Adam Fabiola M S, Adam John M F, Pandeleki Nelson, Mappangara Idar
Indonesian Christian University General Hospital, Department of Internal Medicine, Medical Faculty Hasanuddin University, Makassar.
Acta Med Indones. 2006 Apr-Jun;38(2):67-71.
To compare the results between population-based and office-based diabetes screening.
In 1997, a population-based screening was performed on a group of government employees and retired subjects in the Makassar Municipality. Since the year 2000, we performed screening at the clinic. For clinical-based screening, we focused the screening on those with high risks for developing diabetes mellitus, i.e. all subjects aged > or =45 or those aged < 45 with one or more of the following abnormalities: obese (BMI > 25 kg/m2), elevated blood pressure (> or =140/90 mmHg in adults), family history of diabetes, previous identified IFG or IGT, HDL-cholesterol < or =35 mg/dl and/or triglyceride > or =250 mg/dL, and history of gestational diabetes mellitus or delivery of babies > or =4000 gram. For population-based screening, the criteria for diabetes mellitus was based on a single test 2-hours post load (75 gram glucose), while for office-based screening, the WHO l999 was used i.e. fasting and 2-hours post 75 gram glucose load (OGTT).
During the screening in the population, 941 subjects were screened, 290 women and 651 men. There were 51 diabetic subjects, or a prevalence of 5.42%, 21 women or 7.24% of all women, and 30 men or 4.60% of all men. At the clinical setting, 907 were screened, 483 women and 424 men. Among these subjects, 155 fulfilled the diabetes criteria, with a prevalence of 17.1%. There were 78 diabetic women or 16.1% of all women, and 77 men or 18.2% of all men. If the diagnosis of diabetes mellitus in the clinical setting is based only on 2 hours post load (the same as for population-based) only 70 patients can be detected, for a prevalence of 7.7%, which is still higher compared to the results of the population-based screening. All figures obtained from the office-based screening were higher as compared to the population-based results.
These results show that office-based screening detected more asymptomatic diabetes compared to population-based screening. It is suggested that early detection of asymptomatic diabetes is performed at the clinic, either at the hospital or doctor's private office.
比较基于人群的糖尿病筛查和基于门诊的糖尿病筛查的结果。
1997年，对望加锡市的一组政府雇员和退休人员进行了基于人群的筛查。自2000年起，我们在诊所进行筛查。对于基于临床的筛查，我们将筛查重点放在有患糖尿病高风险的人群上，即所有年龄≥45岁的受试者，或年龄<45岁但有以下一种或多种异常情况的受试者：肥胖（体重指数>25kg/m²）、血压升高（成年人收缩压≥140/90mmHg）、糖尿病家族史、既往确诊的空腹血糖受损（IFG）或糖耐量受损（IGT）、高密度脂蛋白胆固醇≤35mg/dl和/或甘油三酯≥250mg/dL，以及妊娠糖尿病史或分娩体重≥4000克的婴儿。对于基于人群的筛查，糖尿病的诊断标准基于单次负荷后2小时（75克葡萄糖）检测结果，而对于基于门诊的筛查，则采用世界卫生组织1999年的标准，即空腹及75克葡萄糖负荷后2小时（口服葡萄糖耐量试验，OGTT）。
在人群筛查期间，共筛查了941名受试者，其中女性290名，男性651名。有51名糖尿病患者，患病率为5.42%，其中女性21名，占所有女性的7.24%，男性30名，占所有男性的4.60%。在临床环境下筛查了907名受试者，其中女性483名，男性424名。在这些受试者中，有155名符合糖尿病标准，患病率为17.1%。其中糖尿病女性78名，占所有女性的16.1%，男性77名，占所有男性的18.2%。如果在临床环境中糖尿病的诊断仅基于负荷后2小时（与基于人群的筛查相同），则只能检测到70名患者，患病率为7.7%，这仍高于基于人群的筛查结果。与基于人群的筛查结果相比，基于门诊的筛查所获得的所有数据都更高。
这些结果表明，与基于人群的筛查相比，基于门诊的筛查能检测出更多无症状糖尿病患者。建议在医院或医生私人诊所的临床环境中对无症状糖尿病进行早期检测。
