| ObjectivesTo investigate the epidemic distribution and trend of diabetes mellitus in Wuhan residents from 1975 to 2008, to evaluate the current epidemic situation of diabetes in Wuhan, and to reveal the relevant risk factors and high risk groups. The results might give clues to the local prevention and treatment of diabetes, and provide baseline data for the public health policy makers and researchers.MethodsThe epidemic data of diabetes mellitus from 1975 to 2008 in Wuhan, on where the study focused, was collected. And study of the epidemic situation of diabetes mellitus was conducted in 3 parts. Partâ… :I analyzed data of the whole-resident survey about diabetes mellitus in Wuhan,2006. The prevalence of diabetes mellitus and its distribution in different populations were described, the current situation of pathoglycemia in Wuhan residents was studied, and its risk factors were figured out. Part II:A retrospective descriptive study was conducted based on the death registration material of diabetes mellitus collected consecutively from 1975 to 2008 in Wuhan, thus to explore the distribution and death trend of diabetes mellitus. Partâ…¢:Two predictive models of the diabetes mellitus mortality in Wuhan were established using Grey predictive model and time series analysis method, with data from 1975 to 2008. The accuracy and predictive effectiveness of these two models were compared and the diabetes mellitus mortality from 2009 to 2015 in Wuhan was predicted using both models.ResultsPartâ… :The result of diabetes mellitus epidemiology survey in WuhanIn the overall threat to human caused by mainly chronic disease, the level of threat caused by diabetes mellitus was consecutively increasing in Wuhan, especially in urban districts. However, as to the function limitation caused by diabetes mellitus in everyday life, things were worse in rural districts than in urban districts, indicating the threat of diabetes mellitus in rural districts was more serious.The FPG level in male was higher than that in female, especially in 25-30 age group and>45 age group, indicating that man should be warned the invasion of diabetes mellitus after 25. The prevalence rate of diabetes mellitus in Wuhan was 8.8%, while the adjusted prevalence rate of diabetes mellitus was 5.3%. The prevalence rate of diabetes mellitus was inconsistent in various regions. It was 5.1% in urban districts and 4.4% in rural districts.Negative correlation was shown between prevalence rate of diabetes mellitus and educational level in residents of Wuhan. The higher the educational level, the lower the prevalence rate.The non-diagnostic rate of diabetes mellitus was 58.5% in Wuhan, which was 49.0% in urban districts and 81.8% in rural districts. Similar result was showed in the National survey in 2007. However, the result in rural districts was lower than the level in countryside of the whole country. Above results provide the baseline data for future measures on prevention and treatment of diabetes mellitus in rural districts.Partâ…¡:The death trend of diabetes mellitus in Wuhan from 1975 to 2008From 1975 to 2008, the diabetes mellitus mortality increased 12.76 times in Wuhan. The average annual growth rate was 8.02%, higher than the national level. During the same time period, the proportion of people over 60 in Wuhan increased from 7.86% to 13.98% and the diabetes mellitus mortality in this group increased from 10.24 per one hundred thousand to 134.45 per one hundred thousand.The diabetes mellitus mortality in female was higher than that in male in Wuhan. However, the male mortality showed higher increasing rate and trended to get close to the female mortality.This study suggested that the potential years of life lost and the potential rate of life lost in the residents of Wuhan caused by diabetes mellitus both increased.When considering the regional diversity of death caused by diabetes mellitus, it was found that the higher death rates were linked to regions with higher living standard and more serious population aging problem.Part III:The prediction of the diabetes mellitus mortality in WuhanThe GM (1,1) model in this study fit for the series data of 34 years. The predictive results showed that the diabetes mellitus mortality of Wuhan residents would keep increasing in the next decade. The estimated specific mortality rate of diabetes mellitus in 2010 was 28.72 per one hundred thousand, and 41.65 per one thousand in 2015, which was 2.83 times larger than the rate in 2000.The ARIMA (0,1,2) model in this study also fit for the series data. The prediction based on this model showed that the diabetes mellitus mortality of Wuhan residents would keep increasing in the next decade. The estimated specific mortality rate of diabetes mellitus in 2010 was 29.00 per one hundred thousand, and 43.42 per one thousand in 2015, which was 2.95 times larger than the rate in 2000.The average relative error rate in the ARIMA (0,1,2) model was 6.42%, which was lower than the average relative error rate of the GM (1,1) model(10.24%). On the whole, the diabetes mellitus mortality in Wuhan had been undergoing exponential growth, of which the increasing rate was not large, so both predictive methods fit for the data. Relatively speaking, the time series method had better fitting effect and was more precise.ConclusionAccording to the epidemiological survey of diabetes mellitus in 2006 and death registration material from 1975 to 2008, we found that the prevalence rate and mortality of diabetes mellitus ascended continually with the aging of the population and the increasing of risk factors. The overall prevalence rate and mortality in Wuhan were slightly higher than the average level in China, corresponded to other capital cities, but lower than municipalities.The diabetes mellitus prevalence rate among the male people was higher than females, which was opposite to the situation of mortality. In the developed region with severe problem of aging population, both the prevalence rate and the mortality were higher than other regions. The prevalence rate and mortality characteristics of diabetes mellitus in Wuhan were similar. We should consider them unified when making the prevention policy.As the data suggested, the prevalence rate and mortality of diabetes mellitus are both in a relatively high level now, but the residents still lack the awareness of self-prevention. I suggest enhancing the health education in the community to improve the self-prevention opinion for diabetes mellitus and to help people establish healthier life style in their early life. The elderly persons are the main target of the diabetes prevention. The complication risk of this group could be reduced by early detecting and timely treating. Different measures may be implemented in different regions. In urban districts, we should carry out the knowledge publicity and health education, to advocate the good life style and remind people to seek medication in time. In rural districts, the government should provide the treatment for the patients to control the state of the illness, prevent the complication and decrease the disease burden.Creative points of the studyNumbers of epidemiology studies of diabetes mellitus have been carried out all around the world, few have covered both the epidemic situation and death trend of diabetes of a city.Comparing to the other studies of the chronic diseases, the prevalence rate and the death situation of one disease were firstly combined together in our research. We analyzed the epidemic situation of diabetes mellitus in Wuhan in 2006, the prevalence and distribution of diabetes in the residents of the whole city and the trend of death caused by diabetes mellitus from 1975 to 2008. Our findings about the prevalence and the death of diabetes in this city provide the base data for the establishment and evaluation of the prevention measures and treating strategies, as well as the theoretical support for the community interventions of diabetes.
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