Analysis Of Fasting Plasma Glucose Among Villagers In Western Anhui And Development Of A Standard Operation Procedure For Preventing Diabetes Via Village Doctors

Objectives The study was aimed to a) describe the status of fasting plasma glucose among villagers in western Anhui and probe possible influence factors of prediabetes; b) design a standard operation procedure(SOP) for village doctors in prediabetes intervention, in order to combine diabetes prevention and medical service and improve diabetes prevention and control in rural area of western Anhui.Methods 1.We randomly selected six townships from seven counties and then randomly selected one administrative village in each township using cluster random sampling method. Eligible villagers in all the selected administrative villages were recruited to administer a face-to-face interview using a structured questionnaire and perform a number of physical measurements including weight, height, blood pressures and fasting plasma glucose(FPG). Data analyses included descriptive analysis, chi-square test and multivariate logistic regression analysis using SPSS 17.0 software. 2. According to the theoretical model of motivational interviewing, we designed a SOP for village doctors in prediabetes intervention by methods of literature review, case analysis, expert consultation and rapid prototyping. Besides, we also developed a network platform for the SOP(i.e. web-based SOP) based on B/S network structure via C# as programme language, Visual Studio 2008 as application development platform, Apache as web server and SQL Server 2005 as database platform.Results 1.A total of 4040 villagers participated in the survey and 3546(87.8%) completed the fasting plasma glucose test. They featured female dominance(65.7% females vs. 34.3% males) and low education(never go to school accounted for 48.4%). Villagers aged 40-49 years, 50-59 years and 60-69 years accounted for 29.6%, 29.5% and 40.9%. The percentages of villagers falling into three FPG ranges of FPG<5.6 mmol/L, 5.6≤FPG<7.0 mmol/L and FPG≥7.0 mmol/L were 38.6%, 52.5% and 8.9% respectively. Overweight and obesity account for 43.5% and 16.9% and hypertension accounted for 61.6%. 2. The results of univariate logistic regression analysis showed that age, gender, education, body mass index, hypertension, smoking index, physical activity level and life events index were influence factors of prediabetes except for alcohol intake. 3. The results of multivariate logistic regression analysis suggested that overweight(OR=1.330, 95% CI: 1.124-1.574), obesity(OR=1.958, 95% CI: 1.543-2.485), alcohol intake ≥50 g/d(OR=1.511, 95% CI: 1.125-2.029) and stressful life events(middle level OR=1.373, 95% CI: 1.143-1.649; high level OR=1.618, 95% CI: 1.340-1.954) may be risk factors of prediabetes. Besides, primary school education(OR=0.773, 95% CI: 0.648-0.923), middle school education or above(OR=0.713, 95% CI: 0.566-0.898) and high physical activity level(OR=0.804, 95% CI: 0.665-0.973) may be protective factors. 4. Obesity and stressful life events were risk factors of prediabetes for both male and female villagers. Alcohol intake ≥50 g/d displayed high risk of prediabetes for males, while overweight for females. In addition, primary school education or above may be protective factor but only for female villagers. 5. The SOP for prediabetes intervention included five modules which consist of promoting fasting glucose screening, informing normal fasting glucose, supporting transfer treatment for suspected diabetes, promoting fasting glucose control for prediabetes and strengthening fasting glucose control for prediabetes. Then by using Visual Studio 2008 development platform, web-based SOP incorporated the five modules above and achieved the initial goal of prediabetes intervention.Conclusions 1.The status of FPG merit more attention for villagers in western Anhui and it is urgent need to carry out prediabetes intervention among them. 2. Overweight,obesity, alcohol intake ≥50 g/d and stressful life events may be risk factors of prediabetes, while high education and physical activity level may be protective factors. 3. There may be gender differences in influence factors of prediabetes, thus we should take gender-specific intervention in diabetes prevention. 4. The web-based SOP provided a novel thought for prediabetes intervention in rural areas, and it should be field implemented and further evaluated.