ABSTRACT
Objective:To evaluate the association of HbA 1C level and variability with annual decline in glomerular filtration rate in elderly patients with type 2 diabetes. Methods:A total of 527 elderly type 2 diabetic patients with baseline estimated glomerular filtration rate(eGFR)≥60 mL·min -1·(1.73 m 2) -1 at the diabetes center of a tertiary hospital in Jiangsu province were included and followed up. The mean value and the variability of HbA 1C, including standard deviation(HbA 1C-SD), variation coefficient(HbA 1C-CV), and adjusted standard deviation(Adj-HbA 1C-SD) were calculated. According to the annual decreased rate of eGFR, the patients were divided into △eGFR>5% group and △eGFR≤5% group. Cox proportional risk regression model was used to evaluate the relationship between HbA 1C variability and the risk of decreased glomerular filtration rate. Results:With a mean follow-up time of 19 months, there were 176 patients whose △eGFR>5%. Compared with △eGFR≤5% group, the HbA 1C-mean and HbA 1C variability were significantly higher in △eGFR>5% group( P<0.05). Cox regression analysis showed that HbA 1C-mean, HbA 1C-SD, HbA 1C-CV, and Adj-HbA 1C-SD were significantly correlated with decreased glomerular filtration rate. After adjustment for age, gender, HbA 1C-mean, and other factors, only Adj-HbA 1C-SD was correlated with renal insufficiency [ HR=3.32(1.68-6.57)]. Conclusions:HbA 1C variability is independently associated with annual decline in glomerular filtration rate in elderly patients with type 2 diabetes. The Adj-HbA 1C-SD is the most sensitive indicator in predicting decreased glomerular filtration rate.
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Objective To analyze the effect of intervention programs and influencing factors regarding the community “5 + 1” staged diabetes target management on patients with type 2 diabetes mellitus (T2DM) and to provide evidence for improving the quality of life (QOL).Methods A total of 12 community health service centers from Shanxi province,Jiangsu province,and Ningxia Hui autonomous region were selected as intervention group and control group,by stratified cluster sampling method.“5 + 1” model was used in intervention groups and basic public health services model was applied in control groups for this two-year follow-up.Data was collected through a questionnaire on demographic and disease-related information,while the QOL was measured with SF-36.Multiple linear regression and conducted by SAS 9.4.Results A total of 2 467 subjects were included at baseline and 1 924 had completed a two-year-long management service.After intervention programs being implemented,the net effect of PCS score between the intervention and the control groups was 13.6,with the net effect of MCS score as 29.8.Results from the multiple linear regression showed that the main factors affecting PCS scores included age,type of medical insurance,baseline PCS score and regions of residency.Main factors related to MCS score included age,type of medical insurance,baseline MCS score,hypertension,and region of residency.Conclusion Community “5 + 1” staged diabetes target management model presented favorable effect of improving the QOL on T2DM patients.
ABSTRACT
Objective To analyze the effect of intervention programs and influencing factors regarding the community “5 + 1” staged diabetes target management on patients with type 2 diabetes mellitus (T2DM) and to provide evidence for improving the quality of life (QOL).Methods A total of 12 community health service centers from Shanxi province,Jiangsu province,and Ningxia Hui autonomous region were selected as intervention group and control group,by stratified cluster sampling method.“5 + 1” model was used in intervention groups and basic public health services model was applied in control groups for this two-year follow-up.Data was collected through a questionnaire on demographic and disease-related information,while the QOL was measured with SF-36.Multiple linear regression and conducted by SAS 9.4.Results A total of 2 467 subjects were included at baseline and 1 924 had completed a two-year-long management service.After intervention programs being implemented,the net effect of PCS score between the intervention and the control groups was 13.6,with the net effect of MCS score as 29.8.Results from the multiple linear regression showed that the main factors affecting PCS scores included age,type of medical insurance,baseline PCS score and regions of residency.Main factors related to MCS score included age,type of medical insurance,baseline MCS score,hypertension,and region of residency.Conclusion Community “5 + 1” staged diabetes target management model presented favorable effect of improving the QOL on T2DM patients.
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This study was conducted to evaluate the relationship between serum insulin levels and the production of insulin antibody (IA) in type 2 diabetes (T2DM).A total of 647 T2DM were included.Among them,20.9％ patients were IA positive,who were elder and had a longer duration,lower BMI,a higher positive rate of glutamic acid decarboxylase antibody(GADAb) and higher serum insulin levels during an insulin secretion test.More patients were treated with insulin in IA positive group than in IA negative group (65.9％ vs 41.0％,P =0.000).Fasting serum insulin level was associated with occurrence of IA in all patients (OR =1.02,P =0.001) and insulin treated patients (OR =1.033,P =0.002).The cut-off point of fasting serum insulin level for predicting IA positive was 17.87 mIU/L (sensitivity 55.1％,specificity 89.0％).Exogenous insulin use is associated with the presence of IA.Fasting serum insulin level can be used as a predictor for the production of IA in insulin-treated patients.