喀拉拉邦社区筛查项目中2型糖尿病并发症的患病率及决定因素
Prevalence and determinants of complications of type 2 diabetes in a community screening program in Kerala.
作者信息
Sreedevi Aswathy, Pillai Gopal S, Sathish Syama, Numpeli Mathews, Menon Vishnu B, Varughese Steffi A, Georgy Sneha, Najeeb Shana Shirin, Selvam Sumithra, Menon Jaideep C, Ajay Aparna, Mohandas Neeraj V, Nair Rajeesh R, Rijju Vineetha, Radhakrishnan Revathy Krishnan, Nair Prem
机构信息
Department of Community Medicine, Amrita Institute of Medical Sciences, Kochi, Kerala, India.
Harvard T H Chan School of Public Health, Boston, Massachusetts, USA.
出版信息
BMJ Public Health. 2025 May 19;3(1):e002333. doi: 10.1136/bmjph-2024-002333. eCollection 2025.
INTRODUCTION
This study aims to estimate the prevalence and identify the determinants of peripheral neuropathy (PN), retinopathy and peripheral arterial disease (PAD) among persons with type two diabetes mellitus.
METHODS
A cross-sectional study with a two-stage cluster sampling was conducted in Kerala in 33 clusters among individuals with type 2 diabetes. The first 85-90 participants who visited the camp with a duration of diabetes of more than a year were enrolled in the study from 33 camps. Thus, a total of 3083 persons with diabetes were enrolled. Mixed effects logistic regression was used to find the factors associated with diabetic retinopathy (DR), PN and PAD.
RESULTS
The prevalence of PN, DR and PAD was found to be 48.5% (95% CI 46.74 to 50.26), 28.9% (95% CI 27.36 to 30.56) and 46.3% (95% CI 42.65 to 49.95) respectively. Increased risk of PN was observed among participants with age >60 years (aOR 1.71; 95% CI 1.41 to 2.03), diabetes duration >15 years (aOR 1.88; 95% CI 1.04 to 3.38), unsatisfactory glycosylated haemoglobin (HbA1c) (aOR 1.29, 95% CI 1.05 to 1.61) and unemployment (aOR 1.3, 95% CI 1.09 to 1.59). Women appeared to have a lower risk of 0.68 (95% CI 0.50 to 0.92) compared with men. PAD was higher among those from urban areas (aOR 1.56, 95% CI 1.08 to 2.27). The independent determinants of retinopathy were increasing duration of diabetes from 1.4 (95% CI 1.01 to 1.97) at 6-10 years to 3.58 (95% CI 2.48 to 5.15) more than 15 years and an unsatisfactory HbA1c had a two times (95% CI 1.50, 2.67) higher risk of retinopathy.
CONCLUSION
There is a high prevalence of peripheral vascular disease, PN and retinopathy in Kerala. Retinopathy is more likely with longer duration of type two diabetes and high HbA1c levels. Older age and longer diabetes duration increase the risk of neuropathy, while PAD is more common in urban areas. This highlights the need to include regular screening through the public health system.
引言
本研究旨在估计2型糖尿病患者周围神经病变（PN）、视网膜病变和外周动脉疾病（PAD）的患病率，并确定其决定因素。
方法
2017年在喀拉拉邦进行了一项采用两阶段整群抽样的横断面研究，研究对象为33个整群中的2型糖尿病患者。从33个营地中，选取糖尿病病程超过1年且最先前来营地就诊的85 - 90名参与者纳入研究。因此，共纳入3083名糖尿病患者。采用混合效应逻辑回归分析来确定与糖尿病视网膜病变（DR）、PN和PAD相关的因素。
结果
PN、DR和PAD的患病率分别为48.5%（95%置信区间46.74至50.26）、28.9%（95%置信区间27.36至30.56）和46.3%（95%置信区间42.65至49.95）。年龄>60岁的参与者（调整后比值比1.71；95%置信区间1.41至2.03）、糖尿病病程>15年的参与者（调整后比值比1.88；95%置信区间1.04至3.38）、糖化血红蛋白（HbA1c）控制不佳的参与者（调整后比值比1.29，95%置信区间1.05至1.61）以及失业者（调整后比值比1.3，95%置信区间1.09至1.59）发生PN的风险增加。女性发生PN的风险似乎低于男性，为0.68（95%置信区间0.50至0.92）。城市地区的参与者发生PAD的风险更高（调整后比值比1.56，95%置信区间1.08至2.27）。视网膜病变的独立决定因素包括糖尿病病程从6 - 10年时的1.4（95%置信区间1.01至1.97）增加到超过15年时的3.58（95%置信区间2.48至5.15），以及HbA1c控制不佳会使视网膜病变风险增加两倍（95%置信区间1.50，2.67）。
结论
喀拉拉邦外周血管疾病、PN和视网膜病变的患病率较高。2型糖尿病病程较长且HbA1c水平较高时更易发生视网膜病变。年龄较大和糖尿病病程较长会增加神经病变的风险，而PAD在城市地区更为常见。这凸显了通过公共卫生系统进行定期筛查的必要性。
Zotero 插件