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Epidemiology of Diabetes in Adults in Gansu Province of Northwest China

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Epidemiology of Diabetes in Adults in Gansu Province of Northwest China Epidemiology of Diabetes in adults in GanSu province of northwest China Qi Zhang Gansu Provincial Hospital Tiankang Guo Gansu provincial hospital Limin Tian Gansu Provincial Hospital Jie Yang Gansu Police Vocational College Yanjia Xu Gansu Provincial Hospital Juxiang Liu Gansu Provincial Hospital Jinxing Quan Gansu Provincial Hospital Siqin An Gansu Provincial Hospital Jing Yu Gansu Provincial Hospital Jia Liu Gansu Provincial Hospital Luyan Zhang Gansu Provincial Hospital Suhong Wei Gansu Provincial Hospital Mao Li Gansu Provincial Hospital Zibing Qian Gansu University of Traditional Chinese Medicine Peiyun Zeng Gansu University of Traditional Chinese Medicine Jing Liu ( [email protected] ) Gansu provincial hospital Page 1/22 Research article Keywords: Prevalence, epidemiology, diabetes, prediabetes, Gansu province Posted Date: November 19th, 2020 DOI: https://doi.org/10.21203/rs.3.rs-32037/v2 License: This work is licensed under a Creative Commons Attribution 4.0 International License. Read Full License Page 2/22 Abstract Background: The purpose of this study was to study the characteristics and distribution of adult diabetes and prediabetes in Gansu province, northwest China. Methods: We conducted a population-based, cross-sectional survey in GanSu province of northwest China. A representative sample of 31417 adults, aged 20-74 years, from 14 regions participated in the study. After an overnight fast, a 2-hour oral glucose tolerance test (OGTT) 75 g glucose load was conducted among participants without a self-reported history of diagnosed diabetes. Questionnaire survey, physical examination and serum lipid level were also conducted in the study. Results: The rough prevalence of diabetes in adults in Gansu province of northwest China was 10.6% (12.3% among men and 9.2% among women) and the age-standardized prevalence of diabetes is 9.0%. The prevalence of diagnosed and emerging diabetes was 5.2% and 5.4%, respectively. The prevalence of diabetes among Han, Hui, Tibetan, Yugur, Dongxiang nationality and the Baoan nationality were 10.7%, 11.3%, 5.5%, 7.7%, 8.9% and 7.9% respectively. In addition, the prevalence of prediabetes was estimated to be 15.2% (15.7% among men and 14.7% among women). The prevalence of impaired fasting glucose (IFG) and impaired glucose tolerance (IGT) were 3.5% and 11.6% respectively. The prevalence of diabetes and prediabetes increased with increasing age and body mass index (BMI). The prevalence of diabetes among urban residents was higher than that among rural residents (11.5% vs. 9.5%) which is different from prediabetes (14.2% vs. 16.3%). Binary logistic regression analysis showed that age, male sex, urban residents, smoking, family history of diabetes, abdominal obesity, overweight, generalized obesity, hypertension, dyslipidemia, low levels of education, and high level of economic development were signicantly associated with diabetes. Simultaneously, age, male sex, rural residents, drinking, abdominal obesity, overweight, general obesity, hypertension and low levels of education were signicantly associated with prediabetes. Conclusions: The epidemic situation of diabetes in northwest China's Gansu province is serious. The distribution of diabetes between different sex, age groups and different ethnic groups were signicantly different. More than half of the diabetes patients are undiagnosed, which showed the low hospitalizing rate and the lack of public awareness of diabetes. 1. Background Attributing to rapid economic de velopment, improved living standards, urbanization, an aging population and a sedentary lifestyle, the prevalence of diabetes is high and is increasing (1). The International Diabetes Federation has estimated that in 2013, 382 million people had diabetes throughout the world and this number is expected to rise to 592 million by 2035, indicating a growing burden of diabetes, particularly in developing countries (2). China as the largest developing country, the prevalence of diabetes has markedly increased from less than 1% to 11.6% in the past three decades (3-7). The newest data documented that the prevalence of diabetes and prediabetes was 11.6% and 50.1% respectively (7). Page 3/22 In addition, hyperglycemia and diabetes are important causes of mortality and morbidity worldwide (8- 10), patients with type 2 diabetes have greater increased risks of CVDs (11), which also cause signicant morbidity and mortality among diabetic subjects. The economic costs for diabetes are high and will continue to rise accordingly(12-13). Gansu is a province with multi-ethnic and located in the northwest of China, which is not very developed when compared with the eastern coastal provinces. People in Gansu province almost live at middle altitude. Considering the epidemic of diabetes mellitus, the increasing healthcare expenditures, the paucity of data about the prevalence of Gansu province in recent years and the importance of the prevalence for rational planning of health services, we successfully conducted a cross-section survey between 2013 and 2014 to estimate the prevalences and risk factors of diabetes and prediabetes in the general population in northwest China's Gansu province. 2. Methods 2.1 population We conducted a population-based, cross-sectional survey in the 14 regions in Gansu province between 2013 and 2014. In each region, a stratied, cluster and random sampling design was used to select participants who were representative of residents in Gansu province. Only persons who had been living in their local residence for at least 5 years were qualied to participate. In the rst stage, all the 14 regions were chosen and separated by whether there are minorities. In the second stage, if there are minorities, one general county and one ethnic minority county were chosen, otherwise, tow general counties were chosen randomly. In the third stage, each county was stratied by urban and rural locations, 3 subdistricts in urban areas or town in rural areas were selected randomly according to economic development status from each site with probability proportional to size. In the fourth stage, 3 neighborhood communities or administrative villages were selected randomly with probability proportional to size. In the fth stage, households in each neighborhood community and administrative village were listed, 50 households were selected randomly, all persons who were 20-74 years old in these household were selected. If the selected households or persons refused to take part in, we conducted a replacement from all households in the nearest neighborhood or village to ensure an adequate sample size within each selected neighborhood community and administrative village. We achieved the information of all the households from the government household registration system. All these counties were segmented into developed area, intermediately developed area and undeveloped area based on gross domestic product (GDP) per capita. We also divided the participants into two levels according to the elevation of people living: 1000m-2000m and 2000m-3000m. A representative sample of 34,792 adults, aged 20-74 years, from all the 14 regions participated in the study. After the exclusion of 3375 persons for whose information was incomplete or fasting or 2-hour plasma glucose levels were missing, 31,417 adults (14,083 men and 17,334 women) were included in the nal analysis. Page 4/22 The study protocol was approved by the ethical review committee and the institutional review board of people’s hospital in Gansu province. Written informed consent was obtained from all study participants. 2.2 Variables collection First, the participants were invited to attend a interview to complete a questionnaire at their health centre. Information including age, sex, education level, income levels, smoking, drinking, leisure time sports, eating habits, the history of menstruation and reproduction, personal medical history and family history of diabetes (rst and/or second degree relatives) were recorded. After checking their personal information, physical examinations including weight, height, body mass index, (BMI) waist and hip circumference, waist hip rate (WHR), blood pressure and heart rate were measured by standard methods. BMI is calculated as weight in kilograms divided by height in meters squared. Using a mercury sphygmomanometer, three blood pressure measurements were obtained from the right arm in a seated position by nurses according to a common protocol adapted from procedures recommended by the American Heart Association (14), the mean of the three measurements was used in the statistical analysis. Venous blood samples were collected by trained nurses in all participants after an overnight fast of about 8-10 hours in the local health stations. Plasma glucose, TG, TC, HDL and LDL levels were measured. A standard OGTT using 75 g glucose load was performed if participants without a self reported history of diabetes and the 2-hour plasma glucose level was measured. Blood specimens were centrifuged and placed in ice-cooled containers immediately and measured within 2 hours. Plasma glucose was measured using glucose oxidase method and blood lipid was detected using enzyme method by Olympus AU5400. 2.3 Diagnostic Criteria Diabetes was diagnosed and classied in accordance with the 1999 WHO criteria. Diabetes was conrmed according to a self-reported or those who had a fasting glucose≥7.0mmol/L and/or a 2h post- glucose level≥11.1 mmol/L; impaired fasting glucose(IFG) was dened as fasting glucose level ≥6.1 mmol/L and <7.0 mmol/L,
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