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標題: | 社區第二型糖尿病流行病學初探~以社區長期追蹤世代分析 Epidemiology of Type 2 Diabetes with Community-based Longitudinal Cohort |
作者: | Bih-Tsuen Hsu 徐碧村 |
指導教授: | 陳秀熙 |
關鍵字: | 糖尿病,口服葡萄糖耐性試驗,葡萄糖耐受不良,空腹血糖異常,糖尿病前期,盛行率,發生率,危險因子, Diabetes Mellitus,Oral Glucose Tolerance test,Community-based,Impaired glucose tolerance,Impaired Fasting Glucose,pre-diabetes,prevalence,incidence,risk factor., |
出版年 : | 2011 |
學位: | 碩士 |
摘要: | 背景 國內外有關糖尿病前期進展到糖尿病的相關研究中,多為單次或二次的橫斷式調查資料,且大多為盛行率調查報告,關於發生率報告很少,且缺乏長期時間觀察結果及以社區群體為基礎的實證研究。此外,由血糖正常期進展至糖尿病盛行率資料較常見,由糖尿病前期進展至糖尿病等研究則相當少見。
研究目的 本論文擬以基隆市社區闔家歡篩檢為基礎,探討基隆市糖尿病及糖尿病前期盛行率、發生率及相關危險因子。 材料與方法 本論文的研究族群來自於參與基隆市社區闔家歡篩檢的民眾,該篩檢計畫為一整合性篩檢服務計畫,主要針對設籍基隆市年滿20歲以上的民眾提供包括癌症及慢性病篩檢,並利用結構式問卷收集生活習慣及個人病史等資料。自2000年至2009年間,共259,875人次參加社區闔家歡健康篩檢,排除未抽血者、未滿20歲及非設籍者,共有247,649人次參加篩檢,扣除重複參加次數,篩檢世代共107,501人,其中男性占39.7%,女性占60.3%,涵蓋率約37.1%。 在篩檢服務計畫中,除了利用空腹血漿血糖及個人病史確認第二型糖尿病之外,於2002~2005年針對空腹血糖介於110~125 mg/dL及2006年後100~125 mg/dL的族群轉診進行口服葡萄糖耐量試驗,並確定是糖尿病或「葡萄糖耐受性異常」(Impaired glucose tolerance ,IGT)。 不同性別、年齡別之下葡萄糖耐受性異常及糖尿病盛行率及發生率,並利用2000年世界標準人口進行年齡標準化計算。以羅吉斯迴歸模式分析糖尿病盛行的危險因子,並以卜瓦松迴歸模式分析糖尿病發生率的危險因子。此外,亦利用比例危險迴歸模式分析正常、葡萄糖耐受性異常及糖尿病的危險因子。由於口服葡萄糖耐量試驗轉介率僅約50%,因此本論文分別以Missing complete at random (MCAR)及Missing at random (MAR)的原則插補未轉介個案的疾病狀態。 結果 本計畫共計107,501人參與闔家歡篩檢計畫,取其第一次參加篩檢資料為本研究盛行率計算的分析世代,其中約52%的個案(55,983人)曾經接受重覆篩檢,為本研究發生率計算的分析世代。結果發現在2005年之前高血糖個案需轉介口服葡萄糖耐量試驗者約為4%,因2002年才開始進行轉介,轉介率40.2%,2006年之後的高血糖需轉介個案約佔12%,轉介率54.0%,平均轉介率約為50%。高血糖轉介完成的個案中,在2005年之前約有29%被確認為糖尿病、34%為葡萄糖耐受性異常,在2006年之後則分別為18%及34%。 本篩檢世代計有9,288位糖尿病盛行個案,盛行率約8.6%,男性盛行率10.1%,高於女性之7.7%,盛行率在男性及女性均隨著年齡增加而增加。經轉介OGTT 2小時血糖介於140~199 mg/dL間,診斷為IGT有567人,盛行率約0.53%,男性約0.63%,女性約0.46%。糖尿病年齡標準化盛行率於男性為7.70%,女性為6.53%,整體為6.95%;IGT年齡標準化盛行率為0.51%,女性為0.40%,整體為0.44%。以MCAR調整後,年齡標準化後的糖尿病盛行率為7.6%,男性為8.4%,女性為7.2%,IGT推估盛行率為1.3%,男性為1.4%,女性為1.2%;若以MAR調整,年齡標準化後的糖尿病盛行率為7.6%,男性為8.4%,女性為7.2%,IGT推估盛行率為1.3%,男性為1.5%,女性為1.2%。 影響糖尿病盛行率之相關因子,包括年齡(OR=1.048, 95%CI: 1.046-1.05)、男性(OR=1.06, 95%CI: 1.01-1.11)、肥胖(OR=1.20, 95%CI:1.14-1.28)、高血壓(OR=1.70, 95%CI:1.61-1.79)、嚼檳榔(OR=1.16, 95%CI:1.02-1.32)、腹部肥胖(OR=1.81, 95%CI:1.71-1.92)、高膽固醇(OR=0.79, 95%CI:0.73-0.87)、高三酸甘油酯(OR=2.40, 95%CI: 2.28-2.52)及C型肝炎(OR=1.16, 95%CI:1.04-1.30)等因子,在互相調整後仍與糖尿病有顯著相關,但除高膽固醇與糖尿病在多變量分析中呈現負相關外,其餘因子皆與糖尿病呈正相關。以比例危險迴歸分析影響糖尿病盛行率之相關因子,其結果與羅吉斯迴歸分析結果差異不大。 發生率方面,基隆市20歲以上民眾糖尿病發生率約為1.58%,其中男性發生率2.01%高於女性1.37%,男性糖尿病標準化發生率為1.295%,女性糖尿病標準化發生率為0.983%,整體而言,基隆市社區糖尿病標準化發生率為1.087%,不論何種年齡層男性糖尿病發生率皆高於女性。進一步分析篩檢世代追蹤年間各組糖尿病發生率,由正常血糖值進展至IGT發生率約0.83%,男性0.97%高於女性0.76%;由正常血糖值進展至糖尿病發生率約1.33%,男性1.72%高於女性1.14%;以上發生率均隨年齡增加而增加。由IGT進展至糖尿病發生率約17.46%,男性17.00%略低於女性17.78%,值得注意的是IGT返回正常血糖值發生率高達35.28%。 影響糖尿病發生率之相關因子,包括年齡(RR=1.035, 95%CI: 1.032-1.038)、肥胖(RR=1.57, 95%CI: 1.45-1.71)、高血壓(RR=1.46, 95%CI: 1.36-1.57)、吸菸(RR=1.16, 95%CI: 1.06-1.28)、嚼檳榔(RR=1.31, 95%CI:1.07-1.60)、腹部肥胖(1.75, 95%CI: 1.61-1.91)、高膽固醇(RR=1.28, 95%CI: 1.11-1.48)、高三酸甘油酯(RR=1.80, 95%CI: 1.67-1.93)、C型肝炎(RR=1.27, 95%CI: 1.08-1.49)等因子,在相互調整後皆為糖尿病危險因子。 結論 本研究為全世界少數以族群為主的大規模糖尿病流行病學世代追蹤研究,所提供社區糖尿病及糖尿病前期之盛行及發生訊息,相當重要且可貴,藉由本研究的重要發現,能進一步幫助臨床及公共衛生決策者,在制訂糖尿病防治策略時,有此實證資料以為參考之依據。 Background: Type 2 diabetes and its associated complications are major contributions to deaths in developed countries. It also causes serious medical burden in society. Therefore, the understanding of the epidemiological profile of type 2 diabetes plays important role in medical source allocation and planning. There is lacking long-term longitudinal and community-based study in the literatures. The aim of the current study was to investigate the prevalence, incidence, and risk factors for type 2 diabetes based on Keelung Community-based Integrated Screening (KCIS). Materials and Methods: The study population was from the attendee of KCIS, which targeted at residents in Keelung and aged 20 years or above with screening for three chronic diseases and five cancers. In addition to biochemical examination, information of life style, personal history, and family history were collected with a structured questionnaire. A total of 259,875 visits were made by 107,501 subjects between 2000 and 2009 (Male 39.7%, Female: 60.3%), covering 37.1% population aged 20 years and above in Keelung. In the KCIS program, type 2 diabetes was ascertained with fasting glucose >=126 mg/dl or self-report. In addition, for those with elevated fasting glucose but not reached the level of type 2 diabetes (110-125 mg/dl before 2005 and 100-125 mg/dl after 2006) were referred for OGTT (Oral Glucose Tolerance test) to identify cases of IGT (Impaired glucose tolerance) or type 2 diabetes. This thesis reports the age- and gender-specific prevalence and incidence of IGT and type 2 diabetes. Age-standardized figures were calculated in the light of 2000 World standard population. Logistic regression models and Poisson regression model were used to identify risk factors for the prevalence and the incidence of type 2 diabetes, respectively. Proportional odds models were used to identify risk factors for IGT and type 2 diabetes treating as different disease status simultaneously. Missing complete at random and missing at random were applied to implement the missing values of disease status for those refusing OGTT referral. Results: Among the 107,501 subjects in the KCIS program, 52% received more than one screening. The were 4% needed to refer for OGTT before 2005, and 12% after 2006. The referral rates were 40.2% before 2005 and 54.0% after 2006. The proportions of IGT and type 2 diabetes among those referred were 34% and 29% before 2005 and 34% and 18% after 2006. In Keelung, the crude prevalence of type 2 diabetes was 8.6% (male: 10.1%, female 7.7%), increasing with advancing age. The age-standardized figure was 6.95% (7.7% for male and 6.53 for female). For IGT, the age-standardized figure was 0.51% (male 0.51%, female 0.40%). With adjustment in the light of MCAR method, the age standardized prevalence was 7.6% for type 2 diabetes, and 1.3% for IGT. The figures were similar with adjustment in the light of MAR method. Significant risk factors affecting prevalence of type 2 diabetes included age (OR=1.048, 95%CI: 1.046-1.05), male(OR=1.06, 95%CI: 1.01-1.11), elevated BMI(OR=1.20, 95%CI:1.14-1.28), hypertension(OR=1.70, 95%CI:1.61-1.79), betel quid chewing (OR=1.16, 95%CI:1.02-1.32), central obesity (OR=1.81, 95%CI:1.71-1.92), elevated cholesterol (OR=0.79, 95%CI:0.73-0.87), elevated triglyceride(OR=2.40, 95%CI: 2.28-2.52), and anti-HCV(OR=1.16, 95%CI:1.04-1.30) in the multivariate logistic regression model. The proportional odds model found similar risk factors for IGT and type 2 diabetes. The crude incidence for type 2 diabetes was 1.58% (male: 2.01%, female: 1.37%). The standardized incidence for type 2 diabetes was 1.087% (male 1.295%, female: 0.983). The transition rate was 0.83% from normal to IGT, 1.33% from normal to type 2 diabetes, 17.46% from IGT to type 2 diabetes, but as high as up to 35% for regression from IGT to normal. Factors affecting the incidence of type 2 diabetes include age(RR=1.035, 95%CI: 1.032-1.038), elevated BMI (RR=1.57, 95%CI: 1.45-1.71), hypertension (RR=1.46, 95%CI: 1.36-1.57), smoking (RR=1.16, 95%CI: 1.06-1.28), betel quid chewing (RR=1.31, 95%CI:1.07-1.60), central obesity (1.75, 95%CI: 1.61-1.91), elevated cholesterol (RR=1.28, 95%CI: 1.11-1.48), elevated triglyceride (RR=1.80, 95%CI: 1.67-1.93), anti HCV (RR=1.27, 95%CI: 1.08-1.49) in the multivariable Poisson regression model. Conclusion: This study is one of the few studies investigating the epidemiological profile for incidence and prevalence of type 2 diabetes with longitudinal and community-based study. The results of study are anticipated to aid public health decision-makers. |
URI: | http://tdr.lib.ntu.edu.tw/jspui/handle/123456789/48347 |
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