Association between different metabolic types of obesity and glycemic control among community type 2 diabetes patients in Nanjing
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摘要:
目的 探讨南京市社区不同肥胖和代谢类型的2型糖尿病患者分布及血糖控制情况。 方法 2021年4―6月在南京市12个区，采取多阶段分层整群随机抽样方法招募2型糖尿病患者，进行问卷调查、体格检查和临床生化指标检测。根据代谢及肥胖状态，将研究对象分为体重正常代谢正常(metabolically healthy and normal weight, MHNW)、体重正常代谢异常(metabolically unhealthy but normal weight, MUHNW)、代谢正常性肥胖(metabolically healthy obese, MHO)和代谢异常性肥胖(metabolically abnormal obese, MAO)。采用logistic回归分析模型进行多因素分析。 结果 共纳入研究对象1 389名，平均年龄为(65.14±7.71)岁，男性598名(43.05%)。其中MHNW者296名(21.31%)，MUHNW者319名(22.97%)，MHO者109名(7.85%)，MAO者665名(47.87%)。年龄越大，发生MUHNW和MAO的比例越高；女性、糖尿病病程≥5年人群中MUHNW比例较高。调查对象空腹血糖(fasting blood glucose, FPG)、糖化血红蛋白(hemoglobinA1c, HbA1c)控制达标率分别为44.92%、48.88%。多因素分析结果显示，MAO者FPG控制未达标率是MHNW者的1.525倍(OR=1.525，95% CI：1.148~2.025，P=0.004)；MAO者HbA1c控制未达标率是MHNW者的1.516倍(OR=1.516，95% CI：1.140~2.016，P=0.004)。 结论 南京市社区2型糖尿病患者MUHNW和MAO较多，MAO的2型糖尿病患者血糖控制较差。应对不同肥胖亚群的2型糖尿病患者进行早期识别和分类干预，能够有效控制血糖，预防糖尿病并发症的发生。 Abstract:Objective To investigate the distribution characteristics and glycemic control of type 2 diabetes patients with different metabolic types and obesity in community in Nanjing. Methods From April to June 2021, multi-stage stratified cluster random sampling method was adopted to recruit type 2 diabetes patients in 12 districts of Nanjing, questionnaire responses, physical examinations and clinical indicators were gathered. According to their metabolic and BMI, the population was divided into metabolically healthy and normal weight (MHNW), metabolically unhealthy but normal weight (MUHNW), metabolically healthy obese (MHO), and metabolically abnormal obese (MAO). Logistic regression was used for multivariate analysis. Results A total of 1 389 subjects were included, with an average age of (65.14±7.71) years old, 598 males (43.05%), among which MHNW, MUHNW, MHO, MAO were 21.31%, 22.97%, 7.85% and 47.87%. The older the age, the higher the incidence of MUHNW and MAO; The proportion of MUHNW in women and patients with diabetes course ≥5 years was higher. The control up to standard rates of fasting blood glucose(FPG) and hemoglobinA1c(HbA1c) among the subjects were 44.92% and 48.88%, respectively. The results of multivariate analysis showed that the incidence of FPG control failure in MAO patients was 1.525 times higher than that in MHNW (OR=1.525, 95% CI: 1.148-2.025, P=0.004); The incidence of HbA1c control failure in MAO patients was 1.516 times higher than that in MHNW patients (OR=1.516, 95%CI: 1.140-2.016, P=0.004), with statistically significant (P < 0.05). Conclusions There are more type 2 diabetes patients with MUHNW and MAO in Nanjing, and the type 2 diabetes patients with MAO have poor glycemic control. Early identification and classified intervention should be carried out for type 2 diabetes patients with different obesity subgroups to effectively control blood glucose, and to prevent and control complications of diabetes. -
Key words:
- Type 2 diabetes /
- Metabolic type /
- Obesity /
- Glycemic control
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表 1 南京社区不同代谢类型和肥胖的2型糖尿患者群基本特征
Table 1. Characteristics of patients with type 2 diabetes in different metabolic types of obese in Nanjing communities
变量 Variable 合计 ①
Total ①体重正常代谢正常 ①
Metabolically healthy and normal weight ①体重正常代谢异常 ①
Metabolically unhealthy but normal weight ①代谢正常性肥胖 ①
Metabolically healthy obese ①代谢异常性肥胖 ①
Metabolically abnormal obese ①F/χ2值
valueP值
value年龄/岁 Age/years 65.14±7.71 64.44±7.98 65.48±7.17 63.62±8.03 65.53±7.74 3.040 0.028 性别 Gender 15.557 0.001 男性 Male 598(43.05) 139(46.96) 107(33.54) 51(46.79) 301(45.26) 女性 Female 791(56.95) 157(53.04) 212(66.46) 58(53.21) 364(54.74) 文化程度 Educational level 7.549 0.056 初中及以下 Middle school or below 947(68.18) 184(63.16) 215(67.40) 76(69.72) 472(70.98) 高中及以上 High school or above 442(31.82) 112(37.84) 104(32.60) 33(30.28) 193(29.02) 地区 Area 7.511 0.057 城区 Urban 676(48.67) 164(55.41) 155(48.59) 52(47.71) 305(45.86) 郊区 Rural 713(51.33) 132(44.59) 164(51.41) 57(52.29) 360(54.14) 吸烟 Smoking 2.830 0.419 否 No 1 057(76.10) 226(76.35) 253(79.31) 83(76.15) 495(74.44) 是 Yes 332(23.90) 70(23.65) 66(20.69) 26(23.85) 170(25.56) 饮酒 Drinking 6.944 0.074 否 No 1 102(79.34) 237(80.07) 266(83.39) 79(72.48) 520(78.20) 是 Yes 287(20.66) 59(19.93) 53(16.61) 30(27.52) 145(21.80) 经常参加体育锻炼 Regular physical activity 2.555 0.465 否 No 491(35.35) 100(33.78) 107(33.54) 45(41.28) 239(35.94) 是 Yes 898(64.65) 196(66.22) 212(66.46) 64(58.72) 426(64.06) 糖尿病病程/年Years of diabetes/years 8.483 0.037 < 5 356(25.63) 75(25.34) 65(20.38) 36(33.03) 180(27.07) ≥5 1 033(74.37) 221(74.66) 254(79.62) 73(66.97) 485(72.93) BMI/(kg·m-2) 24.70±3.21 21.62±1.42 22.36±1.20 26.21±2.53 26.94±2.58 607.288 < 0.001 NC/cm 35.46±4.14 33.70±4.08 34.66±3.67 35.28±4.64 36.66±3.91 44.200 < 0.001 WC/cm 86.87±8.64 78.85±6.07 83.99±5.54 86.90±7.27 91.81±7.69 266.869 < 0.001 SBP/mmHg 130.43±13.98 123.95±13.19 131.65±13.35 123.60±10.90 133.83±13.71 45.342 < 0.001 DBP/mmHg 76.86±8.02 74.64±7.91 77.44±8.23 75.36±6.38 77.81±7.99 12.090 < 0.001 TC/(mmol·L-1) 4.73±1.19 4.75±1.14 4.80±1.23 4.71±0.99 4.69±1.22 0.637 0.591 TG/(mmol·L-1) 1.73±1.41 1.08±0.58 2.05±1.49 1.14±0.39 1.95±1.60 40.709 < 0.001 HDL-C/(mmol·L-1) 1.40±0.42 1.59±0.35 1.39±0.47 1.54±0.41 1.29±0.38 40.745 < 0.001 LDL-C/(mmol·L-1) 2.73±0.96 2.70±0.88 2.76±1.07 2.64±0.84 2.73±0.96 0.440 0.725 FPG/(mmol·L-1) 7.76±2.26 7.51±2.39 7.64±2.09 7.69±2.11 7.93±2.29 2.790 0.039 HbA1c/% 7.28±1.50 7.13±1.66 7.14±1.57 7.12±1.32 7.43±1.41 4.580 0.003 注：NC, 颈围；WC, 腰围；SBP, 收缩压；DBP, 舒张压；TC, 总胆固醇；TG, 三酰甘油；HDL-C, 高密度脂蛋白；LDL-C, 低密度脂蛋白；FPG, 空腹血糖；HbA1c, 糖化血红蛋白；1 mmHg＝0.133 kPa。
①以人数(占比/%)或x±s表示。
Note：NC, neck circumference；WC, waist circumference；SBP, systolic blood pressure；DBP, diastolic blood pressure；TC, total cholesterol；TG, triglyceride；HDL-C, high-density lipoprotein cholesterol；LDL-C, low-density lipoprotein cholesterol；FPG, fasting blood glucose；HbA1c, hemoglobinA1c；1 mmHg=0.133 kPa.
① Number of people (proportion/%) or x±s.
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表 2 不同特征社区2型糖尿病患者血糖控制情况分析
Table 2. Analysis of glycemic control in type 2 diabetic patients with different characteristics in community
变量 Variable FPG控制达标 FPG control up to standard HbA1c控制达标 HbA1c control up to standard 是 ① Yes ①
(n=624)否 ① No ①
(n=765)t/χ2值
valueP值
value是 ① Yes ①
(n=679)否 ① No ①
(n=710)t/χ2值
valueP值
value年龄/岁 Age/years 64.50±7.82 65.66±7.58 7.755 0.005 64.39±7.82 65.85±7.43 3.540 < 0.001 性别 Gender 2.906 0.088 1.253 0.263 男性 Male 253(40.54) 345(45.10) 282(41.53) 316(44.51) 女性 Female 371(59.46) 420(54.90) 397(58.47) 384(55.49) 文化程度 Educational level 4.558 0.033 7.606 0.006 初中及以下 Middle school or below 407(65.22) 540(70.59) 439(64.65) 508(71.55) 高中及以上 High school or above 217(34.78) 225(29.41) 240(35.35) 202(28.45) 地区 Area 1.238 0.281 14.570 < 0.001 城区 Urban 314(50.32) 362(47.32) 366(53.90) 310(43.66) 郊区 Rural 310(49.68) 403(52.68) 313(46.10) 400(56.34) 吸烟 Smoking 10.118 0.001 2.021 0.155 否 No 500(80.13) 557(72.81) 528(77.76) 529(74.51) 是 Yes 124(19.87) 208(27.19) 151(22.24) 181(25.49) 饮酒 Drinking 3.958 0.047 0.051 0.821 否 No 510(81.73) 592(77.39) 537(79.09) 565(79.58) 是 Yes 114(18.27) 173(22.61) 142(20.91) 145(20.42) 经常参加体育锻炼 Regular physical activity 0.075 0.785 0.318 0.573 否 No 223(35.74) 268(35.03) 235(34.61) 256(36.06) 是 Yes 401(64.26) 497(64.97) 444(65.39) 454(63.94) 糖尿病病程/年 Years of diabetes/years 44.628 < 0.001 47.357 < 0.001 < 5 214(34.29) 142(18.56) 230(33.87) 126(17.75) ≥5 410(65.71) 623(81.44) 449(66.13) 584(82.25) BMI/(kg·m-2) 24.49±3.06 24.86±3.32 2.133 0.033 24.46±2.99 24.92±3.39 2.641 0.008 NC/cm 34.99±4.52 35.84±3.76 3.838 < 0.001 34.99±4.43 35.90±3.78 4.101 < 0.001 WC/cm 86.01±8.36 87.57±8.80 3.355 0.001 86.19±8.11 87.52±9.07 2.872 0.004 SBP/mmHg 129.48±13.89 131.18±14.02 2.182 0.029 129.29±13.85 131.54±14.03 2.924 0.004 DBP/mmHg 76.71±7.69 76.98±8.28 0.614 0.539 77.14±7.86 76.58±8.17 -1.266 0.206 TC/(mmol·L-1) 4.58±1.12 4.85±1.23 4.216 < 0.001 4.71±1.11 4.75±1.26 0.679 0.497 TG/(mmol·L-1) 1.59±1.21 1.84±1.54 3.259 0.001 1.61±1.39 1.84±1.42 3.009 0.003 HDL-C/(mmol·L-1) 2.62±0.89 2.81±1.01 3.722 < 0.001 2.69±0.97 2.75±0.95 1.098 0.272 LDL-C/(mmol·L-1) 1.40±0.44 1.39±0.40 -0.431 0.666 1.43±0.47 1.36±0.36 -3.318 0.001 不同代谢类型肥胖
Different metabolic types of obesity9.889 0.020 13.244 0.004 MHNW 154(24.68) 142(18.56) 164(24.15) 132(18.59) MUHNW 146(23.40) 173(22.61) 160(23.56) 159(22.39) MHO 50(8.01) 59(7.71) 61(8.98) 48(6.76) MAO 274(43.91) 391(51.11) 294(43.30) 371(52.25) 注：NC, 颈围；WC, 腰围；SBP, 收缩压；DBP, 舒张压；TC, 总胆固醇；TG, 三酰甘油；HDL-C, 高密度脂蛋白；LDL-C, 低密度脂蛋白；FPG, 空腹血糖；HbA1c, 糖化血红蛋白；MHNW, 代谢正常体重正常；MUHNW, 代谢异常体重正常；MHO, 代谢正常超重或肥胖；MAO, 代谢异常超重或肥胖；1 mmHg＝0.133 kPa。
①以人数(占比/%)或x±s表示。
Note：NC, neck circumference；WC, waist circumference；SBP, systolic blood pressure；DBP, diastolic blood pressure；TC, total cholesterol；TG, triglyceride；HDL-C, high-density lipoprotein cholesterol；LDL-C, low-density lipoprotein cholesterol；FPG, fasting blood glucose；HbA1c, hemoglobinA1c；MHNW, metabolically healthy and normal weight；MUHNW, metabolically unhealthy but normal weight；MHO, metabolically healthy obese；MAO, metabolically abnormal obese; 1 mmHg＝0.133 kPa.
① Number of people (proportion/%) or x±s.
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表 3 南京社区2型糖尿病患者不同代谢类型肥胖与血糖控制关联性分析
Table 3. Correlation analysis of different metabolic types of obesity and glycemic control in community type 2 diabetes patients
因变量 Dependent variable 单因素 Univariate logistic single factor 多因素 Multivariate logistic multifactor OR值value (95% CI) P值value OR值value (95% CI) P值value FPG控制达标 FPG control up to standard MHNW 1.000 1.000 MUHNW 1.285(0.936~1.764) 0.121 1.220(0.880~1.692) 0.233 MHO 1.280(0.824~1.988) 0.272 1.336(0.850~2.102) 0.210 MAO 1.548(1.175~2.038) 0.002 1.525(1.148~2.025) 0.004 HbA1c控制达标 HbA1c control up to standard MHNW 1.000 1.000 MUHNW 1.235(0.899~1.696) 0.193 1.147(0.827~1.593) 0.411 MHO 0.978(0.628~1.521) 0.920 1.015(0.643~1.602) 0.905 MAO 1.568(1.190~2.065) 0.001 1.516(1.140~2.016) 0.004 注：FPG, 空腹血糖；HbA1c, 糖化血红蛋白；MHNW, 代谢正常体重正常；MUHNW, 代谢异常体重正常；MHO, 代谢正常超重或肥胖；MAO, 代谢异常超重或肥胖。
Note：FPG, fasting blood glucose；HbA1c, hemoglobinA1c; MHNW, metabolically healthy and normal weight；MUHNW, metabolically unhealthy but normal weight；MHO, metabolically healthy obese；MAO, metabolically abnormal obese.
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