| BackgroundFew studies have focused on the dose-response relationship between E-selectin,intercellular adhesion molecule-1(ICAM-1),central obesity which defined by waist circumference(WC)and type 2 diabetes mellitus(T2DM).And there were no prospective cohort studies on the relationship between the combined effects of these three factors and diabetes mellitus.PurposesTo explore the relationship between E-selectin,ICAM-1 and central obesity with diabetes defined by fast plasma glucose or 2 hour postload glucose in Mongolian population,and to provide new research ideas for the diagnosis,prevention and treatment of diabetes.MethodsBaseline survey was conducted in 2002-2003 in Naiman banner and Kezuohouqi banner,Tongliao,Inner Mongolia,China,a total of 2589 subjects aged 20 years and older participated in the study.Investigators with unified training conducted questionnaires,physical examinations and blood sample collection on the investigation site.The follow-up survey was conducted from 2013 to 2014.Fasting plasma glucose and 2-hour plasma glucose were measured in the same batch of respondents.All statistical analyses were conducted using SAS 9.4 and R 3.4.3 statistical software.The outcomes of the study were divided into diabetes defined by fast plasma glucose(T2DM-F),diabetes defined by 2 hour postload glucose(T2DM-P)and T2DM according to different diagnostic methods.Logistic regression model and restrictive cubic spline(RCS)model were used to analyze the association of E-selectin,ICAM-1 and WC with the incidence of T2DM-F,T2DM-P and T2DM,respectively.Studied on the relationship between E-selectin,ICAM-1 and diabetes after stratified by WC.The interaction and combination of research factors were analyzed.Decision curve analysis(DCA)was used to establish a model to analyze whether the net benefit of the same outcome changed after the research factors were included.All p-values were based on a 2-sided test and a significance level of 0.05.Results1.A total of 1784 participants with normal fasting glucose were included in current analysis,including 663 males and 1121 females.During the follow-up period,124 cases of T2DM-F,126 cases of T2DM-P and 197 cases of T2DM occurred.The cumulative incidence rates during 10 years were 6.95%,7.06%and 11.04%,respectively.The incidence densities were 6.47/1000 person-years,6.57/1000 person-years and 10.28/1000 person-years,respectively.2.When E-selectin,ICAM-1 and WC increased one standard deviation,the incidence of T2DM-P and T2DM were 1.232,1.201,1.772 times and 1.162,1.217 1.527 times,respectively.The incidence of T2DM-P and T2DM increased with the rising of the study factors.In T2DM-F,the incidence of diabetes only increased with the rising of WC and ICAM-1.The incidence rate ratio(IRR)and 95%CI were 1.558(1.321,1.838)and 1.367(1.145,1.632),respectively.3.According to quartiles of E-selectin,participants were categorized into four groups,which were defined as G1,G2,G3 and G4.Compared with G1,the OR of T2DM-F,T2DM-P and T2DM in G4 group were 1.834,2.491 and 1.876,respectively.The risk of diabetes increased with the increase of E-selection(all P trend?0.05).The RCS model showed that there was a linear dose-response relationship between E-selectin and T2DM-P/T2DM(all P for linearity?0.05),and no linear dose-response relationship between E-selectin and T2DM-F was observed.4.Participants were categorized into four groups according to quartiles of ICAM-1.Compared with G1,the OR of T2DM-F and T2DM in G4 group were 2.435 and 1.843,respectively.With the increase of ICAM-1,the risk of diabetes increased(all P trend ?0.05).There was a linear dose-response relationship between ICAM-1 and T2DM-F/T2DM-P/T2DM in the RCS model(all P for linearity?0.05).5.Multivariate logistic regression was used to analyze the association between WC and diabetes.Compared with G1,the risk of T2DM-F,T2DM-P and T2DM in G4 group were 3.236,5.582 and 3.375,respectively.With the increase of WC,the risk of diabetes increased(all P trend?0.05).It can be found that there was a linear dose-response relationship between WC and T2DM-F/T2DM-P/T2DM after fitting with RCS model,(all P for linearity?0.001).6.The subjects were stratified by WC to study the relationship between E-selectin/ICAM-1 and diabetes.In the WC?79cm participants,the risk of T2DM-P increased in high E-selectin subjects,OR(95%CI)was 3.916(1.666,9.204),and there was a multiplicative interaction between the two factors(P interaction=0.041).Among those with WC<79cm,compared with normal ICAM-1 group,the risk of T2DM-F,T2DM-P and T2DM were 2.745,3.280 and 2.894,respectively.There was a multiplicative interaction between ICAM-1 and WC in T2DM-P and T2DM(Pinteraction?0.05).7.The combined effects of E-selectin and WC or ICAM-1 and WC showed that the risk of diabetes was the greatest in those who had two research factors at the same time compared with the control group.This study found that the net benefits of intervention on T2DM-F,T2DM-P and T2DM increased after the above three factors were added in DCA model.Moreover,after adding WC,ICAM-1 and E-selection into the DCA model,the difference of net benefits in T2DM was the largest,and the threshold probability range of net benefits difference was also the largest.Conclusions1.There was high incidence of diabetes among Inner Mongolian residents.In the diagnosis of diabetes,postprandial blood glucose screening among high-risk population needs to be strengthened.2.E-selectin,ICAM-1 and WC were all risk factors for diabetes,which showed a linear dose-response relationship with the incidence of diabetes.3.Both E-selectin and WC,ICAM-1 and WC had significant multiplicative interaction on the occurrence of diabetes in Inner Mongolia population.4.The clustering of E-selectin,ICAM-1 and WC at baseline markedly increased the risk of developing diabetes.Interventions for individuals with high E-selectin,ICAM-1 and WC can make the individual derive greater benefits. |
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