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南京市社区2型糖尿病患者不同代谢类型肥胖及血糖控制相关性分析

王琛琛 许昊 陈一佳 周海茸 孙倩男 洪忻 周楠

王琛琛, 许昊, 陈一佳, 周海茸, 孙倩男, 洪忻, 周楠. 南京市社区2型糖尿病患者不同代谢类型肥胖及血糖控制相关性分析[J]. 中华疾病控制杂志, 2024, 28(2): 176-182. doi: 10.16462/j.cnki.zhjbkz.2024.02.008
引用本文: 王琛琛, 许昊, 陈一佳, 周海茸, 孙倩男, 洪忻, 周楠. 南京市社区2型糖尿病患者不同代谢类型肥胖及血糖控制相关性分析[J]. 中华疾病控制杂志, 2024, 28(2): 176-182. doi: 10.16462/j.cnki.zhjbkz.2024.02.008
WANG Chenchen, XU Hao, CHEN Yijia, ZHOU Hairong, SUN Qiannan, HONG Xin, ZHOU Nan. Association between different metabolic types of obesity and glycemic control among community type 2 diabetes patients in Nanjing[J]. CHINESE JOURNAL OF DISEASE CONTROL & PREVENTION, 2024, 28(2): 176-182. doi: 10.16462/j.cnki.zhjbkz.2024.02.008
Citation: WANG Chenchen, XU Hao, CHEN Yijia, ZHOU Hairong, SUN Qiannan, HONG Xin, ZHOU Nan. Association between different metabolic types of obesity and glycemic control among community type 2 diabetes patients in Nanjing[J]. CHINESE JOURNAL OF DISEASE CONTROL & PREVENTION, 2024, 28(2): 176-182. doi: 10.16462/j.cnki.zhjbkz.2024.02.008

南京市社区2型糖尿病患者不同代谢类型肥胖及血糖控制相关性分析

doi: 10.16462/j.cnki.zhjbkz.2024.02.008
基金项目: 

南京市医学科技发展项目 ZKX20045

详细信息
    通讯作者:

    周楠,E-mail:nj_zhounan@126.com

    洪忻,E-mail:nj_hongxin@126.com

  • 中图分类号: R181.2

Association between different metabolic types of obesity and glycemic control among community type 2 diabetes patients in Nanjing

Funds: 

Nanjing Medical Science and Technology Development Project ZKX20045

More Information
  • 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。
  • 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
    Total
    体重正常代谢正常
    Metabolically healthy and normal weight
    体重正常代谢异常
    Metabolically unhealthy but normal weight
    代谢正常性肥胖
    Metabolically healthy obese
    代谢异常性肥胖
    Metabolically abnormal obese
    F2
    value
    P
    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.
    下载: 导出CSV

    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
    Yes 
    (n=624)
    No 
    (n=765)
    t2
    value
    P
    value
      Yes
    (n=679)
      No
    (n=710)
    t2
    value
    P
    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 obesity
    9.889 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.
    下载: 导出CSV

    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.
    下载: 导出CSV
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出版历程
  • 收稿日期:  2023-07-28
  • 修回日期:  2023-10-20
  • 网络出版日期:  2024-03-30
  • 刊出日期:  2024-02-10

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