Research Of Trends In Prevalence Of Diabetes Mellitus Based On Wastewater-based Epidemiology

According to the International Diabetes Federation statistics,about 9.3%of adults(463 million)worldwide have diabetes.China is the country with the largest number of diabetic patients,about 116 million,accounting for 27%of the total number of diabetic patients in the world.As a first-line medication for controlling hyperglycemia in diabetic patients and the basic medication in the combination of drugs,the consumption of metformin can well reflect the drug treatment and patient population of diabetes.The study selected oral antidiabetic drug metformin as a health biomarker for diabetes mellitus,analyzed the consumption of metformin by wastewater-based epidemiology and established.a prediction model of adult prevalenc e of diabetes.First of all,the study combined gas chromatography-mass spectrometer analysis with wastewater-based epidemiology to analyze the consumption of metformin in Dalian.Eleven wastewater treatment plants were selected for a four-year(2015-2018)monitoring to assess the consumption of metformin,including spatial distribution characteristics and temporal trends,and the following conclusions were as follow:(1)Spatial distribution characteristics:The average concentration of metformin was 68.3μg/L in the wastewater samples in Dalian.Based on the measured concentration levels,combined with population of the wastewater treatment plants,correction factors and doses,the per capita consumption of metformin(19.2±14.9 mg/d/capita)and the adult prevalence of metformin(2.42%)in Dalian were calculated.There is no significant difference in the spatial distribution of the concentration of metformin in wastewater treatment plants.The per capita consumption of metformin in the administrative area of Dali an has a good positive correlation with the average housing price.There is a positive correlation between economic,level and per capita consumption of metformin,indicating that the economic level may be related to the prevalence of diabetes.(2).Temporal trend:The per capita consumption of metformin in four seasons were 24.2±18.6 mg/d/capita(spring),20.7±26.6mg/d/capita(summer),17.2±18.8 mg/d/capita(autumn),18.5±19.3 mg/d/capita(winter),respectively.The results show that there is no significant seasonal differences in metformin consumption.The per capita consumption of metformin in Dalian increased from 12.1 mg/d/capita(2015)to 28.4 mg/d/capita(2018),indicating an increasing trend year by year.Secondly,the adult prevalence of diabetes was predicted through a reverse calculation model,and analyze the spatial distribution characteristics of each administrative region and the temporal trend of diabetes prevalence from 2015 to 2018.The median adult prevalence of diabetes in administrative regions ranked from highest to lowest:SHK(20.0%),ZS(19.2%),XG(16.9%),GJZ(15.2%).The adult prevalence of diabetes showed an increasing trend from 12.2%in 2015 to 21.6%in 2018,which is consistent with the data predicted by traditional surveys(15.2-19.8%).Additionally,the adult prevalence of diabetes in 2015 estimated was 12.2%,which agreed with the results from the data provided by the Dalian municipal government(12.3%).The study showed that the investigation method based on wastewater-based epidemiology can monitor the consumption fluctuations of metformin in the area for a long time and predict the adult prevalence of diabetes.Wastewater-based epidemiology method can provide rapid and accurate data support for public health monitoring,and as a beneficial technological supplement to traditional epidemiological investigation methods.