Analysis Of Ten-year Prognosis And Relevant Risk Factors In Subjects With Abnormal Glucose Metabolism

[Background]The public health issue,caused by the rapidly increasing incidence of Diabetes,is becoming more and more severe worldwide.There were 194 million diabetic patients in the world in 2003,and in 2015,the number has reached 415 million.For a long time,cardiovascular disease(CVD)has been the leading cause of mortality and morbidity,causing 31% of the mortality globally.Diabetes is one of the risk factors of ischemic heart disease and stroke.In order to relieve the social economical burden of cardiovascular disease,it is incumbent upon us to investigate more specific risk factors of cardiovascular disease.The population with prediabetes incurs a higher risk of developing diabetes.However,its transformation rate varies because of individuality and blood glucose status.Some people may revert to normal,but very few studies have been done regarding reversion.Although prediabetes increases the risk of microvascular disease,its effect on cardiovascular disease is still a moot point at present.[Objectives]1.To investigate the effect of prediabetes alone or combined with hypertension on subsequent occurrence of CVD.2.To analyze the ten-year outcomes of prediabetic patients and their related factors.3.To conclude the cardiovascular risk factors of subjects with type 2 diabetes.[Methods]In the first two parts of the project,we investigated 2132 subjects from Pingliang Community in Shanghai by adopting a stratified,multistage and cluster sampling.Baseline investigation was conducted from Nov.2002 to Jan.2003,and the follow-up was from July 2013 to Oct.2014.The study consisted of standard questionnaire,physical examination,blood glucose,blood lipid and hepatorenal function test.CVD is defined as coronary heart disease and cerebral vascular disease.In order to investigate the effects of different glycemic status on CVD risk,we classified the subjects into 6 groups according to their blood glucose(normal glucose regulation,impaired glucose regulation and diabetes)and blood pressure in the first part.In the second part,we analyzed the prognosis of prediabetes and its gender-related risk factors.All the risk analyses were performed by binary logistic regression model.In the last part,we generalized the risk factors pertinent to macrovascular complications in type 2 diabetic subjects based on the ADVANCE studies.[Results]In the first part,after adjusting for confounding factors,CVD risk was not significantly elevated in isolated prediabetes group,showing no difference to the group with normal glucose regulation and normal blood pressure(reference)(OR,1.10;95%CI,0.47-2.58).However,when combined with hypertension,CVD risk was 2.41 times as high as the reference group(95%CI,1.25-4.64),and diabetes risk,6.37 times(95%CI,3.41-11.89).CVD risk in subjects with combined diabetes and hypertension was 3.43 times as high as the reference group(95%CI,1.66-7.11).The results of the investigation in prediabetic patients in the second part showed that a part of the patients reverted to normal,while the majority stayed still or developed into diabetes.For men,age and physical activity were closely associated with reversion to normal.The odds of reversion to normal in active physical activity group was 3 times as high as that in inactive physical activity group(95%CI,1.09-8.30).Age,TG,blood glucose,smoking history and physical activity significantly correlated to diabetes development.Active physical activity group was 0.34 times as likely as the inactive physical activity group to develop diabetes.As for women,blood glucose and waist circumference were related to reversion to normal.Baseline hypertension,family history of diabetes and waist circumference were associated with developing into diabetes.The larger waist circumference was,the higher the risk of developing into diabetes was.Every unit elevation of waist circumference was associated with lower odds of reverting to normal glucose regulation(OR,0.94;95%CI,0.89-0.98)and higher odds of progressing to diabetes(OR,1.05;95% CI,1.01-1.10).In the third part,we found that high systolic blood pressure,high systolic blood pressure viability,large pulse pressure difference,proteinuria,large waist-to-hip ratio,low MMSE score,poor oral health condition,frequent erectile dysfunction(ED),high resting heart rate,frequent hypoglycemic attack,high blood glucose,history of atrial fibrillation all correlated with high CVD risk in diabetic patients.[Conclusions]1.Prediabets alone does not increase CVD risk,but when combined with hypertension,it increases CVD risk significantly.2.Physical activity is an important factor for the outcome of male prediabetic patients.Waist circumference is an important factor for female prediabetic patients.3.Blood pressure variables,systolic blood pressure viability,proteinuria and kidney malfunction,waist-to-hip ratio and other obesity index,impaired recognition function,oral hygiene,ED,resting heart rate,sever hypoglycemia,high blood glucose,atrial fibrillation are all important prognostic factors for CVD risk in diabetic patients.