| New England Journal of Medicine reported that China's pre-diabetes and diabetes prevalence were 9.7% and 15.5%,which means there are 92.4 million diabetes and 148 million pre-diabetes in China. Studies found that cardiovascular disease and microvascular complications existing in impaired glucose regulation (IGR).Lifestyle intervention on IGR could not only reduce type 2 diabetes (T2DM), but also reduce cardiovascular disease and chronic microvascular complications, so early intervention should be implemented. This study aims to explore and promote an effective and practical dietary intervention pattern.[Objective]To investigate the prevalence and risk factors of nephropathy and peripheral neuropathy in IGR, T2DM and normal glucose people, and to explore an effective and practical dietary intervention pattern for prevention and treatment of microvascular complications in IGR and T2DM.[Methods]Cross-sectional survey was used to investigate subjects from Huadong Hospital and 3 Shanghai urban community hospitals, who diagnosed T2DM no longer than 3 years, or found high-risk for diabetes such as impaired fasting glucose, overweight, obesity, family history of diabetes. A total of 379 cases were divided into T2DM group(108 people), IGR group (93 persons) and the NG group (90 persons) according to diabetes history and blood glucose levels.The difference of age, sex, education and labor intensity was not statistically significant among 3 groups (P> 0.05).The prevalence of microvascular complications was based on urinary albumin creatinine ratio (ACR) and Michigan neuropathy screening (MNSI) score. Body measurements (weight, waist circumference, blood pressure), glucose and lipid metabolism (fasting blood glucose (FBG), postprandial blood glucose (2hPG), glycosylated hemoglobin (HbAlc), fasting insulin (FINS), C peptide, total cholesterol (TC), triglyceride (TG), low density lipoprotein cholesterol (LDL-C), high density lipoprotein cholesterol (HDL-C), oxidative stress (glutathione (GSH), superoxide dismutase (SOD), malondialdehyde (MDA)) were key indicators. Means, standard deviation, ANOVA, non-parametric test,χ2 test and correlation analysis were used for the descriptive and inferential statistics. Self-controlled clinical intervention was performed to the voluntary subjects,49 IGR and 62 T2DM for 12 months. During the early 3 months, integrated intervention characterized by low-GI diet was performed. During the later 9 months, general intervention including diabetes knowledge training, individualized healthy eating plan and individual follow-up guidance was performed.The prevalence of microvascular complications, diet, physical activity, physical examination, lipid metabolism, oxidative stress were key indicators.The tests were performed the 3rd and 12th month after the intervention begin. Means, standard deviation, repeated measures ANOVA, non-parametric test andχ2 test were used for the descriptive and inferential statistics.[Results]1.Cross-sectional survey(1)Prevalence of nephropathy and peripheral neuropathy in three groups of different blood glucose levels:The prevalence of nephropathy was 23.1%(χ2=14.949,P=0.000) in T2DM group,17.5%(χ2=8.076,P=0.004) in IGR group, both significantly higher than 4.4% in NG group.The prevalence of peripheral neuropathy was 13.4% in T2DM group, 13.6% in IGR group,6.7%in NG group, the difference was not statistically significant (P> 0.05).(2) Other metabolic parameters in three groups of different blood glucose levels:T2DM and IGR group compared with the NG group, had higher BMI, blood pressure, blood glucose, metabolic syndrome prevalence and oxidative stress levels;T2DM compared with IGR group, had higher blood glucose levels;IGR compared with NG group, had higher blood lipid levels (P<0.05).2.Self-controlled clinical intervention(1)The impact on the prevalence of nephropathy and peripheral neuropathy:The prevalence of nephropathy in intervention IGR group at baseline,3 months and 12 months were 14.3%, 10.2% and 14.3%,in intervention T2DM group were 22.6%,12.9% and 17.9%.The prevalence of peripheral neuropathy in intervention IGR group before and after intervention were 12.2% and 9.5%,in intervention T2DM group were 9.7%and 3.6%. Dietary and nutrition intervention as the core of an integrated intervention to IGR and T2DM made a downward trend in prevalence of nephropathy and peripheral neuropathy.(2) The impact on dietary pattern:After the first phase of enhanced intervention, subjects increased whole grains, reduced red meat, increased vegetables, increased soybean products, reduced oil and salt intake which tend to be a more reasonable and healthy dietary pattern. (3)The impact on physical activity:Physical activity increased after intervention, increasing the most in the first phase of intervention, of which the most significant increase in walking. Increasing physical activity is conducive to the control on weight, blood glucose and blood pressure.(4) The impact on metabolic indicators:After the intervention in IGR and T2DM group, weight, BMI, waist circumference, FBG,2hPG, HbAlc, TG, C peptide, LDL-C, APOB were significantly decreased (P<0.01),WHR, HDL-C was significantly decreased (P <0.05),APOA was significantly increased (P<0.01).Controlled rate of FBG(P<0.05) and 2hPG(P<0.01)increased significantly in T2DM group in the first phase of intervention.(5)The impact on oxidative stress indicators:After the intervention SOD, GSH in IGR and T2DM group were significantly increased, MDA in T2DM group was significantly decreased (P<0.01).Reducing oxidative stress is conducive to the control of glucose and lipid metabolism and the prevention of microvascular disease.[Conclusion]Prevalence of nephropathy in IGR and T2DM was higher than normal glucose people, which was related to the high level of overweight and obesity, blood pressure, blood glulcose, blood lipids and oxidative stress.Dietary intervention against risk factors was effective for prevention of microvascular disease in IGR and T2DM, and worthy of application and promotion.
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