| BackgroundIt is well known that diabetes has become one of the epidemic diseases of the harm to the society as a whole,as a kind of common disease,multiple diseases,serious effect and harm the human health.There is an upward trend in the world the prevalence of diabetes.The International Diabetes Federation?International Diabetes Federation,IDF?released the new Diabetes map shows:in 2011 the global of the number of people diagnosed with Diabetes has reached$366 million,280 million people in the prophase of Diabetes patients[1].The growth rate of diabetes is increasing at an annual rate of 2.7%,by 2030,the number of cases of diabetes around the world soon to be 552 million;Lower income for the epidemiological trends of diabetes in the developing world will be more prominent[2].Along with the continuous development of the economic level of our country,the change of lifestyle?lifestyle?,and the aging of the population increasing,the number of diabetes patients in China population is rising gradually in every year.And the effects of diabetes to human health,far more than the high blood sugar itself,caused by its various acute or chronic complications,also brought great harm to human.In people with diabetes,Type 2 diabetes accounts for a large proportion of the population.Is a group of type 2 diabetes is characterized by increased blood glucose levels of chronic metabolic disease[3-4],is due to the role of insulin secretion and?or?defects caused by.T2DM is often associated with metabolic disorder of chronic non-communicable diseases like acid hematic disease,and fatty liver,promote each other,serious impact on human health life,at the same time to family and society bring heavy economic burden.Therefore,further study of type 2 diabetes related complications,early detection and prevention of diabetes and its complications,especially chronic complications such as vascular complications and microvascular complications,diabetic nephropathy,and diabetic foots one of the preventive medicine research hot spots of the century.Some of chronic non-communicable diseases such as diabetes,high blood pressure and other disease of heart head blood-vessel,its produce the symptom such as obesity and overweight is that they are one of the leading causes of morbidity and high risk.And the causes of type 2 diabetes was born under various factors combined action,for example,which can keep sitting position of form of life,often eat food of high quantity of heat caused by obesity.A number of epidemiological studies have shown that obesity and overweight can increase the risk of T2DM,which is the independent risk factor for T2DM and the main cause of[5].In the diabetic population distribution,obesity,oerweight diabetic patients is becoming more and more young,at the same time among young people,even the teenage children,the number of overweight and obesity is also growing more and more quickly,they become a large reserve of the diabetes team.DN?Diabetic Kidney diseases?in patients with type 2 diabetes is one of the major disability and death of concurrent Disease,primary prevention is of great significance for Diabetic nephropathy.Determination of urinary albumin/creatinine and 24 hours urine trace albumin test,determination of glomerular filtration rate?GFR?,Cys C,colour to exceed,renal biopsy is an effective tool for screening DN,but these clinical inspection and examination methods need to be patient to return relevant specimens,or has the skilled operation skills of specialized subject doctor check[6].Moreover,the high cost of several inspection methods,time consuming,the subjects had invasive injury.More importantly,at present our country crowd generally lack of self-care knowledge,not enough to realize the danger of the complications of diabetic nephropathy,poor's adherence to the check.Therefore,to explore a simple,rapid,noninvasive,economy,easy to accept the diabetic nephropathy screening tool for development is of great significance to prevent and delay the onset of DN[7].In recent years,principle is based on several major risk factors for disease,and the subjects themselves score themselves.The subjects to self-realization of diabetes risk assessment in addition to the commonly used Finnish diabetes risk list?Finland diabetes risk score,FINDRISC?and Denmark,the Netherlands,India and other countries of diabetes risk list[8].Our country is put forward for the first time the Chinese diabetes risk assessment is in the new version of the 2013"Chinese type 2diabetes prevention guide",this new type of the diabetes risk score against Chinese people had built up project contains six,namely age,waist circumference,body mass index,sex,blood pressure,whether to have a family history of diabetes,the table is put forward and applied to help people with diabetes can carry on the prevention and early detection and diagnosis even intervention,the can reduce the economic burden of the family,to reduce the complications of the generation and improve the quality of life has a great clinical significance.In addition,the FINDRISC associated with the development of insulin resistance and T2DM,prediction of chronic heart disease,stroke,and mortality rate of effective tools,hepatic steatosis can also be used for screening and the metabolic syndrome,etc.[9].However,there is currently no risk assessment for screening DN.This study applies the research of the Chinese medical association"REACTIONSTUDY"henan part of endocrinology branch organization of cross-sectional survey data,using the method of cluster sampling,the selection of zhengzhou city,henan province,six community health service centers?the eight-way,dongfeng road,high way,phoenix palace,renmin road,the future road community?,permanent residents aged over 35 surveyed more than ten thousand people.Investigation contents include questionnaire,physical examination and laboratory examination?fasting blood glucose,OGTT-2 h blood glucose,serum creatinine,liver function,glycosylated hemoglobin,blood lipid four,etc.?.From all survey the number of patients with type 2 diabetes,1035,by the method of case-control study,screening out the overweight obesity from the above research object with 658 cases of type 2 diabetes,the crowd further divided into merger diabetic nephropathy group?case group?and the unincorporated nephropathy group?control group?,the study of risk factors for type 2 diabetic nephropathy.Data recorded by the double double EpiData3.1 software library,using SPSS13.0 statistical software for data analysis.Type 2 diabetes mellitus overweight DN prevalence in the population,and analyze the related risk factors,and then based on the risk factors of DN,risk assessment,risk score method using ROC curve evaluation improved FINDRISC DN in diabetes,overweight population screening efficiency.And cross validation method is used to verify the DN risk assessment method of reliability and applicability.To shed light on the application of overweight obesity T2DM patients with DN risk score provide preliminary theoretical and clinical basis,working for the screening of DN provide valuable scientific basis.Objective:Take zhengzhou area merge with type 2 diabetes in obese and overweight patients divided into merger diabetic nephropathy group?case group?and unincorporated nephropathy group?control group?,to explore and analysis there are high risk factors for type 2 diabetic nephropathy,take advantage of these preliminary build a high-risk factors of overweight obesity with type 2 diabetes nephropathy risk assessment,evaluation of the ROC curve is used to scale screening diabetic nephropathy in diabetic overweight people,at the same time using cross validation method to verify the reliability and applicability of the methods to set up the risk assessment of diabetic nephropathy.To create this evaluation method is to explore a suitable way of grassroots health workers,can easily in the overweight obesity screening of diabetic nephropathy in type 2 diabetic population of high-risk groups,check early,early intervention,rapidly and accurately for the primary prevention of diabetic nephropathy,working for the screening of diabetic nephropathy also provide valuable scientific basis.Subjects:This study combined with the community health service center of zhengzhou city,henan province,six of the actual situation of population distribution from June2010 to December 2010,the application of random cluster sampling method,six community health service center of zhengzhou city residents aged over 35,selection among them has been diagnosed T2DM and combine the cross-sectional survey of overweight or obese people.Meet the following conditions included in this study:?1?full 5 years living in zhengzhou city,T2DM patients aged 35 and older;?2?BMI 25 kg/m2 or;?3?measuring waist circumference,hip circumference,?4?date,diabetes duration and medication compliance of treatment for type 2 diabetes and diabetic nephropathy BingBianShi?not/have?,antihypertensive medication history?not/have?,regular exercise?not/have?,the control diet?not/have?,history of smoking and drinking,etc.,fill in complete information.Exclude the difficulty,poor compliance or communication disorders.Methods:The diagnosis of type 2 diabetic kidney diseases?DN?and classification method is as follows:if the patient has a history DN or current diagnosis of DN,medical workers involved in this study to verify the patient's medical record information,and record the DN of grading.Stage of DN with reference to the internationally recognized standards for diabetic nephropathy Mogensen staging diagnosis of registration.This study chooses not to need special gathering skills,no need to create a DN laboratory examination of DN risk factors,risk assessment,the age,duration of diabetes,antihypertensive medication history,history of smoking,alcohol consumption,body mass index,waist circumference,irregular exercise and diet as alternative risk factors of DN risk assessment is established.In all the overweight obesity T2DM patients,with univariate logistic regression analysis method of simple model to evaluate the optional risk factors,with P<0.05 as screening of risk factors of Xi significant boundaries.Begin from about 70%of total samples randomly selected samples as the training sample,the remaining 30%of the sample for testing samples.Risk assessment of the training sample is used to establish the DN.Then to have statistical significance in the training samples of a number of possible risk factors for multivariate logistic regression analysis of the model,the logistic regression analysis of the output,the regression coefficient of the meaning of the beta is the independent variable for each level,increase the power of individuals at increased risk for DN.According to this principle,with 10 times each variable regression coefficient?a decimal places regression coefficient?as the score of each variable scores that get DN risk list of each variable in the specific rating value.This study use to draw the receiver-operating characteristic curve?ROC curve?risk assessment list DN to screening efficiency,sensitivity,specific,and especially by calculation index to establish the screening point of tangency.At the same time using cross validation method to test the practical application effectiveness of DN risk score,will receive from the training sample selection of risk factors and its score used in the test sample,created to evaluate the actual risk factors evaluation method of screening effect.Tangent point value according to the training sample selection screening,screening point of tangency calculation in the test samples of the specific and sensitivity,when the training samples and test samples of the specific degree of sensitivity and basic quite,argues that the establishment of DN risk score method is reliable and has good applicability.Statistical analysis:Using SPSS13.0 statistical analysis.Measurement data using normal distribution??x±s?said,Non-normal distribution of measurement data using the median and quartiles?P25P75?[M],nonparametric tests;Count data expressed as a percentage,comparison between groups by chi-square test.Using binary classification Logistic regression analysis of the related risk factors for DN,calculate the OR values and95%confidence interval.Respectively through mapping the receiver-operating characteristic curve?ROC curve?and comparing the area under the curve?AUC?size to achieve the establishment of diagnostic point of tangency and effect assessment,and calculate the sensitivity,specific and particular index,AUC is close to 1,tip screening efficiency,the better.P<0.05 think the difference was statistically significant.Results:1 the clinical features of overweight obesity T2DM patientsA total of 658 cases of overweight obesity T2DM patients included in this study,251 cases of male,female 407 cases,the average age was 60.58+/-9.26 years old.including age,gender,diabetes duration,waist circumference,hip circumference,systolic blood pressure,blood sugar 2 hours after meal,glycosylated hemoglobin,serum creatinine,TG and liver transaminase level higher than the patients without DN group?P<0.05?,including body mass index,TC,diastolic blood pressure,fasting blood sugar,high density lipoprotein cholesterol,HDL-C,low density lipoprotein cholesterol,LDL-C level compared with patients without DN group differences between groups have no statistical significance?P>0.05?.2 the DN for the establishment of the risk assessmentWhether Whether patients with DN history as a dependent variable,age,duration of diabetes,antihypertensive medication history,body mass index,waist circumference,regular exercise and diet control,with or without a history of smoking and drinking as independent variables,one by one,the univariate logistic regression analysis,with P<0.05 as screening of risk factors of Xi significant boundaries.Logistic regression analysis results showed that?table 1-23?,age?P=0.014?,and abdominal obesity and diabetes duration?P?0.001??P=0.002?,the history of antihypertensive medication?P=0.007?and diet?P=0.012?are the risk factors influencing the DN occurs,and body mass index?P=0.097?,irregular movement?P=0.174?,history of smoking history?P=0.255?and drinking?P=0.347?is not affect the risk factors of DN.Therefore,this research adopts the age,duration of diabetes,waist circumference,antihypertensive medication history,and diet five indicators DN risk assessment is established.Begin from about 70%of total samples randomly selected samples as the training sample,used to establish the risk rating of DN.Then as to whether patients with DN history as a dependent variable,with age,duration of diabetes,obesity,history of antihypertensive medications and diet as independent variables,to multivariate logistic regression analysis of the model.Logistic regression analysis of the output to the partial regression coefficient of 10 times the variables as the score of each variable scores.Age as a reference class to 35 to 45 years old,46-60 years old and 61-year-old or partial regression coefficient?beta?are 0.383 and 0.165respectively,46-60,and 61 or higher in the risk assessment score of 4 points and 2respectively.Diabetes duration to one year or less as a reference,<1-5 years,<5-10years,10<15 years and>15 years of partial regression coefficient?beta?was 0.664,0.781,1.019 and 0.664,respectively,5<<1-5 years,duration of diabetes,10-10years<15 years and>15 years in the risk assessment score 7 points,respectively,8points,10 points and 16 points.Will the abdominal obesity as a reference,the partial regression coefficient of abdominal obesity?beta?is 0.207,abdominal obesity in the risk assessment score for the two points.There can be no antihypertensive drug taking history as a reference type,has a history of antihypertensive drug taking the partial regression coefficient?beta?is 0.312,antihypertensive drug use in the risk assessment score for the three points.Will be effective diet as a reference,not the partial regression coefficient of effective diet control?beta?is 0.104,the effective diet in the risk assessment score for 1 minute.DN risk score value between 0-26 points.3 the effect of DN risk assessment evaluation and screening point of tangencyRisk score in the training sample screening DN area under the ROC curve is0.673,the standard error of the area is 0.041,the size of the 95%confidence interal,0.592-0.0.753,the risk score for overweight,obesity in patients with T2DM screening DN was statistically significant?P<0.001?,when the risk score value is 16,especially an index,the biggest 16 as the risk score screening point of tangency of DN.The tangent point 16 screening DN,the sensitivity of the screening and specific degrees were 80.8%and 55.1%respectively.Risk score in the test sample screening DN area under the ROC curve is 0.728,the standard error of the area is 0.045,the size of the 95%confidence interal 0.640 to0.816,the risk score is used for testing samples screening DN was statistically significant?P<0.001?.Are chosen on the basis of the training sample screening point of tangency,computational screening point of tangency sensitivity in the test sample and specific degrees.Tangent point 16 screening in the test sample DN value sensitivity and specific degree are 0.800 and 0.577 respectively,and the tangent point values in the training sample screening DN sensitivity?80.8%?and?55.1%?in a specific degree,indicate that DN risk score in this method is reliable and has good applicability.Conclusions:Age,abdominal obesity,diabetes duration,antihypertensive medication history,and diet control is the risk factors of DN.DN risk assessment by age,waist circumference,diabetes duration,antihypertensive medication history,and diet.DN risk score in overweight screening DN efficiency is higher in obese patients with T2DM,risk score 16 screening DN value has higher sensitivity and specific degrees,a risk score of 16 or more patients should be further examined. |
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