| OBJECTIVEDiabetes mellitus (DM) is a complex metabolic disorder characterized with hyperglycaemia and associated with a relative deficiency of insulin secretion, along with a reduced response of target tissues to insulin, resulting in metabolic disorder of carbohydrate, fat and protein. DM can cause chronic damage for many organs. The development of type 2 diabetes(T2DM) is resulted from both genetic and environmental risk factors such as overweight, obesity, physical inactivity, sedentary behavior, and unhealthy dietary habits. According to the 2004 data from WHO, the estimated diabetics number is about 194 million, and about 366 million adults worldwide will have diabetes by the year 2030, 90%~95% of them are T2DM.Diabetes especially T2DM is a well-established modifiable risk factor for cardiovascular disease in western countries, and associated with a high risk for microvascular and macrovascular complications. T2DM has a high prevalence rate in the world along with the development of industrilization and the change of life style. It has become an important public health challenge for economically developing countries, especially in Asia.Anyang iron and steel company is a large industrial corporation in Anyang city of Henan. The community belongs to this company is called Angang community, which is an experimental unit for the prevention and control of chronic noninfectious diseases in China, its population is stable, the compliance of residents is good, and it has a comsummate community service system of public health. So we select this community to carry out an epidemiological investigation of T2DM to study its prevelance, risk factors, awareness rates and complications for the prevention and control of this disease in this community.METHODSThe cluster sampling method was used to select the study participants and thus the forth area from six resident areas was choosen as the study site in Angang community. We carried out an epidemiological investigation of type 2 diabetes in residents aged 40-88 years old of this resident area. Data was collected by questionnaire review (demographic characteristics, medical history, and behavior risk factors), anthropometric measurements (height, weight, waist and hip circumeferences, blood pressure, pulse, and electrocardiogram) and laboratory measurements (FPG, 2-hPG, TC, TG, HDL-C, LDL-C, VLDL-C, ApoAl, ApoB). We used cross-sectional study and case-control study to investigate awareness rate, prevalence, risk factors and complications of T2DM in this community. Statistic methods such as t test, ANOVA, chi-square test, correlation analysis, trend test, multiple regression and logistic regression analysis were employed to analyze the data. Areas under the ROC cure and standardized regression coefficient adjusting sex and age were used to evaluate whether the central or general obesity indexes were more related to T2DM. P value less than 0.05 was considered statistically significant.RESULTS1. Prevalence of IGR and T2DM: Age-standardized prevalence rates of IFG, IGT and T2DM to the 2000 China population were 3.87%, 6.96% and 13.14%, respectively.2. Population distribution characteristics of T2DM prevalence: The prevalence of T2DM was significantly different among groups of different age groups,education levels and occupations (PO.05), but there were no significant differences among gender, race, and family income (P>0.05). IFG (PO.05) but not IGT (P>0.05) was significantly different between groups of different education level. The prevalence rates for IFG, IGT, and T2DM between different sexes were 4.88% VS 3.71%, 7.99% VS 6.85%, and 16.26% VS 13.23%, respectively. Rates of IFG, IGT, T2DM for different age groups (40~, 50~, 60-, 70-) were 2.01% VS 4.30% VS 4.73% VS 7.23%, 4.27% VS 6.96% VS 8.00% VS 13.86%, 9.05% VS 14.96% VS 17.27% VS 16.27%. Rates of IFG, IGT, T2DM for different races (minority, Han) were 4.12% VS 10.53%, 7.34% VS 5.26%, 14.58% VS 35.26%. Rates of IFG, IGT, T2DM for different occupations (brainwork, mainwork, jobless) were 10.39% VS 1.37% VS 4.44%, 18.15% VS 2.39% VS 7.77%, 17.96% VS 13.25% VS 10.00%. Rates of IFG, IGT, T2DM for different education levels (illiterate, elementary school, high school, university) were 6.40% VS 4.46% VS 4.01% VS 3.04%, 9.30% VS 7.61% VS 6.99% VS 6.84%, 18.02% VS 17.59% VS 13.36% VS. 11.79%. Rates of IFG, IGT, T2DM for different family incomes (<425yuan/month, 425~750yuan/month, >750yuan/ month) were 4.72% VS 3.61% VS 4.74%, 6.97% VS 6.98% VS 8.25%, 16.18% VS 14.20% VS 13.40%.3. Risk factors of type 2 diabetes: The univariate unconditional logistic regression analysis showed that age (OR=1.02, OR95%CI was 1.01-1.04), mainwork (OR=0.79, OR95%CI was 0.43-0.98), BMI (OR=1.80, OR95%CI was 1.50-2.17), WC (OR=2.61, OR95%CI was 1.93-3.54), WHR (OR=3.28, OR95%CI was 2.48-4.36), SBP (OR=1.95, OR95%CI was 1.41-2.54), TC (OR=1.54, OR95%CI was 1.15-2.07), TG (OR=2.18, OR95%CI was 1.67-2.84), diabetic family history (OR=2.22, OR95%CI was 1.62-3.05), intake frequency of fishery products (OR=0.74, OR95%CI was 0.54-0.99) and fruits (OR=0.74, OR95%CI was 0.57-0.97) were singnifieant risk factors for T2DM. However, age (OR=1.04, OR95%CI was 1.01-1.07), BMI (OR=1.71, OR95%CI was 1.15-2.54), SBP (OR=1.60, OR95%CI was 1.20-2.13), WHR (OR=3.31, OR95%CI was 1.53-6.02), TC (OR=1.40, OR95%CI was 1.21-1.99), family diabetic history(OR=2.91, OR95%CI was 1.49-5.67), intake frequency of fruits (OR=0.60, OR95%CI was 0.41-0.96) were significant independent risk factors for T2DM.4. The interaction between diabetic family history and environmental risk factors in T2DM: The interaction between diabetic family history and environmental risk factors were analyzed by the comparison of the OR values for the interaction terms and the sum total of the two individual risk factors. The unconditional logistic regression analysis showed that the OR and 95% CI values (interaction term VS the sum total of the two individual risk factors) between BMI, WC, WHR, hypertension history, hyperlipidemia and diabetic family history were 4.52(3.21-6.21) VS 4.40 (3.19-6.08), 5.83 (3.87-8.63) VS 4.83 (3.50-6.57), 7.52 (3.05-9.88) VS 5.50 (4.10-7.14), 4.23 (3.07-6.02) VS 4.10 (3.06-5.51), 6.26 (3.61-8.96) VS 4.86 (3.60-6.57), respectively.5. Relations between indexes of central/general obesity and T2DM: Areas under ROC curve and standardized regression coefficients of multivariate regression analysis for BMI, WC, and WHR were used to determine whether central or general obesity is more related to T2DM. Areas under ROC cure of BMI, WC, and WHR were 0.63, 0.67, 0.70, respectively. The standardized regression coefficients of BMI, WC, and WHR adjusted for sex and age were 0.28, 0.41, and 0.53, respectively.6. The relationship between prevalence of T2DM and risk factors of cardiovascular and cerebrovascular disease: The correlation analysis showed that positive correlation was existed between prevalence of T2DM and BMI(r=0.97), WC(r=0.95), SBP(r=0.95), prevalence of hypertension(r=0.97), TC(r=0.96) and TG(r=0.95) (all P values < 0.05).7. Prevalence of T2DM complications and their risk factors: Among 259 type 2 diabetics, prevalence of hypertension, hyperlipidaemia, stroke, CHD, diabetic foot disease, retinopathy, renal lesions and neuropathy were 64.09%, 71.43%, 6.56%, 19.69%, 0.77%, 6.56%, 0.39% and 2.70%, respectively. All prevalence rates of above complications in diabetics were significantly higher than those in non-diabetics. Duration of T2DM (OR=1.36, 95%CI was 1.21-1.54), hyperlipid-aemia (OR=1.55, 95%CI was 1.33-1.91), BMI (OR=1.79, 95%CI was 1.54-2.09), and plasma glucose level (OR=3.07, 95%CI was 2.20-4.27) were significant risk factors for the complications of T2DM.8. The awareness rate of T2DM: 259 type 2 diabetics were found in Angang community, 111 were new diagnosis cases, other 148 cases were diagnosed before. The awareness rate was 57.14%.9. Distribution characteristics for awareness rate of T2DM: Awareness rates of T2DM for males and females were 66.67% and 54.68% respectively. Awareness rates among different age groups (40-, 50-, 60-, 70~) were 72.22%, 55.45%, 51.06%, 44.44% respectively, which were decreased with the increasing of age. Awareness rates for different occupation (medical staffs, others) were 66.67%, 56.90%, for different education levels (illiterate, elementary school, high school, university) were 33.33%, 52.24%, 54.92%, 65.17%, for different family incomes (<425yuan/month, 425-750yuan/month, >750yuan/month) were respectively 40.38%, 57.39%, 76.03%.10. The plasma glucose control status and its risk factors for the previously diagnosed T2DM patients: 148 cases were previously diagnosed as T2DM, their average FPG level was 9.51±3.41mmol/L. Duration of T2DM, theprapy methods, and physical activity were significant determinants for the plasma glucose control status of the T2DM patients.CONCLUSION1. Prevalence rates of IGT and T2DM in every age stage are higher in the Angang community than the provincial and national date, which suggests that more aggressive preventive measures shoud be initiated in this community.2. Age, obesity, SBP, TG, and diabetic family history are major risk factors of T2DM, and fruits intake often is a protective factor. Diabetic family history has significantly interaction with environmental risk factors for the development of T2DM. Central obesity measurements (waist to hip ratio and waist circumference) are more related to T2DM than general obesity (BMI), more over, waist to hip ratio is much better for predicting T2DM than waist circumference.3. Duration of T2DM, dyslipidaemia, obesity, and plasma glucose level are major risk factors of T2DM complications. T2DM is a significant predictor for the development of cardiovascular and cerebrovascular diseases in the diabetics.4. The awareness rate of T2DM is also low in Angang community, even if it is higher than that of China. Sex, age, occupation, education, family income, and the frequency of self-examination for plasma glucose level are the major influencing factors for the awareness. Carrying out health education and strengthening health protection in diabetic high risk groups are as important as the treat of diabetes.
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