Analysis Of Risk Factors For Pre-diabetes Group

Research background:Diabetes mellitus (DM), is caused by various pathogenic factors which conclude geneticfactors, environment and behavior factors and so on that leads to endocrine and metabolic diseaseand its main indicator is high glucose. According to the statistics, there are more than90%DM istype2diabetes mellitus (T2DM). Pre-diabetes mellitus(PDM), also known as impaired glucoseregulation (IGR), is the abnormal glucose metabolism between normal and diabetic state, includingimpaired fasting glucose (IFG), impaired glucose tolerance (IGT) and IFG with IGT three states.With the continuous development of social economy, there is a big increase in urbanization.Significant physical labour intensity reduced, people sit works significantly increased, life diet hasalso changed a lot, high-calorie diet increased. Now many countries around the world show thetendency of population aging, the prevalence of T2DM showed a trend of rising around the world.DM has become a worldwide public healthy problem in the21stcentury. There are about92.4million adults with diabetes in China. The total number of DM patients in our country is more thanIndia. China is becoming the the world diabetes epidemic center. Due to diabetes patients needlong-term treatment, combined with many kinds of complications, which caused DM patients aretaking on larger treatment and economic pressure. According to statistics data of our countrydiabetes treatment costs, which showed that diabetes treatment costs was much more than GDP, andin2004reached19.9%, ranking the second in all of the chronic diseases. T2DM and itscomplications not only brought the pain to the patients, but brought the huge edonomic pressure andsocial pressure.The particular concern is that there are more than50%diabetes patients are not diagnosed withdiabetes, with the early onset of many T2DM patients had no more specific clinical symptoms, itcan has9to12years latent period before clinical diagnosis. The complications of brain, heart, eye,kidney and other organs have been exist when many patients were cofirmed DM, which not onlyleads to the high incidence of disability and premature death, but bring heavy burden to theindividuals and family.The prevalence of IGR also showed a trend of obviously rapid growth, its prevalence rate hasgreatly exceeded to the prevalence rate of diabetes mellitus. Several large prospective studypublished during1997--2006which for intervention in high-risk groups showed that effective detection and intervention for IGR by the way of drug and life intervention can reduce about50%of the risk of diabetes.So, we are screening for diabetes, to find pre-diabetes group, which is also diabetes inhigh-risk group. Through analyzing the risk factors for pre-diabetes group, we can find them earlyand interfere early. We can prompt population in high risk of diabetes to turn into normal bloodsugar population gradually through the effective intervention measures, which is an importantmeasure to control the incidence of diabetes, which has proactive and important significance.As the extremely victimized country of T2DM, we are facing up to about150million IGRgroup and nearly100million T2DM patients, there are nearly60%patients are not diagnosed,which means we must face the grim situation of prevention and control of DM. Effective measuresand action must be taken to prevent diabetes of the accelerate epidemic situation, in order to letmore patients get timely and effective treatment. Therefore, we should be in view of the IGR groupintervention, prompt them to turn into NGT, in order to delay the development of T2DM. We shouldhave a purpose, with focus on the selectivity of intervention to target groups, which is a key strategyin prevention and treatment of diabetes.Research objective and content:Impaired glucose regulation (IGR) can be called "pre-diabetes" state, is the floorboard of theimpaired glucose tolerance (IGT) and impaired fasting glucose (IFG). In this study, we have theepidemiological investigation mainly in middle-aged and old people in Beijing area. At the sametime, the75g oral glucose tolerance test (OGTT) was carried out in the crowd, including fastingblood glucose detection, so as to pick out the IGR group.1577cases with impaired glucoseregulation (IGR) and normal glucose tolerance (NGT) group were statistically analyzed, and assessimpaired fasting glucose (IFG) rationality of the diagnosis tangent. Analyze the clinicalcharacteristics of IGR components with2003American Diabetes Association (ADA) standards.Compare and analyze the impaired glucose regulation (IGR) group and normal glucose tolerance(NGT) group without large difference on age and sex, and analyze the characteristics of islet betacells and insulin resistance in two groups.The research results:According to the data in this study, the diagnostic criteria of IGR to OGTT2hours bloodglucose (2hPG) in7.8-<11.1mmol/L, and fasting blood glucose (FPG) of5.5mmolL/L is the bestdiagnostic levels. With increasing age, normal blood glucose (NGT) ratio appeared to declinesignificantly, and I-IGT increased, this tendency over65group is more clearly than under65group,(P<0.05). Through logistic regression analysis, shows that independent risk factors of IGR occursare waist circumference, age, total cholesterol (TC), triglyceride (TG) and systolic blood pressure(SBP). According to the results, either the NGT group, or I-IGT group, HOMA-IR were significantlylower than that I-IFG group, but the ISI, FBCI/IR and HBCI/IR was significantly higher than that ofI-IFG group, in addition, the Shima Somintoshi index (ISI-Stumvoll) of NGT group wassignificantly higher than that of I-IFG group, but the Shima Somintoshi index (ISI-Stumvoll) ofI-IFG group was higher than that of I-IGT group, P<0.05. Insulin sensitive index(ISI), homeostasismodel assessment of insulin resistance (HOMA-IR), FBCI/IR and HBCI/IR in I-IGT group werebetween I-IFG group and NGT group; first phase and second phase insulin secretion index,ISI-Stumvoll,△I120/△G120/IR of I-IGT group were lower than I-IFG group and NGT group,(P<0.05). In people without diabetes (NDM), HOMA-IR growth trend are proportional to FPG and2hPG growth, and the first phase and second phase insulin secretion index, Shima Somintoshi index(ISI-Stumvoll),△I120/△G120/IR, insulin sensitivity index (ISI), FBCI/IR and HBCI/IR areinversely proportional to FPG and2hPG growth,(P<0.05).The conclusion of the study:I-IFG mainly caused by the basic state of islet beta cells function impaired with insulinsecretion and hepatic insulin resistance (IR) cell damage. But I-IGT is mainly muscle IR heavier,the ability of secreting insulin in basic state is better than I-IFG, hepatic IR is ligher than I-IFG, isletbeta cell function is more severe after glucose load because of the damage. Islet beta group of cellsdamage and IR of IFG/IGT are more severe.2hPG and FPG was positively correlated with IR, butwith islet beta cells was negatively correlated. Age, waist circumference, TG, TC, SBP are the resultof independent risk factors of IGR. Therefore, over65years old, exceed the standard of waistcircumference, hyperlipidemia, hypertension group should be alert to the occurrence of IGR, forthese high-risk groups, we should strengthen the health education, guide them to have the scientificdiet, exercise habits, and regularly detect blood glucose, lipids, blood pressure, which have positivemeaning in reducing the incidence of DM.Based on the risk factors of T2DM, we can detect the suspicious patients and high riskindividuals early. We have focused and targeted interventions for target population, is the key ofdiabetes prevention and control strategy. According to the risk factors for pre-diabetes population,pre-diabetes individuals can be found early. Having health education and intervention forpre-diabetes population, can prompt IGR population reversed for NGT population, which haspositive significance for reducing the incidence of diabetes.