The Clinical Study To The Screening Strategy And The Poor Glucose Control Of Diabetes

Study 1: The awareness and screening of individuals with high risk of diabetes ObjectiveAlthough the screening for diabetes has important value in public health,China,which had a large population,couldn’t be screened in the whole population.So the guidelines recommended comprehensive screening in the individuals with high risk of diabetes,but the effect of this strategy was not well verified in China.MethodsWe analyzed the data of 2007-08 investigation for diabetes and metabolic syndrome(MS)in China in which a multi-stage stratified sampling method was used to select a nationwide representative sample of Chinese 46239 adults with age above 20 years.The ―recommended screening population‖ includes elderly population with high risk(≥45 years),elderly population with low risk and young population with high risk.ResultsBased on the 46239 cases,30735(66.5%)of them were considered to be the population with recommended screening.10787(35.1%)of them were elderly adults with high risk.12329(40.1%)of them were elderly population with low risk.7619(24.8%)of them were young population with high risk.The prevalence of diabetes was 20.5%,12.6%,8.3%,respectively in the three groups,and was 2.7% in those who weren’t be recommended screening(P < 0.001,between groups).The awareness rates of diabetes was 40.3%,48.5%,27.3%,respectively in the three groups,and was 34.2% in those who weren’t be recommended screening(P < 0.001,between groups).Logistic analysis showed that there was a significant correlation between the population with recommended screening and the increased awareness of diabetes(OR: 1.239,95%CI: 1.164-1.319,P < 0.001).However,the awareness of diabetes in young population with high risk has no significant increases(OR:0.872,95%CI:0.661-1.150,P?0.05).In addition,the proportion of the populations with recommended screening who were diagnosed diabetes by routine health examination,which was similar to the population without recommended screening(38.4%,p=0.237).ConclusionAs expected,the population with recommended screening has a higher prevalence of diabetes.Although there were strong recommendations,the population with recommended screening didn’t have awareness satisfied,only less than half of patients had known that they have diabetes themselves.More important,only one third patients known themselves with diabetes by routine health examination.China has begun to realize the challenge of diabetes,and it has great significance to search the way to endeavor next in the policy level.Our findings indicate that China should make efforts and concentrate screening on the population with recommended screening to increase the rate of diabetes awareness,especially the young population with high risk.Study 2: The consistency about diagnosis of diabetes mellitus with OGTT and SBMT in middle-and-old-aged screening population in communityObjective To evaluate the consistency of oral glucose tolerances test(OGTT)and steamed bread meal test(SBMT)in the middle-and-old-aged community screening population.Methods Xi’an Community-based Management of Diabetes in the middle-aged and elderly population project was a prospective,multicenter cross-sectional study by using multistage,stratified cluster sampling methods.From the beginning of June 2014 to the end of September 2016,in Shaanx i,4 towns,3 suburbs,2 rural areas of Xi’an(and surrounding)were selected.Over 50 years of age individua ls which included 3119 cases were screened.We randomly selected two communities in screening population of town.The OGTT and SBMT were carried out for interva ls of one week in the two community groups,and intervention was not given like life style,public ity and education,drug treatment,etc.Finally it included 491 partic ipants as the study population.The consistency of continuous variables(such as glucose)was evaluated by the interclass correlation coefficients.The consistency of categorical variables(such as whether the diagnosis of diabetes mellitus)was evaluated by the value of Kappa.Results The absolute va lue of the intra group correlation coefficients(ICC)of FPG and 2h PG of OGTT and SBMT was 0.706(95%CI: 0.657-0.748)and 0.527(95%CI: 0.184-0.711),respectively in the middle-aged and elderly community screening population in Xi’an.The Kappa value of diabetes screening for OGTT and SBMT was 0.469;the Kappa value of Hb A1 c and OGTT was 0.402;the Kappa value of Hb A1 c and SBMT was 0.531.Based on the screening using OGTT or SBMT alone,when combined with Hb A1 c,it increased the DM proportion of testers which was 1.63%(8/491)or 2.85%(14/491),respectively.ConclusionThe consistency of OGTT and SBMT was not high for the first diagnosis of diabetes in the middle-aged and elderly community screening population.Among the elderly screening population in the community,the reliability of using only SBMT to replace OGTT screening results is questionable,and it may be necessary to combine other testing indicators(such as glycosylated hemoglobin)for screening.Study 3: Differences between the perspectives of physicians and patients on the potential barriers to optimal diabetes controlAim To investigate the potential barriers to optimal diabetes control by evaluating the different perspectives of physicians and patients on such matters in China.Methods A multi-stage stratified random sampling method which based on the GDP of cities and levels of hospitals from December 2015 to March 2016 was used to sample representative 93 diabetes physicians and 630 patients for questionnaire in 18 hospitals in Shaanxi province,China.Results A total of 85 endocrine professional physicians and 584 patients completed the questionnaire.The top potential barriers to optimal diabetes control were patient’s "insufficient understanding of the danger of diabetes"(62/85 72.9%),―no sticking to lifestyle interventions‖(56/85 65.9%)in physician perception,while they were ―I do not follow a proper diet‖(338/584 57.88%),―I do not exercise as instructed‖(263/584 45.03%)in patient perception.In addition,physicians considered "improving health insurance coverage for diabetes"(38/85 44.7%)as the first important measure to improve diabetes control.Conclusion China’s primary focus about diabetes control in the future should still be put on diabetes education,particular the importance of lifestyle interventions and the danger of diabetes.