Qualitative research on the status quo of screening and management of diabetic kidney disease in six provinces and cities in China / 中华健康管理学杂志

Objective:To investigate and analyse the current status of screening and management of diabetic kidney disease (DKD) in six provinces and cities in China.Methods:The qualitative research method of focus group interview was adopted, based on the semi-structured interview outline, the clinical medical and disease control personnel in Tianjin, Chongqing, Gansu, Hubei, Heilongjiang, and Guangdong were interviewed. The interview transcripts were analyzed using thematic analysis, and MAXQDA analysis software was used for data management and analysis.Results:A total of 6 interviews were conducted with 49 interviewees. Forty respondents (81.6%) claimed that DKD screening was critical; 53.1% think that it was not easy for patients to obtain DKD screening services; 40.8%, 26.5% and 14.3% of the people believed that the technology of DKD screening services was moderate, simple or very simple, respectively. Of the respondents,16.3% thought that the cost of DKD screening service was relatively expensive, while 83.7% thought that the cost was inexpensive; 75.5% of the respondents believed that the patients could receive early DKD screening service. The factors of fully implementing medical reform policies, changing concepts and actively serving patients, and integrating external resources in medical and health institutions at all levels and of all types were conducive to the development of DKD screening and management services. The lack of technology and personnel for DKD screening services at the grassroots level, the lack of trust in the service capabilities of grassroots medical institutions by patients, the low level of patient awareness, and the novel coronavirus infection epidemic had an adverse impact on the development of DKD screening and management services.Conclusion:The screening and management services for DKD are relatively limited in China, and there is a significant fragmentation in the management and care of diabetes and DKD.

The impact evaluation of a community-based intervention supporting type 2 diabetes mellitus patients in their self-management of the disease / 中华预防医学杂志

Objective@#To evaluate the effect of a community-based intervention supporting type 2 diabetes mellitus patients in their self-management of the disease.@*Methods@#This research was a randomized controlled trial conducted in communities in Fangshan District, Beijing, China. Adult patients with type 2 diabetes from 17 communities in 4 sub-district of Fangshan District were randomly assigned to either the intervention or control group. Participants in the intervention group participated in a three-month group-based diabetes self-management intervention service. Data were collected both in intervention and control group at baseline and after the intervention to evaluate the effect of the intervention. A questionnaire survey was completed by all participants to collect their demographic information, diabetes related health behaviors and skills. A physical examination and lab testing including height, weight, blood pressure, and waist circumference as well as HbA1c, fasting blood glucose, lipid profile were conducted before and after the intervention.@*Results@#A total of 500 valid questionnaires were received, including 259 in the intervention group and 241 in the control group. Patients in the intervention group who learned how to conduct the self-monitoring of blood glucose increased from 56.76% (n=147) to 87.26% (n=226) after the intervention, higher than that of control group (63.07%, n=152) (P<0.001). 69.50% (n=180) patients in intervention group had blood glucose monitor at home, which was 60.62% (n=157) prior to the intervention and higher than that of control group (57.68%, n=139) (P=0.004). After the intervention, 3.09% (n=8) patients in intervention group ceased to take medicine by themselves, which was 16.22% (n=42) before the intervention, while the control group was 8.30% (n=20) after the intervention (P=0.009). Patients in the intervention group made significant improvements in implementing self monitoring on blood glucose (SMBG), which was increased from one day per week to 2 days per week, and foot self-examination, which increased from 2 days per week to 7 days per week. The body weight of patients in the intervention group reduced 1.62 kg on average after the intervention, while it increased 0.88 kg in the control group. Similar improvement was found in waist circumstance between the intervention and control group (-0.83 cm vs -0.16 m). There was a significant reduction on body weight and waist circumstance in the intervention group (P<0.05).@*Conclusion@#The group activities focusing on people with type 2 diabetes resulted in improvement in their lifestyle and self management behaviors, as well as their body weight and waist circumstance.

Disease burden of diabetes attributable to high body mass index in China,1990-2016 / 中华流行病学杂志

Objective: To analyze the burden of disease (BOD) on diabetes attributable to high BMI in China from 1990 to 2016. Methods: Data based on population of the 2016 Global Burden of Disease Study for China were used to analyze the attributable fractions (PAF) of BOD for diabetes attributable to high BMI. Measurements for attributable BOD of diabetes included disability adjusted life years (DALY), years of lost life (YLL), years living with disability (YLD), death number and mortality rate. The average world population from 2010 to 2035 was used as a reference. Results: In 2016, death number of diabetes attributable to high BMI was 40 310, which was significantly higher than that in 1990 (15 008). Age-standardized death rate of diabetes attributable to high BMI increased from 2.01/100 000 in 1990 to 2.60/100 000 in 2016, which showed a more significant increasing trend in both males and people aged 15-49 years. DALYs of diabetes attributable to high BMI increased from 1.09 million person years to 3.30 million person years. YLL and YLD also showed increasing trends. The highest increasing rate of YLD was in people aged 15-49 years. High BMI was responsible for 26.01% of the diabetes deaths in 2016 in China, an increase of 39.39% compared with that in 1990 (18.66%). Most provinces in China experienced a sharp increase of DALY of diabetes attributable to high BMI from 1990 to 2016. Inner Mongolia, Xinjiang, Zhejiang, Macao SAR, Sichuan and Qinghai had the most significant increase tendency in terms of DALY rate during this period. Conclusions: There was a rapid increase of the deaths and mortality rate of diabetes attributable to high BMI, causing a heavy disease burden, in China from 1990 to 2016. The BOD varied in both different age and gender groups. More attention should be paid to males and people aged 15-49 years in the prevention and control programs of diabetes.

Effect of intervention programs regarding community "5+1" staged diabetes target management on patients with type 2 diabetes mellitus / 中华流行病学杂志

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.

Disease burden of diabetes attributable to high body mass index in China,1990-2016 / 中华流行病学杂志

Objective To analyze the burden of disease (BOD) on diabetes attributable to high BMI in China from 1990 to 2016.Methods Data based on population of the 2016 Global Burden of Disease Study for China were used to analyze the attributable fractions (PAF) of BOD for diabetes attributable to high BMI.Measurements for attributable BOD of diabetes included disability adjusted life years (DALY),years of lost life (YLL),years living with disability (YLD),death number and mortality rate.The average world population from 2010 to 2035 was used as a reference.Results In 2016,death number of diabetes attributable to high BMI was 40 310,which was significantly higher than that in 1990 (15 008).Age-standardized death rate of diabetes attributable to high BMI increased from 2.01/100 000 in 1990 to 2.60/100 000 in 2016,which showed a more significant increasing trend in both males and people aged 15-49 years.DALYs of diabetes attributable to high BMI increased from 1.09 million person years to 3.30 million person years.YLL and YLD also showed increasing trends.The highest increasing rate of YLD was in people aged 15-49 years.High BMI was responsible for 26.01％ of the diabetes deaths in 2016 in China,an increase of 39.39％ compared with that in 1990 (18.66％).Most provinces in China experienced a sharp increase of DALY of diabetes attributable to high BMI from 1990 to 2016.Inner Mongolia,Xinjiang,Zhejiang,Macao SAR,Sichuan and Qinghai had the most significant increase tendency in terms of DALY rate during this period.Conclusions There was a rapid increase of the deaths and mortality rate of diabetes attributable to high BMI,causing a heavy disease burden,in China from 1990 to 2016.The BOD varied in both different age and gender groups.More attention should be paid to males and people aged 15-49 years in the prevention and control programs of diabetes.

Effect of intervention programs regarding community “5 + 1” staged diabetes target management on patients with type 2 diabetes mellitus / 中华流行病学杂志

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.

Trend on mortalities in all-cause and chronic non-communicable diseases among the labor force population in China, 2007-2016 / 中华流行病学杂志

Objective: To analyze the trends on mortalities of all-cause and deaths caused by chronic and non-communicable diseases (NCDs) among Chinese labor force population during 2007 to 2016. Methods: Data on cause-of-death that collected from the National Mortality Surveillance System was used to analyze the age and area-related specific crude mortality rates, age-standardized mortality rates and component ratios of NCDs, among the Chinese labor force population, during 2007 to 2016. Trend of crude mortality rates and mortality component ratios of the three major diseases (infectious diseases, maternal and infant diseases, nutritional deficiency diseases; NCDs; injuries) were analyzed. Age-standardized mortality of cancer, COPD, cardiovascular and cerebrovascular diseases were also analyzed by gender. Age-standardized mortality was calculated based on the Year 2010 Population Census of China. Joinpoint regression model was used to obtain annual percentage change and 95%CI was set for assessing the trend. Results: In 2016, the age-standardized all-cause mortality rate was 217.23 per 100 000 among the Chinese labor force population, but decreased by -2.8% (95%CI: -3.8%- -1.7%) annually from 2007 to 2016. The gap between different gender and regions gradually narrowed. The proportion of deaths caused by NCDs increased annually by 0.8% (95%CI: 0.7%-0.9%). The age-standardized mortality rate of NCDs appeared as 171.89/100 000, among the Chinese labor force population in 2016, showing a downward trend by -2.4% (95%CI:-3.3% - -1.4%). However, in females, there appeared the greatest decrease, with an average annual change of -3.3% (95%CI:-4.0% - -2.5%). Diseases as cancer, COPD, cardiovascular and cerebrovascular diseases all showed downward trends in the whole country, with an average range of -2.0% (95%CI: -2.6%--1.3%), -8.0% (95%CI: -8.9% - -7.1%), -1.5% (95%CI: -2.9% - -0.1%), -2.3% (95%CI: -2.8% - -1.8%) in a ten-year period, respectively. Conclusion: All-cause and age-standardized mortality rates caused by NCDs among Chinese labor force population were decreasing during 2007 to 2016. However, the constituent ratios appeared increasing, year by year. Close attention needs to be paid on NCDs which affecting the health of the labor force population in China.

Trend on mortalities in all-cause and chronic non-communicable diseases among the labor force population in China, 2007-2016 / 中华流行病学杂志

Objective To analyze the trends on mortalities of all-cause and deaths caused by chronic and non-communicable diseases (NCDs) among Chinese labor force population during 2007 to 2016.Methods Data on cause-of-death that collected from the National Mortality Surveillance System was used to analyze the age and area-related specific crude mortality rates,age-standardized mortality rates and component ratios of NCDs,among the Chinese labor force population,during 2007 to 2016.Trend of crude mortality rates and mortality component ratios of the three major diseases (infectious diseases,maternal and infant diseases,nutritional deficiency diseases;NCDs;injuries) were analyzed.Age-standardized mortality of cancer,COPD,cardiovascular and cerebrovascular diseases were also analyzed by gender.Age-standardized mortality was calculated based on the Year 2010 Population Census of China.Joinpoint regression model was used to obtain annual percentage change and 95％CI was set for assessing the trend.Results In 2016,the age-standardized all-cause mortality rate was 217.23 per 100 000 among the Chinese labor force population,but decreased by-2.8％ (95％CI:-3.8％--1.7％) annually from 2007 to 2016.The gap between different gender and regions gradually narrowed.The proportion of deaths caused by NCDs increased annually by 0.8％ (95％CI:0.7％-0.9％).The age-standardized mortality rate of NCDs appeared as 171.89/100 000,among the Chinese labor force population in 2016,showing a downward trend by-2.4％ (95％CI:-3.3％--1.4％).However,in females,there appeared the greatest decrease,with an average annual change of-3.3％ (95％CI:-4.0％--2.5％).Diseases as cancer,COPD,cardiovascular and cerebrovascular diseases all showed downward trends in the whole country,with an average range of-2.0％ (95％CI:-2.6％--1.3％),-8.0％ (95％CI:-8.9％--7.1％),-1.5％ (95％CI:-2.9％--0.1％),-2.3％ (95％CI:-2.8％--1.8％)in a ten-year period,respectively.Conclusion All-cause and age-standardized mortality rates caused by NCDs among Chinese labor force population were decreasing during 2007 to 2016.However,the constituent ratios appeared increasing,year by year.Close attention needs to be paid on NCDs which affecting the health of the labor force population in China.

On National Demonstration Areas: a cluster analysis / 中华流行病学杂志

Objective To understand the'backward'provinces and the relatively poor work among the construction of National Demonstration Area,so as to promote communication and future visions among different regions.Methods Methods on Cluster analysis were used to compare the development of National Demonstration Area in different provinces,including the coverage of National Demonstration Area and the scores of non-communicable disease (NCDs) prevention and control work based on a standardized indicating system.Results According to the results from the construction of National Demonstration Area,all the 29 provinces and the Xinjiang Production and Construction Corps (except Tibet and Qinghai) were classified into 6 categories:Shanghai;Beijing,Zhejiang,Chongqing;Tianjin,Shandong,Guangdong and Xinjiang Production and Construction Corps;Hebei,Fujian,Hubei,Jiangsu,Liaoning,Xinjiang,Hunan and Guangxi;Shanxi,Jilin,Henan,Hainan,Sichuan,Anhui and Jiangxi;Inner Mongolia,Shaanxi,Ningxia,Guizhou,Yunnan,Gansu and Heilongjiang.Based on the scores gathered from this study,24 items that representing the achievements from the NCDs prevention and control endeavor were classified into 4 categories:Manpower,special day on NCD,information materials development,policy/strategy support,financial support,mass media,enabled environment,community fitness campaign,health promotion for children and teenage,institutional structure and patient self-management;healthy diet,risk factors on NCDs surveillance,tobacco control and community diagnosis;intervention of high-risk groups,identification of high-risk groups,reporting system on cardiovascular and cerebrovascular events,popularization of basic public health service,workplace intervention programs,construction of demonstration units and mortality surveillance;oral hygiene and tumor registration.Contents including oral hygiene,tumor registration,intervention on high-risk groups,identification of high-risk population,reporting system on cardiovascular and cerebrovascular events,popularization of basic public health service,workplace intervention programs,construction of demonstration units and mortality surveillance were discerned as the relatively weak areas in the construction programs of National Demonstration Area.Conclusions Western regions,especially in some remote provinces had the poorest performance during the construction of National Demonstration Area.Programs regarding chronic disease surveillance,identification and intervention on high-risk groups showed the lowest scores and these outcome-oriented tasks should be further focused on,during the next term of review,in these areas.

On National Demonstration Areas: a cluster analysis / 中华流行病学杂志

Objective To understand the'backward'provinces and the relatively poor work among the construction of National Demonstration Area,so as to promote communication and future visions among different regions.Methods Methods on Cluster analysis were used to compare the development of National Demonstration Area in different provinces,including the coverage of National Demonstration Area and the scores of non-communicable disease (NCDs) prevention and control work based on a standardized indicating system.Results According to the results from the construction of National Demonstration Area,all the 29 provinces and the Xinjiang Production and Construction Corps (except Tibet and Qinghai) were classified into 6 categories:Shanghai;Beijing,Zhejiang,Chongqing;Tianjin,Shandong,Guangdong and Xinjiang Production and Construction Corps;Hebei,Fujian,Hubei,Jiangsu,Liaoning,Xinjiang,Hunan and Guangxi;Shanxi,Jilin,Henan,Hainan,Sichuan,Anhui and Jiangxi;Inner Mongolia,Shaanxi,Ningxia,Guizhou,Yunnan,Gansu and Heilongjiang.Based on the scores gathered from this study,24 items that representing the achievements from the NCDs prevention and control endeavor were classified into 4 categories:Manpower,special day on NCD,information materials development,policy/strategy support,financial support,mass media,enabled environment,community fitness campaign,health promotion for children and teenage,institutional structure and patient self-management;healthy diet,risk factors on NCDs surveillance,tobacco control and community diagnosis;intervention of high-risk groups,identification of high-risk groups,reporting system on cardiovascular and cerebrovascular events,popularization of basic public health service,workplace intervention programs,construction of demonstration units and mortality surveillance;oral hygiene and tumor registration.Contents including oral hygiene,tumor registration,intervention on high-risk groups,identification of high-risk population,reporting system on cardiovascular and cerebrovascular events,popularization of basic public health service,workplace intervention programs,construction of demonstration units and mortality surveillance were discerned as the relatively weak areas in the construction programs of National Demonstration Area.Conclusions Western regions,especially in some remote provinces had the poorest performance during the construction of National Demonstration Area.Programs regarding chronic disease surveillance,identification and intervention on high-risk groups showed the lowest scores and these outcome-oriented tasks should be further focused on,during the next term of review,in these areas.

Evaluation on the status quo of self monitoring of blood glucose and self-efficacy of diabetes patients in community / 中华预防医学杂志

<p><b>OBJECTIVE</b>To investigate the status quo and influence factors of self monitoring of blood glucose (SMBG) and self-efficacy of diabetes patients' that participated in community diabetes self management group.</p><p><b>METHODS</b>Beijing, Shanghai, Chongqing, Jiangsu, Guangdong, and Zhejiang were selected as the study sites considering patients management experiences they had. 1 401 adult diabetes patients were recruited from communities via health records system screening, telephone notification, poster advertisement, letters invitation ways. Face to face questionnaire survey was applied to obtain patients' general information, diabetes history, diabetes knowledge awareness, SMBG, and self-efficacy information. Multiple linear regression was used to analyze the relationship between factors and self efficacy.</p><p><b>RESULTS</b>There were 519 male patients (37.0%) and 882 female patients (63.0%) with an average age of (64.9 ± 8.9) years old. Patients lived in city accounted for 48.0% (672/1 401) and rural patients accounted for 52.0% (729/1 401). Patients who conducted SMBG accounted for 79.9% (1 120/1 401) and 33.3% (446/1 401) patients conducted blood glucose monitoring 1-3 times per month. Rural patients, primary school educated, and new rural cooperative medical system (NCMS) covered patients had a higher proportion of never conducting SMBG which were 21.9% (160/729), 24.2% (160/662), and 26.3% (125/475) , respectively. Scores of self-efficacy was (69.24 ± 16.30) (hundred-mark system) with a relative lower score in monitoring of blood glucose (64.09 ± 20.08) and foot care (63.63 ± 21.40), as well as a highest score in taking medicine and insulin injections (76.10 ± 22.00). Multiple regression analysis on self-efficacy and its related factors show a negative correlation between patients' place of residence and self-efficacy (β' = -0.076) and a positive correlation between education and self-efficacy (β' = 0.114) as well as between diabetes knowledge awareness and self-efficacy (β' = 0.193)(t = -2.46, 3.71, 7.18, P < 0.05).</p><p><b>CONCLUSION</b>Community diabetes patients had a low self-efficacy and it was even lower among low economic and education degree patients. The worst parts were SMBG and foot care. Place of residence, education, and diabetes knowledge awareness are factors that influence patients' self efficacy.</p>