爱尔兰全科医疗中的糖尿病检测项目。

Irish diabetes detection programme in general practice.

作者信息

Smith S M, Holohan J, McAuliffe A, Firth R G

机构信息

UCD Department of Community Health and General Practice, Trinity College Dublin, Dublin, Ireland.

出版信息

Diabet Med. 2003 Sep;20(9):717-22. doi: 10.1046/j.1464-5491.2003.00998.x.

DOI:10.1046/j.1464-5491.2003.00998.x

PMID:12925050

Abstract

OBJECTIVES

To assess the prevalence of undiagnosed diabetes, impaired fasting glucose (IFG) and impaired glucose tolerance (IGT) in patients over the age of 40 years attending their general practitioner (GP) in Ireland, through opportunistic screening, using a three-step screening tool involving self-determined high-risk groups, random venous plasma glucose (RVPG) measurement and oral glucose tolerance tests.

DESIGN

In participating general practices, 100 consecutive patients > 40 years, completed a screening questionnaire relating to diabetes-related symptoms and risk factors. Patients with previously diagnosed diabetes were not excluded from the study and the screening instrument included a question about known diabetes. Patients without known diabetes mellitus (DM) and with at least two risk factors and/or symptoms underwent a RVPG test. Those with an RVPG above 5.5 mmol/l underwent an oral glucose tolerance test.

RESULTS

Forty-one practices returned 3821 questionnaires. The prevalence of Type 2 diabetes mellitus in the study population was 9.2% (353), of whom 23.5% (83) were previously undiagnosed. DM was detected on the basis of an RVPG >11.1 mmol/l in 0.8% (32) of the studied population. DM was detected on the basis of the oral glucose tolerance test in 1.3% (51) of the population. One per cent (39) had a fasting plasma glucose (FPG) > or = 7.0 mmol/l, 0.6% (24) had a 2-h >11.0 mmol/l and 0.3% (12) had both. Diabetes would not have been detected in 12 people had the 2-h test been omitted. The prevalence rate for IFG and/or IGT was 3.9% (148). Of the 103 patients with IGT, 83 (81%) would have been missed had the GTT been omitted.

CONCLUSION

Opportunistic diabetes screening in general practice using a screening questionnaire followed by RVPG testing and GTT for those above 5.5 mmol/l is feasible, with a high participation rate. The use of GTTs rather than fasting glucose testing alone improves patient identification, in particular those with IGT who are at higher cardiovascular risk.

摘要

目的

通过机会性筛查，使用一种三步筛查工具，包括自我确定的高危人群、随机静脉血浆葡萄糖（RVPG）测量和口服葡萄糖耐量试验，评估爱尔兰40岁以上就诊于全科医生（GP）的患者中未诊断糖尿病、空腹血糖受损（IFG）和糖耐量受损（IGT）的患病率。

设计

在参与的全科诊所中，100名连续的40岁以上患者完成了一份与糖尿病相关症状和风险因素有关的筛查问卷。既往诊断为糖尿病的患者不排除在研究之外，筛查工具包括一个关于已知糖尿病的问题。无已知糖尿病（DM）且至少有两个风险因素和/或症状的患者接受RVPG测试。RVPG高于5.5 mmol/l的患者接受口服葡萄糖耐量试验。

结果

41家诊所返回了3821份问卷。研究人群中2型糖尿病的患病率为9.2%（353例），其中23.5%（83例）既往未被诊断。在0.8%（32例）的研究人群中，基于RVPG>11.1 mmol/l检测到糖尿病。在1.3%（51例）的人群中，基于口服葡萄糖耐量试验检测到糖尿病。1%（39例）的空腹血糖（FPG）≥7.0 mmol/l，0.6%（24例）的2小时血糖>11.0 mmol/l，0.3%（12例）两者兼有。如果省略2小时测试，12人将无法检测出糖尿病。IFG和/或IGT的患病率为3.9%（148例）。在103例IGT患者中，如果省略葡萄糖耐量试验（GTT），83例（81%）将被漏诊。