Analysis On Risk Factors Of Type 2 Diabetes Mellitus With Microvascular Complications In Shanghai

Objective:Previous researches on the prevalence of microvascular complications in type 2diabetes mellitus were conducted in china.But the data was usually from hospitals or the sample size was not big enough.This study was based on communities and the sample was big.A cross-sectional research was carried out in type 2 diabetes mellitus patients managed by community health service centers to look into the prevalence,the relationship and risk factors of diabetic microvascular complications.Methods:3 communities were randomly selected respectively from Shanghai Pudong new area and Yanpu area.And 5245 subjects with T2DM were enrolled with cluster sampling method.Among these enrolled subjects,167 patients were excluded from this study because of their unqualified questionnaires,leaving 5078 subjects included for analyses.Basic information,clinical data,laboratory data and fundus photography of the subjects were collected.Results:(1)Among the 5078 type 2 diabetic patients participating in this study,the average age was(64.50±6.93)years old,the average duration of diabetes mellitus was(9.68±6.98)years,the average onset age was(55.37±8.74)years old.And45.6%and 20.9%of them were overweight and obese.The average level of fasting blood glucose(FBG),postprandial blood glucose(PBG)and hemoglobin A1C(HbA1c)was(8.01±2.68)mmol/L,(12.31±4.88)mmol/L and(7.30±1.45)%respectively.(2)Standard-reaching rates of HbA1C,FBG and PBG were 48.9%,40.0%and35.4%,while the rates of total cholesterol(TC)and triglyceride(TG)were 37.3%and43.5%.And 37.4%of the patients controlled their blood pressure under the standard.Female behaved better than male on blood glucose and blood pressure control,while male behaved better on blood lipid control(P<0.05).(3)21.1%of the patients had evidence of diabetic retinopathy(DR).The prevalence of mild non-proliferative retinopathy(NPDR),moderate NPDR,severe NPDR and proliferative retinopathy(PDR)was 14.1%,3.2%and 3.8%respectively.(4)38.4%of the patients had evidence of diabetic nephropathy(DN).And the prevalence of microalbuminuria and macroalbuminuria was 34.7%and 3.8% respectively.(5)The differences of age,onset age,duration of diabetes,FBG,PBG and HbA1c between DR patients and non-DR patients was statistically significant(p<0.05).(6)The differences of age,duration of diabetes,BMI,FBG,PBG,HbA1c,suffering from hypertension and hyperlipidemia between DN patients and non-DN patients was statistically significant(p<0.05).(7)When the duration of diabetes less than 5 years,the prevalence of DR and DN in T2DM was already 11.5%and 33.3%.The prevalence of DR and DN increased by 6%and 4%for each additional 5 years of the duration of diabetes?The longer the duration was,the closer the prevalence of DR and DN was.(8)Logistic regression showed that disease duration?5 years,HbA1c?7.0%,PBG?10.0mmol/L and bad control of HDL-C were independent risk factors of DR and onset age?50 was the protect factor(P<0.05).Logistic regression also showed that disease duration?15 years,HbA1c?7.5%,BMI?24kg/m~2,FBG?11.0mmol/L,bad control of TC and HDL-C and hypertension were independent risk factors of DN(P<0.05).(9)The classification tree model showed that HbA1c was the most important risk factor for microvascular complications of T2DM and the cut-off value was 7.5%.FBG and PBG were independent risk factors,while the influence was not the same to different kinds of microvascular complications.The duration of diabetes and suffering from hypertension were respectively the main risk factor of DR and DN.(10)The relation of prevalence and severity between diabetic retinopathy and diabetic nephropathy was existent.Logistic regression showed that DR and DN were risk factors for each other.Patients who had DN had 1.3 times higher developing DR than normal albuminuria patients.Patients who had DR had 1.3 times higher developing DN than non-DR patients.Conclusion:The prevalence of DR based on community population study was lower than that reported in previous study based on hospital patients.The DR severity of most patients in this study was mild.The prevalence of DN was in the scope of most previous studies and DN focused on early stage.HbA1c was the most important risk factor of microvascular complications in type 2 diabetes mellitus.FBG and PBG were independent risk factors,while the influence was not the same to different kinds of microvacular complications.The disease duration had more important and earlier influence to DR than DN.Hypertension was the independent risk factor of DN while onset age was the protect factor of DR.DR and DN were risk factors for each other.There was some relationship including prevalence and severity between them.Therefore,attention should be caused to prevent one microvascular complications when the other was occurred.