Analysis of diabetes screening in high-risk population in different communities in Shanghai from 2016 to 2017
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摘要:
目的 描述2016-2017年上海市社区居民糖尿病高危人群筛查的结果，分析糖调节受损及糖尿病患者的危险因素。 方法 选择上海市长宁区和松江区35岁及以上居民进行糖尿病风险评估，对高危人群进行体格检查和血糖检测。 结果 两个社区共完成筛查33 469人，检出糖调节受损者4 555名和糖尿病患者3 412名，检出率分别13.6%和10.2%。高危人群中，随着年龄增加，居民发生糖尿病（男：P < 0.001；女：P < 0.001）和糖调节受损（男：P < 0.001；女：P < 0.001）的风险均增加；郊区男性患糖尿病的风险低于城区男性（OR=0.873，95%CI：0.771~0.988），而郊区女性发生糖调节受损的风险高于城区女性（OR=1.249，95%CI：1.131~1.379）；自述有糖调节受损史（男：P < 0.001；女：P < 0.001）、亲属有2型糖尿病家族史（男：P < 0.001；女：P < 0.001）、高血压（男：P < 0.001；女：P < 0.001）、血脂异常（男：P < 0.001；女：P=0.015）、体型超重/肥胖者（男：P < 0.001；女：P < 0.001）、长期静坐的生活方式的男性（P=0.002）和有多囊卵巢综合征史的女性（P=0.011）出现血糖异常的风险更高，居民的高危因素种类数越多，发生糖尿节受损和糖尿病的风险就越大（P < 0.001）。 结论 上海市社区糖尿病的发现和防治工作形势十分严峻，应继续加强对糖尿病高危人群的监测和干预，以减少糖尿病的发生。 Abstract:Objective To describe the results of screening for high-risk population of diabetes mellitus among community residents in Shanghai from 2016 to 2017 and analyze the characteristics of subjects with impaired glucose regulation or diabetes patients. Methods After the diabetes risk assessment for the residents aged 35 and older in Changning and Songjiang district of Shanghai, physical examination and blood glucose test were conducted for high-risk groups. Results A total number of 33 469 people in the two communities were screened, 4 555 patients with impaired glucose regulation and 3 412 patients with diabetes were detected. The detection rates were 13.6% and 10.2%, respectively. In high-risk population, aging was significantly correlated with the risk of diabetes(males: P < 0.001;females: P < 0.001) and impaired glucose regulation(males: P < 0.001;females: P < 0.001). The risk of diabetes in rural males was lower than that in urban males (OR=0.873, 95% CI: 0.771-0.988), while rural females had a higher risk of impaired glucose regulation than urban females (OR=1.249, 95% CI: 1.131-1.379). Self-reported history of impaired glucose regulation(males: P < 0.001;females: P < 0.001), family history of type 2 diabetes(males: P < 0.001;females: P < 0.001), hypertension(males: P < 0.001;females: P < 0.001), dyslipidemia(males: P < 0.001;females: P=0.015), overweight/obesity(males: P < 0.001;females: P < 0.001), long-term sedentary lifestyle in males (P=0.002) and a history of polycystic ovary syndrome in females (P=0.011) were related to the risk of dysglycemia. The more of the number of high-risk factors for residents, the higher the risk of impaired glucose regulation and diabetes (P < 0.001). Conclusions The situation of community diabetes detection and prevention in Shanghai is very serious. Therefore, it is necessary to strengthen the monitoring of high-risk groups of diabetes and take targeted intervention measures to reduce the occurrence of diabetes in high-risk population. -
Key words:
- Diabetes /
- High-risk population /
- Screening /
- Prevention
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表 1 上海市不同社区参加糖尿病筛查的人群基本特征[n(%)]
Table 1. Demographic characteristics of participants in different communities in Shanghai[n(%)]
长宁区 松江区 合计 性别 女 7 226(57.9) 12 268(58.4) 19 494(58.2) 男 5 250(42.1) 8 725(41.6) 13 975(41.8) 年龄(岁) < 40 797(6.4) 1 257(6.0) 2 054(6.1) 40- 2 701(21.6) 3 228(15.4) 5 929(17.7) 50- 2 994(24.0) 6 439(30.7) 9 433(28.2) ≥60 5 984(48.0) 10 069(48.0) 16 053(48.0) 文化程度 大专及以上 2 116(17.9) 1 067(6.1) 3 183(10.8) 中职及高中 3 815(32.3) 2 732(15.5) 6 547(22.3) 初中及以下 5 885(49.8) 13 771(78.4) 19 656(66.9) 自述高危因素 糖调节受损史 340(2.7) 2 183(10.4) 2 523(7.5) 一级亲属2型糖尿病 1 836(14.7) 2 678(12.8) 4 514(13.5) 巨大儿生产史/GDM史a 123(1.0) 221(1.1) 344(1.0) 高血压 3 738(30.0) 9 891(47.1) 13 629(40.7) 血脂异常 1 892(15.2) 2173(10.4) 4 065(12.1) ASCVD史b 988(7.9) 921(4.4) 1 909(5.7) 过性类固醇DMc 62(0.5) 50(0.2) 112(0.3) PCOS史 41(0.3) 33(0.2) 74(0.2) 长期抗精神病/抑郁 37(0.3) 99(0.5) 136(0.4) 静坐生活方式 12 152(97.4) 20 726(98.7) 32 878(98.2) 超重/肥胖 6 872(55.1) 12 018(57.2) 18 890(56.4) 注：aGDM(gestational diabetes mellitus)妊娠期糖尿病；bASCVD(atherosclerotic cardiovascular and cerebrovascular diseases)：动脉粥样硬化性心脑血管疾病；cDM(diabetes mellitus)：糖尿病。 
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表 2 不同特征高危人群筛查结果[n(%)]
Table 2. Screening results of different subgroup participants[n(%)]
变量 血糖正常者 糖调节受损者 糖尿病者 χ2值 P值 性别 52.8 < 0.001 男 10 245(73.3) 1 907(13.6) 1 612(11.5) 女 14 797(75.9) 2 648(13.6) 1 800(9.2) 年龄(岁) 1 465.5 < 0.001 < 40 1 928(93.9) 58(2.8) 58(2.8) 40~ 5 169(87.2) 401(6.8) 291(4.9) 50~ 7 230(76.6) 1 159(12.3) 926(9.8) ≥60 10 715(66.7) 2 937(18.3) 2 137(13.3) 文化 82.4 < 0.001 初中及以下 14 718(74.9) 2 631(13.4) 1 994(10.1) 中职及高中 5 013(76.6) 860(13.1) 620(9.5) 大专及以上 2 573(80.8) 340(10.7) 254(8.0) 城乡 87.3 < 0.001 城区 9 649(77.3) 1 547(12.4) 1 171(9.4) 郊区 15 393(73.3) 3 008(14.3) 2 241(10.7) 高危种类数(个)a 2 402.8 < 0.001 0 136(91.9) 10(6.8) 1(0.7) 1 6 893(88.4) 542(7.0) 300(3.8) 2 9 428(79.0) 1 408(11.8) 932(7.8) 3 5 885(68.4) 1 454(16.9) 1 121(13.0) 4 2 079(57.5) 789(21.8) 689(19.1) ≥5 621(45.6) 352(25.8) 369(27.1) 合计 25 042(74.8) 4 555(13.6) 3 412(10.2) 注：a未包含年龄在内高危因素的数量。
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表 3 Logistic回归模型分析影响男性血糖代谢的危险因素
Table 3. Analysis of risk factors affecting male glucose metabolism (Logistic model)
变量 糖调节受损结局 糖尿病结局 OR值 95%CI值 P值 OR值 95%CI值 P值 年龄(岁) 1.035 1.030~1.040 < 0.001 1.029 1.023~1.034 < 0.001 城乡 城区 1.000 郊区 0.931 0.831~1.043 0.215 0.873 0.771~0.988 0.032 文化 大专及以上 1.000 中职及高中 1.094 0.931~1.286 0.277 1.235 1.033~1.476 0.021 初中及以下 1.020 0.891~1.168 0.775 1.189 1.022~1.384 0.025 自述高危因素 糖调节受损史 3.778 3.198~4.462 < 0.001 5.390 4.570~6.358 < 0.001 一级亲属2型DM 1.294 1.108~1.512 0.001 1.552 1.325~1.819 < 0.001 高血压 1.323 1.185~1.477 < 0.001 1.394 1.236~1.573 < 0.001 血脂异常 1.223 1.049~1.426 0.010 1.620 1.388~1.891 < 0.001 ASCVD史 1.147 0.944~1.394 0.167 0.854 0.679~1.073 0.176 过性类固醇DM 1.633 0.703~3.795 0.254 1.712 0.744~3.937 0.206 精神/抑郁 1.595 0.740~3.436 0.234 0.833 0.274~2.529 0.747 静坐生活方式 1.402 0.949~2.073 0.090 2.359 1.391~4.000 0.002 超重/肥胖 1.555 1.394~1.734 < 0.001 1.786 1.580~2.017 < 0.001
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表 4 Logistic回归分析模型分析影响女性血糖代谢的危险因素
Table 4. Analysis of risk factors affecting female blood glucose metabolism (Logistic model)
变量 糖调节受损结局 糖尿病结局 OR值 95%CI值 P值 OR值 95% CI值 P值 年龄(岁) 1.039 1.035~1.044 < 0.001 1.041 1.036~1.047 < 0.001 城乡 城区 1.000 1.000 郊区 1.249 1.131~1.379 < 0.001 0.992 0.880~1.119 0.900 文化 大专及以上 1.000 1.000 中职及高中 1.139 0.990~1.310 0.069 0.960 0.808~1.142 0.646 初中及以下 1.080 0.971~1.202 0.156 1.042 0.919~1.182 0.519 自述高危因素 糖调节受损史 2.980 2.590~3.429 < 0.001 4.874 4.210~5.643 < 0.001 一级亲属2型DM 1.464 1.300~1.648 < 0.001 1.622 1.412~1.864 < 0.001 巨大儿生产史/GDM史 0.825 0.582~1.169 0.280 0.966 0.658~1.418 0.860 高血压 1.346 1.226~1.479 < 0.001 1.642 1.466~1.839 < 0.001 血脂异常 1.262 1.117~1.427 < 0.001 1.198 1.036~1.384 0.015 ASCVD史 1.127 0.953~1.333 0.162 0.891 0.725~1.094 0.271 过性类固醇DM 2.197 1.218~3.962 0.009 1.809 0.865~3.783 0.116 PCOS史 0.783 0.368~1.663 0.524 2.204 1.199~4.051 0.011 精神/抑郁 0.955 0.499~1.827 0.889 0.687 0.269~1.753 0.432 静坐生活方式 1.182 0.811~1.723 0.385 1.074 0.691~1.670 0.751 超重/肥胖 1.769 1.616~1.937 < 0.001 2.320 2.069~2.601 < 0.001
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[1] DeFronzo RA, Ferrannini E, Zimmit P, et al. International textbook diabetes mellitus[M]. Wiley-Blackwell, 2015. [2] Ogurtsova K, da Rocha Fernandes JD, Huang Y, et al. IDF diabetes atlas: global estimates for the prevalence of diabetes for 2015 and 2040[J]. Diabetes Res Clin Pract, 2017, 128: 40-50. DOI: 10.1016/j.diabres.2017.03.024. [3] Cho NH, Shaw JE, Karuranga S, et al. IDF diabetes atlas: global estimates of diabetes prevalence for 2017 and projections for 2045[J]. Diabetes Res Clin Pract, 2018, 138: 271-281. DOI: 10.1016/j.diabres.2018.02.023. [4] 曹卫华, 隋萍, 张爱华. 糖调节受损与糖尿病风险预测[J]. 医学综述, 2006, 12(20): 1279-1280. DOI: 10.3969/j.issn.1006-2084.2006.20.028.Cao WH, Sui P, Zhang AH, Impaired glucose regulation and risk prediction of diabets[J]. Med Recapitulate, 2006, 12(20): 1279-1280. DOI: 10.3969/j.issn.1006-2084.2006.20.028. [5] 王文娜, 龚红红, 刘超. 糖尿病前期的治疗研究进展[J]. 中国中医药现代远程教育, 2018, 16(15): 156-158. DOI: 10.3969/j.issn.1672-2779.2018.15.066.Wang WN, Gong HH, Liu C. Research progress and treatment of prediabetes mellitus[J]. Chinese Medicine Modern Distance Education of China, 2018, 16(15): 156-158. DOI: 10.3969/j.issn.1672-2779.2018.15.066. [6] Li G, Zhang P, Wang J, et al. Cardiovascular mortality, all-cause mortality, and diabetes incidence after lifestyle intervention for people with impaired glucose tolerance in the da qing diabetes prevention study: a 23-year follow-up study[J]. Lancet Diabetes Endocrinol, 2014, 2(6): 474-480. DOI: 10.1016/S2213-8587(14)70057-9. [7] Engelgau MM, Gregg EW. Tackling the global diabetes burden: will screening help?[J]. Lancet, 2012, 380(9855): 1716-1718. DOI: 10.1016/S0140-6736(12)61682-1. [8] 中华医学会糖尿病学分会. 中国2型糖尿病防治指南(2013年版)[J]. 中华内分泌代谢杂志, 2014, 30(10): 893-942. DOI: 10.3760/cma.j.issn.1000-6699.2014.10.020.Chinese Diabetes Society, Guidelines for the prevention and treatment of type 2 diabetes in China (2013 edition)[J]. Chin J Endocrinol Metab, 2014, 30(10). DOI: 10.3760/cma.j.issn.1000-6699.2014.10.020. [9] 刘子琪, 刘爱萍, 王培玉. 中国糖尿病患病率的流行病学调查研究状况[J]. 中华老年多器官疾病杂志, 2015(7): 547-550. DOI: 10.11915/j.issn.1671-5403.2015.07.125.Liu ZQ, Liu AP, Wang PY. Epidemiological situation of diabetes prevalence in China. [J]. Chin J Mult Organ Dis Elderly, 2015, (7): 547-550. DOI: 10.11915/j.issn.1671-5403.2015.07.125. [10] Wang L, Gao P, Zhang M, et al. Prevalence and ethnic pattern of diabetes and prediabetes in China in 2013[J]. JAMA, 2017, 317(24): 2515-2523. DOI: 10.1001/jama.2017.7596. [11] Tabak AG, Herder C, Rathmann W, et al. Prediabetes: a high-risk state for diabetes development[J]. Lancet, 2012, 379(9833): 2279-2290. http://europepmc.org/abstract/MED/22683128 [12] 李菁. 上海某社区高危人群糖尿病筛查结果分析[J]. 上海医药, 2018, 39(12): 39-41. https://www.cnki.com.cn/Article/CJFDTOTAL-SYIY201812017.htmLi Q. Analysis of the screening results of the high risk population of diabetes in a community in shanghai[J]. Shanghai Med Pharm J, 2018, 39(12): 39-41. https://www.cnki.com.cn/Article/CJFDTOTAL-SYIY201812017.htm [13] 梁森, 韩冰, 范雷, 等. 河南省35~74岁人群糖尿病患病率及相关因素分析[J]. 中华疾病控制杂志, 2018, 22(6): 569-572, 589. DOI: 10.16462/j.cnki.zhjbkz.2018.06.007.Liang S, Han B, Fan L, et al. Prevalence of diabetes mellitus and associated risk factors in population aged 35-74 years in Henan Province[J]. Chin J Dis Control Prev, 2018, 22(6): 569-572, 589. DOI: 10.16462/j.cnki.zhjbkz.2018.06.007. [14] 席天舒, 潘利, 任晓岚, 等, 甘肃省糖尿病、糖尿病前期患病率及影响因素分析[J]. 中华疾病控制杂志, 2018, 22(10): 987-991. DOI: 10.16462/j.cnki.zhjbkz.2018.10.002.Xi TS, Pan L, Ren XL, et al, The prevalence and associated factors of diabetes and pre-diabetes in gansu province[J]. Chin J Dis Control Prev, 2018, 22(10): 987-991. DOI: 10.16462/j.cnki.zhjbkz.2018.10.002. [15] Ma RCW. Epidemiology of diabetes and diabetic complications in China[J]. Diabetologia, 2018, 61(6): 1249-1260. DOI: 10.1007/s00125-108-4557-7. [16] Le C, Jun D, Zhankun S, et al. Socioeconomic differences in diabetes prevalence, awareness, and treatment in rural southwest China[J]. Trop Med Int Health, 2011, 16(9): 1070-1076. DOI: 10.1111/j.1365-3156.2011.02805.x. [17] 杜群, 石福彦, 丁奇龙, 等. 空腹血糖受损、糖耐量受损人群2年自然转归及其影响因素的研究[J]. 中华内分泌代谢杂志, 2004, 20(3): 223-226. DOI: 10.3760/j.issn:1000-6699.2004.03.015.Du Q, Shi FY, Ding QL, et al. Natural outcome of impaired fasting glucose and impaired glucose tolerance-a survey of two-year follow-up and the related risk factor analysis[J]. Chin J Endocrinol Metab, 2004, 20(3): 223-226. DOI: 10.3760/j.issn:1000-6699.2004.03.015. [18] International Diabetes Federation Guideline Development Group. Global guideline for type 2 diabetes[J]. Diabetes Res Clin Pract, 2014, 104(1): 1-52. DOI: 10.1016/j.diabres.2012.10.001. [19] 刘莉莉, 孙子林, 金晖, 等. 医院社区联动自我管理教育模式对糖尿病患者治疗效果的影响研究[J]. 中国全科医学, 2011, 14(1): 59-61, 69. DOI: 10.3969/j.issn.1007-9572.2011.01.019.Liu LL, Sun ZL, Jin H, et al. Effect of hospital-community integrated self education and management mode for diabetics[J]. Chin Gen Pract. 2011, 14(1): 59-61, 69. DOI: 10.3969/j.issn.1007-9572.2011.01.019. -
