Klein Woolthuis Erwin P, de Grauw Wim J C, van Gerwen Willem Hem, van den Hoogen Henk J M, van de Lisdonk Eloy H, Metsemakers Job F M, van Weel Chris
Department of General Practice, Radboud University Nijmegen Medical Centre, Nijmegen, the Netherlands.
Fam Pract. 2007 Jun;24(3):230-6. doi: 10.1093/fampra/cmm018. Epub 2007 May 16.
Screening for type 2 diabetes is recommended in at-risk patients. The GP's electronic medical record (EMR) might be an attractive tool for identifying them.
To assess the value of the GP's EMR in identifying patients at risk for undiagnosed type 2 diabetes and the feasibility to use this information in usual care to initiate screening.
In 11 Dutch general practices (25 GPs), we performed an EMR-derived risk assessment in all patients aged > or =45 and < or =75 years, without known diabetes, identifying those at risk according to the American Diabetes Association recommendations. Patients with an EMR-derived risk or risk after additional risk assessment during regular consultation were invited for capillary fasting plasma glucose (FPG) measurement.
Of 13 581 patients, 3858 (28%) had an EMR-based risk (hypertension, cardiovascular disease, lipid metabolism disorders and/or obesity). Additional risk assessment in those without an EMR-based risk showed that in 51%, greater than one risk factor was present, mainly family history (51.2%) and obesity (59%). Ninety per cent returned for the FPG measurement. In both groups, we found patients with an FPG exceeding the cut point for diabetes (5.9% versus 4.1%).
With additional risk assessment during consultation, the GP's EMR was valuable in identifying patients at risk for undiagnosed type 2 diabetes. It was feasible to use this information to initiate screening. At-risk patients were willing to take part in screening. Better registration of family history and obesity will improve the EMR as a tool for identifying at-risk patients in opportunistic screening in general practice.
建议对高危患者进行2型糖尿病筛查。全科医生的电子病历（EMR）可能是识别这些患者的一个有吸引力的工具。
评估全科医生的电子病历在识别未诊断2型糖尿病高危患者中的价值，以及在常规医疗中利用这些信息启动筛查的可行性。
在荷兰的11家全科诊所（25名全科医生）中，我们对所有年龄≥45岁且≤75岁、无已知糖尿病的患者进行了基于电子病历的风险评估，根据美国糖尿病协会的建议识别出高危患者。邀请那些基于电子病历有风险或在定期会诊期间进行额外风险评估后有风险的患者进行空腹毛细血管血糖（FPG）测量。
在13581名患者中，3858名（28%）基于电子病历有风险（高血压、心血管疾病、脂质代谢紊乱和/或肥胖）。对那些基于电子病历无风险的患者进行的额外风险评估显示，51%的患者存在一个以上的风险因素，主要是家族史（51.2%）和肥胖（59%）。90%的患者返回进行FPG测量。在两组中，我们都发现有FPG超过糖尿病切点的患者（分别为5.9%和4.1%）。
通过会诊期间的额外风险评估，全科医生的电子病历在识别未诊断2型糖尿病高危患者方面很有价值。利用这些信息启动筛查是可行的。高危患者愿意参与筛查。更好地记录家族史和肥胖情况将改善电子病历作为全科医疗机会性筛查中识别高危患者工具的作用。
