| In China, the number of people with diabetes [more than 90% are type 2 diabetes mellitus(T2DM)] has reached to 98.4 million by 2013, which has become a major public health problem.Multiple metabolic disorders is the individualgathered situation of metabolic disorders such as overweight/obesity, hypertension, hyperglycemia, hyperlipemia and other components of metabolic indexes, which can increase therisk of T2 DM and cardiovascular diseases. Therefore, detecting and controllingthose risk factors of T2 DM could be helpful to identify at-risk population and make upstream preventive strategies to combat the epidemic of diabetes. ObjectiveThis study focused onthe following four points and provided scientific evidence for the prevention and control of T2DM:1. The association of risk of incident T2 DM with baseline each multiple metabolic disorders component;2. The relationship between the combinations of baseline BMI, WC and WHt Rand T2 DM risk;3. The relationship the cluster of baselinemultiple metabolic disorders and T2 DM risk;4. The relationship between the dynamic change of multiplemetabolic disorders from baseline to follow-up and T2 DM risk. MethodsThe cohort was established between July to Augst 2007 and July to August 2008. Overall, 20194 participants were selected by cluster sampling method from Xin’an county in Henan province. Subjects were ≥18 years old and the investigation included questionnaires, anthropometric measurements, fasting plasma glucose and lipid profile examination. And 17265(85.50%) participants were followed up from July to August 2013 and July to October 2014. Finally, 11718 participants(4426 males and 7292 females) were included in this study. Incidence and Cox proportional hazards regression models were used to evaluate T2 DM risk related tomultiple metabolic disorders.Results1. Overall, 11718 participants(4,426 men and 7,292 women) were retained for this analysis and 677 participants(254 men and 423 women) developed T2 DM during a median duration of follow-up of 6.01 years. Incidence of T2 DM was 9.52 and 9.76 per 1000 person-years in men and women, respectively.2. The relationship between each multiple metabolic disorders component and their clustering at baseline as well as the combination of BMI or WC with WHt R and T2 DM risk:(1) After adjustment for sex, age, smoking, drinking, family history of diabetes at baseline, T2 DM risk of abnormal BMI(overwight/obesity), WC, WHt R, SBP, DBP, FPG, TC, TG and HDL-C groups were significantly higher than that of the corresponding normal groups, and the HR(95%CI) were 2.28(1.83-2.84), 4.78(3.80-6.01), 3.00(2.47-3.65), 3.37(2.68-4.22), 1.56(1.27-1.92), 1.68(1.37-2.06), 9.10(7.61-10.89), 2.10(1.49-2.96), 2.83(2.36-3.39), 1.52(1.28-1.82), respectively and the group of abnormal FPG have the highest T2 DM risk.(2) After adjustment for sex, age, smoking, drinking, family history of diabetes at baseline, Whether BMI was normal or not, T2 DM risk increased if WHt R was abnormal when compared to normal BMI/normal WHt R group, and the HR(95%CI) of normal BMI/abnormal WHt R group, abnormal BMI/abnormal WHt R group were 1.80(1.27-2.56), 3.79(2.99-4.80), After adjustment for the same factors, Whether WC was normal or not, T2 DM risk increased if WHt R was abnormal when compared to normal WC/normal WHt R group, and the HR(95%CI) of normal WC/abnormal WHt R group, abnormal WC/abnormal WHt R group were 2.21(1.62-3.00), 3.98(3.14-5.04).(3) After adjustment for sex, age, smoking, drinking, family history of diabetes at baseline, compared with the people who were free of all the metabolic disorders components(central obesity, hypertension, impaired fasting glucose, hyperlipemia), the multivariate-adjusted HR(95%CI) in persons who suffered 1, 2, 3 or 4 of the components were 1.55(1.11-2.18), 4.39(3.20-6.00), 8.68(6.27-12.04) and 28.07(19.10-41.26), respectively.3. The relationship between the dynamic change of multiple metabolic disorders from baseline to follow-up and T2 DM risk:(1) After adjustment for baseline sex, age, smoking, drinking, family history of diabetes, In the baseline normal WC, WHt R, DBP, TC, TG or HDL-C group, T2 DM risk increased when baseline normal WC, WHt R, DBP, TC, TG or HDL-C developed abnormality during follow-up and the HR(95%CI) were 2.28(1.67-3.13), 3.15(2.09-4.74), 1.42(1.07-1.90), 3.19(2.32-4.38), 3.17(2.50-4.03) and 1.53(1.20-1.95), respectively. After adjustment for the same factors, in the baseline abnormal BMI, WC, WHt R, TC or TG group, T2 DM risk was higher for subjects with uncontrolled BMI, WC, WHt R, TC or TG comparing with thosewhose BMI, WC, WHt R, TC or TG had been under control, and the HR(95%CI) were 1.47(1.00-2.14), 1.60(1.10-2.33), 1.84(1.20-2.83), 2.22(1.12-4.39) and 1.41(1.03-1.93), respectively.(2) After adjustment for baseline sex, age, smoking, drinking, family history of diabetes, comparing with those maintain normal blood lipid at baseline and follow-up,T2 DM risk increased for subjects who had the normal blood lipid at baseline but developed dyslipidemia during follow-up and the HR(95%CI) were 2.41(1.83-3.19). And in the baseline dyslipidemia group, T2 DM risk was higher for subjects with uncontrolled blood lipid during follow-up comparing with thosewhose blood lipid had been under controland the HR(95%CI) were 1.53(1.15-1.99). Conclusions1. The abnormity of each component of metabolic disordersat baseline could increase the risk of developing T2 DM.2. Whether baseline BMI/WC was normal or not, T2 DM risk increased if baseline WHt R was abnormal.3. The risk of T2 DM gradually increased with the increasing of cluster number of multiple metabolic disorders components.4. Whether baseline WC, WHt R, TC or TG was normal or not, the risk of developing T2 DM could be reduced if the WC, WHt R, TC or TG had been effectively under control. |
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