting that NAFLD and the above factors there may be have a common mechanism in the occurrence of DN4. HOMA-IR is the main mechanism of NAFLD to increased kidney damage; early NAFLD mainly through HOMA-IR and FFA damage to the kidney, increase the incidence of DN, along with the increase of fat content in liver, NAFLD can mobilize TNF-α HCY, omentin-1factors to increase urinary albumin excretion, decrease the level of GFR; urinary albumin itself also can aggravate the damage to the kidneys.