| ObjectivesWith the development of social economy and the improvement of living standards,diabetes has become a chronic noncommunicable disease seriously threatening people's health after cardiovascular disease and malignant tumor.In this study,type 2 diabetic patients managed by communities were investigated to assess the control levels of blood glucose,blood lipid,blood pressure?BP?and body mass index?BMI?in Jiangsu province.Meanwhile,total calories,dietary nutrients and all kinds food intake among patients were analysed to evaluate the diet and nutrition status of diabetic patients.Fasting plasma glucose?FPG?and glycosylated hemoglobin A1c?HbA1c?were used as evaluation indicators to explore the association of fruit intake and glycemic control in patients with type 2 diabetes and to provide the basis for formulating control measures as well as for medical staff to better instruct balanced diet in these patients.Methods1.From December 2013 to January 2014,using to cluster random sampling,20053patients with type 2 diabetes who have received disease management according to the National Basic Public Health Service were recruited in Changshu Country of Suzhou City,Huai'an and Qinghe Districteds of Huai'an City.Questionnaire survey,anthropometric and laboratory measurements were conducted.According to the China Guideline for Type 2Diabetes?2013?,the control levels of blood glucose,blood lipid,BP and BMI were assessed.2.The food frequency questionnaire was used to collect the information of the kinds and amounts of food consumption in the past 12 months among patients with type 2 diabetes,and the means of daily dietary energy,protein,fat,carbohydrate,cholesterol,dietary fiber minerals and vitamins were calculated.According to the China Medical Nutrition Therapy Guideline for Diabetes?2013?,Chinese Dietary Reference Intakes?2013?and Dietary Guidelines for Chinese Residents?2016?,total calories,dietary nutrients and all kinds food intake in type 2 diabetes patients were assessed.3.FPG and HbA1c were used to assess glycemic control status in patients with type 2diabetes.The status of FPG control was defined as poor when the level of FPG?7.0mmol/L,and the status of HbA1c control was defined as poor when the level of HbA1c?7.0%.Multiple logistic regression was used to access the relationship between fruit intake and glycemic control,and odds ratio?OR?and corresponding 95%confidence intervals?CI?were calculated.Statistical interaction between fruit intake and behavior risk factors,such as tobacco use and alcohol drinking,on glycemic control were assessed on additive scale.Results1.Among patients with type 2 diabetes,the proportion for FPG and HbA1c achievement was 31.5%and 41.9%respectively,and 25.3%of the patients simultaneously achieved goals of FPG and HbA1c control in Jiangsu province.There were 23.9%,55.7%,75.5%and 24.2%of the patients met the goals for total cholesterol?TC?,triglyceride?TG?,high density lipoprotein cholesterol?HDL-C?and low density lipoprotein cholesterol?LDL-C?,respectively.Only 10.3%the patients achieved the four targets of blood lipid simultaneously.Furthermore,25.4%and 35.9%patients achieved BP and BMI targets respectively,and the control rates for BP and BMI of female were higher than those of male?all P<0.05?.Less than 1%of the patients had all eights indices controlled at target levels.2.The median of daily consumption of cereals,vegetables,fruits,meats,eggs,aquatic products and soy products was 314g,250g,7g,43g,17g,14g and 14g,respectively,and over50 percent of patients do not consume dairy and nurts.According to the Dietary Guidelines for Chinese Residents?2016?,60.6%objects ate cereals more than the daily recommended standard.Meanwhile,the proportion of insufficient daily intake of vegetables,fruits,eggs,aquatic products,dairy and soy products was 53.6%,95.8%,60.3%,66.6%,96.2%and72.2%,respectively.The average total calorie intake was estimated to be 1769.5±573.0kcal,and the proportion of excessive and insufficient calorie intake was 38.1%and 37.6%,respectively.The energy ratio provided by protein,fat and carbohydrate was 11.6%,22.9%and 64.0%,respectively,the protein intake was relatively lower,the carbohydrate intake was relatively higher.The average intake of dietary fiber,vitamin B1,vitamin B2,vitamin C,vitamin K,calcium?Ca?,magnesium?Mg?,potassium?K?and selenium?Se?in participants was lower than the recommend standard of adult diet nutrients,and reached 29.3%,63.2%,45.8%,57.6%,58.3%,35.1%,68.4%,57.3%and 35.8%of recommend standard respectively.3.Compared to the patients who did not consume fruit,the risk of poor glycemic control was declined in patients with fruit consumption?FPG:OR=0.91,95%CI:0.85-0.98;HbA1c:OR=0.84,95%CI:0.79-0.90?,and the risk of poor glycemic control decreased with increased frequency and amount of fruit consumption(all of P for trend<0.05).Compared with patients without fruit consumption,the risk of poor FPG control and poor HbA1c control in patients with fruits consumption more than 5 times per week decreased 22%?95%CI:0.70-0.86?and21%?95%CI:0.72-0.88?,such risk decline and corresponding 95%CI was 26%?95%CI:0.65-0.83?and 22%?95%CI:0.72-0.88?in patients with daily fruits consumption of more than 100g.The results of stratified analyses showed that fruit intake was significantly associated with glycemic control in both gender,smoking,alcohol drinking,antidiabetic treatment and physical activity,as well as among patients with the course of illness less than10 years?all of P<0.05??In addition,the adverse effects of smoking,alcohol drinking,overweight/obesity,lower physical activity on poor glycemic control could be reduced by fruit consumption,although the significant interactions between fruit intake and these factors were not observed on additive scale.Conclusions1.The achievement of comprehensive targets among community patients with type 2diabetes remains poor in Jiangsu.Follow-up and management of typ2 diabetes should be strengthened in communities,health education and comprehensive intervention on disease and related complications also should be reinforced accordingly.2.The dietary energy control among patients of type 2 diabetes was not ideal in Jiangsu,and both excessive and insufficient energy intakes were observed.Dietary structure and nutrients intake were unreasonable in patients with type 2 diabetes.Health education on nutrition and diet should be enforced in these patients,the consumption of staple food should be reduced properly,and the intake of vegetables,fruits,eggs,dairy,aquatic products,and soy products should be increased.3.The association of furit intake and glycemic control was statistically significant in patients with type 2 diabetes.With the increase of frequency and amount of fruit consumption,the levels of FPG and HbA1c showed a decreased trend which indicated that fruit intake might be beneficial for glycemic control at target levels. |
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