holistic study

 holistic study

we identified some characteristics of patients that may help to improve the health of people with diabetes. The study is strengthened by a well-defined sample size, detailed study design and the use of a standardised and robust data collection method.We identified some characteristics that need to be further studied and considered. We observed a greater frequency of 'diabetes asymptomatic' in our sample. Only 27.5% of patients had symptoms of diabetes but a large number (72.5%) did not. The proportion was similar across BMI, age and glycaemic control level. The rate of patients with 'diabetes asymptomatic' was higher in males, non-smokers, and in rural, rather than urban residence, and in those with lower education level. This finding is important, since it suggests that we might need to screen for diabetes in rural, rather than urban, settings. Another characteristic that was commonly found was an earlier age at diagnosis. We found that patients who developed T2DM at age of 36 years or below had a higher glycaemic control level than those who developed T2DM after 36 years of age. This suggests that we should pay more attention to people diagnosed at a younger age in a diabetes prevention programme, and we need to develop programmes to help patients prevent diabetes from developing.Several limitations need to be considered when interpreting the results of this study. First, the cross-sectional design of this study limits the ability to make causal inferences. A major issue with the self-reporting of diabetes symptoms is recall bias. For example, patients may not recall accurately what they experienced and their perception of symptoms might have changed during the past decade. Therefore, the number of patients who developed T2DM might be underestimated and the diagnosis of diabetes could have been delayed. Second, despite efforts to ensure a large, representative sample of the population, no formal sample size calculation was performed. We tried to minimize the selection bias by using stratified random sampling method, and also performed a non-response analysis.In conclusion, we identified several characteristics of people with diabetes in Jiangsu, which may help to improve patient's health. This is the first study to examine the 'diabetes asymptomatic' rate and its characteristics in Jiangsu province. Our findings may be used to design effective intervention programmes. The proportion of 'diabetes asymptomatic' in Jiangsu seems to be high, compared with China and around the world \[[@CR22]--[@CR24]\]. In addition, these characteristics need to be further studied and considered in future studies.Publisher's Note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.We thank the investigators for their work in collecting data and all participants in the survey for their involvement. We are grateful to the National Key R&D Program of China (2016

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