Predict and Prevent Microvascular Complications of Type 2 Diabetes: A Cross-Sectional and Longitudinal Study in Chinese Communities

Zhaoxiang Liu ¹ Lianhao Zhou ² Wenhui Zhao ¹ Lixia Jin ¹ Jinping Zhang ³ Yajing Zhang ⁴ Yufeng Li ⁴ Guixia Deng ⁵ Jiquan He ⁶ Xinghua Zhao ⁷ Wenli Zheng ⁸ Yong Tian ⁹ Ji Wu ² Jianzhong Xiao ^1* Jiandong Gao ^2*

• ¹ Beijing Tsinghua Changgung Hospital, Beijing, China
• ² Department of Electronic Engineering, School of Information Science and Technology, Tsinghua University, Beijing, China
• ³ China-Japan Friendship Hospital, Beijing, Beijing Municipality, China
• ⁴ Beijing Pinggu District Hospital, Beijing, China
• ⁵ Beijing Pinggu District Yukou Community Central Health Center, beijing, China
• ⁶ Beijing Pinggu District Xiagezhuang Township Hospital, beijing, China
• ⁷ Beijing Huairou District Yangsong Township Hospital, beijing, China
• ⁸ Beijing Daxing District Yinghai Community Central Health Center, beijing, China
• ⁹ Beijing Huairou Hospital of Traditional Chinese Medicine, Beijing, China

Purpose: This study investigates the incidence, predictors, and preventive strategies for microvascular complications in type 2 diabetes patients in community settings.Methods：Data were collected from 3,008 type 2 diabetes patients enrolled across 31 clinics in Beijing and Hebei. Prevalence and incidence of diabetic kidney disease (DKD), diabetic retinopathy (DR), and diabetic peripheral neuropathy (DPN) were assessed. Predictors were identified using XGBoost and Cox regression, and the impact of lifestyle and multifactorial interventions (MFI) was analyzed.The prevalence of DKD, DR, and DPN were 39.5%, 26.2%, and 27.1%, respectively, with incidences of 74, 21, and 28 per 1000-person year. XGBoost identified that diabetes duration, age, HbA1c, FBG, triglyceride, BP, serum creatinine, proteinuria, aspirin and statin use were associated with those microvascular complications. The risk of DKD increased more rapidly as HbA1c exceeded 7.5% and decreased as blood pressure was maintained below 120/70 mmHg. Cox regression models showed that community-based intervention, including lifestyle modifications, were associated with a lower risk of DR and DPN. The study also found that higher variability in HbA1c and albumin-to-creatinine ratio (ACR) was associated with an increased risk of microvascular complications..: Community-based interventions significantly reduce the of DR and DPN, highlighting the need for individualized glycemic and BP management in primary care. The findings emphasize the importance of comprehensive management strategies to prevent the development and progression of microvascular complications in type 2 diabetes patients.