Kahn Henry S, Cheng Yiling J, Thompson Theodore J, Imperatore Giuseppina, Gregg Edward W
Centers for Disease Control and Prevention, 4770 Buford Highway Northeast, Atlanta, GA 30341, USA.
Ann Intern Med. 2009 Jun 2;150(11):741-51. doi: 10.7326/0003-4819-150-11-200906020-00002.
Simple prediction scores could help identify adults at high risk for diabetes.
To derive and validate scoring systems by using longitudinal data from a study that repeatedly tested for incident diabetes.
Prospective cohort, divided into derivation and validation samples.
The ARIC (Atherosclerosis Risk in Communities) study, which followed participants for 14.9 years beginning in 1987 to 1989.
12 729 U.S. adults (baseline age, 45 to 64 years; 22.8% black). Follow-up was 96.1% at 5 years and 72.2% at 10 years.
Anthropometry, blood pressure, and pulse (basic system) plus a fasting blood specimen assayed for common analytes (enhanced system). Diabetes was identified in 18.9% of participants. Risk score integer points were derived from proportional hazard coefficients associated with baseline categorical variables and quintiles of continuous variables.
The basic scoring system included waist circumference (10 to 35 points); maternal diabetes (13 points); hypertension (11 points); and paternal diabetes, short stature, black race, age 55 years or older, increased weight, rapid pulse, and smoking history (< or =8 points each). The enhanced system included glucose (6 to 28 points); waist circumference (5 to 21 points); maternal diabetes (8 points); and triglycerides, black race, paternal diabetes, low high-density lipoprotein cholesterol concentration, short stature, high uric acid, age 55 years or older, hypertension, rapid pulse, and nonuse of alcohol (< or =7 points each). When applied to the validation sample, ascending quintiles of the basic system were associated with a 10-year incidence of diabetes of 5.3%, 8.7%, 15.5%, 24.5%, and 33.0%, respectively. Quintiles of the enhanced system were associated with a 10-year incidence of 3.5%, 6.4%, 11.5%, 19.3%, and 46.1%.
The risk scoring systems had no question regarding previous gestational diabetes, and knowledge of parental diabetes may be uncertain. The analyzed cohort was restricted by age and race; the systems may be less effective in other samples.
Basic information identified adults at high risk for diabetes. Additional data from fasting blood tests better identified those at extreme risk.
简单的预测评分有助于识别糖尿病高危成年人。
利用一项对新发糖尿病进行反复检测的研究中的纵向数据推导并验证评分系统。
前瞻性队列研究，分为推导样本和验证样本。
社区动脉粥样硬化风险（ARIC）研究，该研究从1987年至1989年开始对参与者进行了14.9年的随访。
12729名美国成年人（基线年龄45至64岁；22.8%为黑人）。5年随访率为96.1%，10年随访率为72.2%。
人体测量学指标、血压和脉搏（基本系统）加上一份用于检测常见分析物的空腹血标本（增强系统）。18.9%的参与者被确诊患有糖尿病。风险评分整数分来自与基线分类变量及连续变量五分位数相关的比例风险系数。
基本评分系统包括腰围（10至35分）；母亲患糖尿病（13分）；高血压（11分）；以及父亲患糖尿病、身材矮小、黑人种族、年龄55岁及以上、体重增加、脉搏快和吸烟史（每项≤8分）。增强系统包括血糖（6至28分）；腰围（5至21分）；母亲患糖尿病（8分）；以及甘油三酯、黑人种族、父亲患糖尿病、高密度脂蛋白胆固醇浓度低、身材矮小、高尿酸、年龄55岁及以上、高血压、脉搏快和不饮酒（每项≤7分）。应用于验证样本时，基本系统五分位数对应的糖尿病10年发病率分别为5.3%、8.7%、15.5%、24.5%和33.0%。增强系统五分位数对应的糖尿病10年发病率分别为3.5%、6.4%、11.5%、19.3%和46.1%。
风险评分系统未涉及既往妊娠糖尿病情况，且父母患糖尿病的信息可能不准确。分析的队列受年龄和种族限制；该系统在其他样本中可能效果较差。
基本信息可识别糖尿病高危成年人。空腹血检的额外数据能更好地识别极高危人群。
