Dorsey Rashida R, Songer Thomas J, Zgibor Janice C, Orchard Trevor J
Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.
Dis Manag. 2006 Apr;9(2):93-101. doi: 10.1089/dis.2006.9.93.
Screening for the long-term complications of diabetes is a critical component of diabetes management; however, evidence demonstrates that screening rates in diabetes populations are suboptimal. Our objective was to determine the use and predictors of optimal screening behavior, defined as receiving a fasting lipid test, dilated eye exam, spot urine test, foot examination, blood pressure reading, and hemoglobin A1c (HbA1c) in the previous year in a representative cohort of subjects with type 1 diabetes. Data are from the Pittsburgh Epidemiology of Diabetes Complications Study, a prospective cohort study of subjects with childhood onset type 1 diabetes. Data from 325 participants who responded to a survey during 1999-2001 were included in analyses. Reported screening rates were as follows: 87.9% had at least one HbA1c measurement in the past year, 63% had a foot exam, 73.3% had a spot urine test, 81.9% had a dilated eye exam, 93.5% had a blood pressure reading and 68.7% received a fasting lipid profile. Within this group, 37.7% of subjects reported undergoing all five tests (optimal screening). Independent correlates of optimal screening were receiving care from a specialist provider (odds ratio [OR] = 2.4; 95% confidence interval [CI]: 1.4-4.1) and blood glucose monitoring at least weekly (OR = 2.6; 95% CI: 1.1-6.2). These findings indicate that a large proportion of persons with type 1 diabetes are not being screened at the optimal level. Our data indicate that efforts to rectify this should focus on men and those who do not monitor blood glucose, and should involve primary care practitioners.
糖尿病长期并发症的筛查是糖尿病管理的关键组成部分；然而，有证据表明糖尿病患者群体的筛查率并不理想。我们的目标是确定最佳筛查行为的应用情况及预测因素，最佳筛查行为定义为在前一年接受空腹血脂检测、散瞳眼科检查、随机尿样检测、足部检查、血压测量以及糖化血红蛋白（HbA1c）检测，研究对象为1型糖尿病患者的代表性队列。数据来自匹兹堡糖尿病并发症流行病学研究，这是一项针对儿童期发病的1型糖尿病患者的前瞻性队列研究。分析纳入了1999年至2001年期间对一项调查做出回应的325名参与者的数据。报告的筛查率如下：87.9%的人在过去一年至少进行了一次HbA1c检测，63%的人进行了足部检查，73.3%的人进行了随机尿样检测，81.9%的人进行了散瞳眼科检查，93.5%的人进行了血压测量，68.7%的人接受了空腹血脂检测。在这组人群中，37.7%的受试者报告接受了所有五项检测（最佳筛查）。最佳筛查的独立相关因素是接受专科医生的治疗（优势比[OR]=2.4；95%置信区间[CI]：1.4 - 4.1）以及至少每周进行一次血糖监测（OR = 2.6；95%CI：1.1 - 6.2）。这些发现表明，很大一部分1型糖尿病患者未接受最佳水平的筛查。我们的数据表明，纠正这一情况的努力应聚焦于男性以及那些不监测血糖的人群，并且应让初级保健医生参与进来。
