Study On The Relationship Between Visceral Fat Index And Blood Glucose And Blood Pressure Control In Type 2 Diabetic Patients

Objective:With the changes of living conditions and dietary pattern,abdominal obesity has been increasing rapidly.Abdominal obesity is closely related to insulin resistance.Excessive visceral fat can easily lead to disorders of glucose and lipids metabolism,and diabetes has become one of the top three chronic non-communicable diseases that seriously threaten the health of residents.Visceral fat index?VAI?is a specific index for evaluating visceral fat function,and is strongly correlated with diabetes mellitus.In this study,we investigated nearly 20,000 patients with type 2 diabetes mellitus in Jiangsu Province,analyzed the distribution of VAI in type 2 diabetes mellitus patients,and explored the associations for VAI with the control of fasting blood glucose,glycosylated hemoglobin and blood pressure.The interactions of smoking,drinking,physical activity and VAI on fasting blood glucose,glycosylated hemoglobin and blood pressure control in type 2 diabetes mellitus patients was also evaluated.Moreover,the area under receiver operating characteristics?ROC?curves was applied to compare the efficiency of VAI,body mass index?BMI?and waist circumference?WC?on evlaution of fasting blood glucose,glycosylated hemoglobin and blood pressure control in type 2diabetes mellitus patients.Ths theis aims to provide more scientific basis for better controlling the development of diabetes and improve the quality of life of diabetic patients.Methods:1.Patients with type 2 diabetes mellitus and who were receiving National Basic Public Health Serveices in Changshu and Huai'an of Jiangsu Province were reruited as study participants by cluster sampling method from December 2013 to January 2014.After excluding those participants with missing data,a total of 19 910 subjects aged over 35 years old were involved in this study.2.A structured standardized health information questionnaire was used by trained stafffor face-to-face interview.General demographic information,behavior and lifestyle,disease history and others were collected.Anthropometric measurements on height,weight,waist circumference and other physical examination indicators were conducted at interview,body mass index?BMI?was calculated.Fasting venous blood samples were collected,and fasting blood glucose,glycosylated hemoglobin,high density lipoprotein cholesterol,triglyceride and other biochemical indicators were tested in a qualified lab.SPSS20.0 and SAS9.2 software were used for cleaning laboratory test data and statistical analyses.3.Quantatitive data with normal distribution were described as mean±stanadard deveiation?SD?,and inter-group comparison was conducted by t test or analysis of variance.For variavbles with skewed distribution,they were described by M?Q25,Q75?,and the inter-group comparison was conducted by non-parametric tests.Qualitative data were described by rate or consitutent ratio.By Chi-square test was carried out for inter-group comparisons of general demographic information and VAI,as well as the distribution of body fatness and its relationship with fasting blood glucose,glycosylated hemoglobin and blood pressure in type 2 diabetes mellitus patients.Logistic regression analysis was used to analyze the influence of VAI on the control of fasting blood glucose,glycosylated hemoglobin and blood pressure in type 2 diabetes mellitus patients,and to explore such effects of smoking,drinking and body pressure as well.The joint effects of lifestyle and visceral fat index on fasting blood glucose,glycated hemoglobin and blood pressure control in type2 diabetes mellitus patients were analyzed by additive and multiplicative scales respectively..The efficacy of visceral fat index,body mass index and waist circumference on evaluating fasting blood glucose,glycosylated hemoglobin and blood pressure control were compared by using area under the receiver operating characteristics?ROC?curve of subjects.Results:1.The median visceral fat index of type 2 diabetes mellitus in Jiangsu Province was 1.81,with the maximum of 60.28 and the minimum of 0.13,the standard deviation was 2.98.The control of fasting blood sugar of among male and female was 28.8%and 33.3%,the control of glycosylated hemoglobin was 40.2%among male and was 43.0%among female,the blood pressure of male was21.6%and for female was 26.3%,male was lower than female?P<0.05?.After categorizing VAI into four groups by using quartiles,the proportion of reaching control targets?group I to group IV?for fasting blood glucose were 36.0%,33.1%,30.8%,26.2%;for glycosylated hemoglobin were48.6%,43.3%,40.1%,35.5%;for blood pressure were 31.8%,25.2%,22.1%,18.7%,respectively.With the increase of VAI,the control rate of fasting blood sugar,glycosylated hemoglobin and blood pressure reached the standard rate gradually decreased.The risk of failure to contral fasting blood glucose in VAI group 2-4 increased by 16%,28%and 60%,respectively;while for hemoglobin and blood pressure,The proportion of failure to control increased 25%,42%and 73%;39%,65%and 106%from group 2 to group 4,respectively.2.Compared with never alcohol drinking patients,the risk of fasting blood glucose failure control increased by 25%?ORadj=1.25,95%CI:1.13-1.39?.Compared with non-smoking patients,the risk of glycosylated hemoglobin failure control in smoking patients increased by 32%?ORadj=1.32,95%CI:1.21-1.43?,and the risk of blood pressure failure in drinking patients increased by43%?ORadj=1.43,95%CI:1.28-1.59?.When type 2 diabetes mellitus smoked and had high visceral fat index,the risk of high fasting blood sugar increased by 1.44 timesand the risk of unctrolled glycosylated hemoglobin increased by 1.87 times.The risk of fasting blood sugar not meeting the standard increased by 1.56 times when drinking alcohol and high visceral fat index co-exsits,and the risk of glycosylated hemoglobin not meeting the standard increased by 1.54 times when drinking alcohol and high visceral fat index co-exsits.An additive interaction was observed between alcohol consumption and visceral fat index for blood pressure control among type 2diabetes mellitus patients,but no multiplicative interaction was found.3.Compared with individuals with normal BMI,the risk of unsatisfactory glycated hemoglobin in low BMIgroup decreased by 24%?ORadj=0.76,95%CI:0.59-0.98?but increased by 11%(OR_adj=1.11,95%CI:1.04-1.20)and 34%?ORadj=1.34,95%CI:1.23-1.47?in overweight and obesity group,respectively.Compared with normal BMI group,the risk of unsatisfactory blood pressure in overweight and obesity group increased by 26%(OR_adj=1.26,95%CI:1.23-1.47)and68%(OR_adj=1.68,95%CI:1.48-1.91),respectively.The areas under the ROC curve of visceral fat index,body mass index and waist circumference were 0.56,0.51 and 0.53 respectively,and AUC of visceral fat index was larger than that of body mass index and waist circumference?P<0.05?.For glycosylated hemoglobin,AUC for VAI,BMI and WC was 0.56,0.53 and 0.54 respectively,and VAI was larger than that of BMI and WC?P<0.05?.In women,AUC of fasting blood glucose control for VAI,BMI and WC was 0.55,0.49 and 0.52 and for glycosylated hemoglobin control was0.56,0.53 and 0.55,respectively,and the area under ROC curve of visceral fat index was larger than body mass index and waist circumference?P<0.05?.Conclusions:1.For community managemed type 2 diabetes mellitus patients in Jiangsu Province,the control rate of fasting blood glucose,glycosylated hemoglobin and blood pressure is not high,visceral fat index has an impact on the three indicators,community management needs to be further strengthened,and more detailed education strategies should be formulated to prevent and control the monitoring indicators.2.For type 2 diabetes patients managed in community in Jiangsu Province,smoking,drinking,and physical activity have an impact on the rate of achieving the goal of fasting blood sugar,glycosylated hemoglobin and blood pressure control.Furthermore,alcohol consumption and visceral fat index was found to have a more than addtive interactions on blood pressure control which may lead to increase the risk of not meeting the target,therefore,it is necessary to strengthenbehavior and lifestyle intervention among diabetic patients,combined with strengthen education on the synergistic effect of visceral fat index.3.With the increase of body mass index,the risk of uncontrolled glycosylated hemoglobin and blood pressure increased.Visceral fat index has a more close relationship with fasting blood glucose and glycosylated hemoglobin as compared with BMI and WC.General Practionners in communities need to raise awareness on visceral fat index and pay more attention to its effects on blood glucose and blood pressure control in type 2 diabetic patients.