| Abstract | 【Background】Diabetes mellitus(DM) is a syndrome of glucose,protein and lipid metabolism disorder due to absolute / relative shortage of insulin or the cell metabolism defects.The current prevalent trend of diabetes in the global is upward;it has become a serious public health problem.Impaired glucose regulation(IGR) is considered as pre-diabetic state.At presents,the epidemiological study of IGR was less than DM.The endocrine and metabolic changes of DM patients can cause changes of anthropometric indexes,studying the change trends of these anthropometric indexes and confirming the values and cutoff point of these anthropometric indexes for DM screening is of great significance for DM screening and prevention.However,as the research methods,race is different among these study,the results vary greatly and were not be used unified.At presents,the number of risk factors of DM has reached a consensus,but the research of the risk factors of IGR is less than DM.Due to the lack of baseline data,the prevalence and risk factors of DM and IGR in midwestern areas of Shandong province is not clear,the relationship between the anthropometric indexes and DM,IGR,the best cutting point of various anthropometric indexes to screen DM,which apply to people in Shandong province,is still at blank. Because of the different race,the results at home and abroad can only be as a reference. Therefore,basing on the baseline survey data of “Luxembourg-WHO-Shandong province health personnel training and Non-communicable chronic diseases prevention and control project”,we research the epidemiological characteristics of DM and IGR in midwestem areas of Shandong province,analyze the relationship between DM,IGR and anthropometric indexes,evaluate the value of anthropometric indexes for DM screening, identify the best cutting point of anthropometric indexes which suitable for people in Shandong province,explore the risk factors of IGR and DM in Shandong province, provide scientific data for the development of DM prevention planning of Shandong province.【Objectives】The major purpose of this study as follow:◆To survey the epidemiological characteristics of DM and IGR among rural population with more than 25 years-old in midwestern areas of Shandong province.◆To analyze the relationship between DM,IGR and anthropometric indexes, master the change trends.◆To evaluate the value of anthropometric indexes for DM screening.◆To identify the best cutting points of anthropometric indexes which suitable for rural population of Shandong province.◆To explore the risk factors of IGR and DM in Shandong province.【Methods】This study is a descriptive epidemic study.Multi-stage stratified randomized sampling was used in this study.Collecting 8 counties,16 townships and 40 villages, 62,517 people.Samples has levels and clumps structure,the probability of each individual was selected is unequal.So,at first,the data should be weighted.The distribution of DM and IGR in different gender,region,age and occupation were described;the prevalence rate,the weighted prevalence rate and the standardized prevalence rate were calculated,the trends was analyzed and the differences between the prevalence rate was compared.The changes of age,weight,systolic blood pressure,diastolic blood pressure,BMI, waist circumference,waist to hight ratio of normal,I-IFG,IFG/IGT and DM patients were described;First of all,the comparison of variance among all groups of the overall parameters were done with multiple variance analysis,then comparison between each two groups was done and the reasons were explored.Finally,the differences and reason between each parameter of normal,I-IFG,IFG/IGT and DM were analyzed with the variance analysis or t-test.The prevalence trend of DM and IGR in different BMI,waist circumference,waist to height radio were described;In order to control the mutual interference of two type obesity,stratified analysis was used to analyze the relationslfip between obesity,central obesity and DM,IGR.Using Logistic regression to controll the influence of age,gender, DM and hypertension history and other factors,calculate OR value,curve was drown to explore the real relationship between obesity,central obesity and DM,IGR.Basing on the study results aboved,the ROC area under the curve(AUC) was used to evaluate the value of BMI,waist circumference,waist to height radio to screen DM. After divided the groups by age and height of about 75%percent,the AUC of different age and height groups were computed and compared to evaluate the screen value of different anthropometric indexes in different age and height groups.Optimal cutoff point to screen DM was determined by the maximum of Youden index,after controlling other factors’ interference through Logistic regression,the accuracy of determined cutoff point were verified by observe the change of OR value in different cutoff points,In order to evaluate the consistency of the best cutoff point of various anthropometric indexes and the existence of internal consistency,the screening consistency analysis,was done by compared the screening results of one best cutoff point of one anthropometric indicator to other anthropometric indicator,the different Kappa values were computed.Modeling the orderly or disorderly multi-classification Logistic regression model was determined by the test result of classification of Y value useing the parallel test in the risk factors analysis.First of all,0.1 as the inclusion criteria,Single-factor Logistic regression was done to screen the meaningful variables and whether there is a linear relationship between all the variables and log(P) is verified.The variables in the model as an orderly classification variable if there is a linear relationship between these,or less, the dumb variables was considered to used.The linear diagnosis was used to verify and eliminate the linear of all variables in the model.The complex sample design multi-classification Logistic regression model was modeled;the effect of model fitting was evaluated by the ROC curve constructed by the predicted probability of model.【Results】1.The basic situation of the population surveyed40 administrative villages,200,87 people were surveyed actually,medical examination was conducted in a sample of 16388 rural residents,the means of age is 51.21±13.51,the ratio of male to female is 0.75:1(7,014/9,374). 2.The epidemiological characteristics of DM and IGR.2.1 The weighted prevalence rate of IFG;DM,I-IFG and IFG/IGT were 8.13%, 4.13%,5.34%1.00%,the standardized prevalence rate were 6.85%,3.38%,4.41%, 0.83%respectively.All of the DM patients,30.13%patients were confirmed before the survey,new patients accounting for 69.87%of the total.2.2 The prevalence rates of IGR and DM are significant in different areas and there is no consistency of the IGR and DM region distribution.The prevalence rate for IGR among the different income,education and vocation is no significant.The prevalence rate for DM is the lowest in the middle-income population(3.53%) and is relatively higher in the higher income population(5.26%),the lowest in the junior middle school education level population(3.29%) and the highest in the illiteracy and high school education and above level population(4.83%,4.82%),the lowest in the workers(2.83%),the highest in the rural people not to participate labor(8.72%).2.3 The IGR prevalence rate is significantly higher in the group aged≥35 years than those aged＜35 years,there is no significant difference among the group aged＞35 years(P＞0.05).The prevalence rate of DM increased significantly with age,χ~2 trend test was significant(P＜0.05),but the prevalence rate of DM is the highest in the group aged≥45 years.2.4 Compared with the normal,the measuring indexes of I-IFG,IFG/IGT and DM have the progressive change;multiple variance analysis showed that both men and women or the whole,this change was significant.But the change between IFG/IGT and DM had no significant differences.3.The relationship between DM,IGR and the anthropometric indexesThere is a linear trend between the prevalence rate of IGR,DM and waist circumference,waist to hight radio,”√” trend with a BMI.Controlling a number of mixed factors by stratified analysis and Logistic regression analysis,the results have shown that,IGR prevalence rate and OR value increased with the rise of the BMI and waist circumference.DM prevalence rate and OR value increased with the rise of waist circumference only,not with the rise of BMI.4.The value of anthropometric indexes for DM screening and the best cutoff point analysis.The AUC of waist circumference,BMI and waist to height radio are statistically significant,there is no difference between the AUC of waist circumference,BMI and waist to height radio for male.The AUC of BMI is less than these of waist circumference and waist to height radio and there is no difference between the AUC of waist circumference and waist to height radio for female.The Youden index came to maximum when waist circumference is 85cm,BMI is 25.00 kg/m~2,weight to height radio is 0.50 for the males and waist circumference is 80cm,BMI is 24.00 kg/m~2, weight to height radio is 0.50 for the females.Logistic regression showed that,except there is a linear trend in waist circumference of female,OR walue increased significantly from the cut offpoint that the Youden index is the maximum and the Kappa value came to maximum in these cut off points.5.The risk factors of DM and IGR analysisThe disorderly multi-classification Logistic regression of complex sample model was modeled.Model showed that,there are same and difference risk factors between IGR and DM.The main risk factors of I-IFG is age,BMI,history of hypertension,the common risk factors of IFG/IGT and DM is age,hypertension,waist circumference, DM family history,In addition,the risk factors of DM is dyslipidemia.ROC curve shows that the AUC of DM is the maximum,IFG/IGT is medium,I-IFG is the minimum.【Conclusion】The prevalence rates of IFG,DM,I-IFG and IFG/IGT is serious in midwest areas of Shandong province.The awareness rate of their illness in DM patients is very low, the prevalence rate of IGR is the highest in the group aged≥35 years.The prevalence rate of DM increased significantly with age,the prevalence rate of DM is the highest in the group aged≥45 years.High blood sugar has caused the change of anthropometric indexes in I-IFG,IFG/IGT and DM.the impact of high blood sugar for anthropometric indexes of IFG/IGT and DM has reached the same level.There is a linear trend between the prevalence rate of IGR,DM and waist circumference,waist to height radio,”√” trend with BMI.Stratified analysis and Logistic regression analysis shown that,BMI and waist circumference are closely related with the IGR,but the DM are closely related with the waist circumference,has nothing to do with BMI.Waist circumference,waist to height radio and BMI are effective indicator for DM screening.The value of DM screening of these three anthropometric indexes is same in the male,the value of BMI is smaller in the female.The optimal cutoff point of waist circumference is 85cm,BMI is 25.00 kg/m~2,waist to height radio is 0.50 in the males and waist circumference is 80cm,BMI is 24.00kg/m~2,waist to height radio is 0.50 in the females to screen DM and define the risk population of DM in Shandong province. There is good consistency in these three cutoff points.The main risk factors of I-IFG is age,BMI,history of hypertension,the common risk factors of IFG/IGT and DM is age,hypertension,waist circumference,DM family history,In addition,the risk factors of DM is dyslipidemia.【Suggestions】1.To further strengthen epidemiological investigations and studies of IGR and DM in Shandong province,particularly in the eastern region,to master the prevalence rates and trend of IGR and DM,to provide theoretical basis for the development of prevention and interventions planning.2.To strengthen the comprehensive study on DM screening methods and combine the methods with the metabolic syndrome,cardiovascular disease screening study,find out the economic,feasibility,user-friendly screening methods.To strengthen the screening of the high-risk groups,detect the patients early;treat to improve the patient’s quality of life early.3.To strengthen the study of IFG/IGT patients,through the cohort study,master the conversion rate of DM and prognosis;Study the comprehensive treatment for IFG/IGT patients.4.To strengthen the health education of DM prevention.The education contents include the early detection of patients,waist circumference,BMI and waist to height radio as alert indexes.To improve the self-detection rate and the patient’s prevention awareness,increasing the knowledge of prevention.5.According to risk factors of IGR and DM,targeted interventions was adopted to reduce its prevalence rate.6.Base on the research findings above,to develop “DM prevention planning in Shandong Province “,planning should include screening methods,health education, IGR and DM patient management,etc. |
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