Department of Medicine, University of Wisconsin School of Medicine and Public Health, 600 Highland Ave, H6/169, Madison, WI 53792, USA.
Mayo Clin Proc. 2010 Jan;85(1):27-35. doi: 10.4065/mcp.2009.0289.
To compare the case-finding ability of current national guidelines for screening diabetes mellitus and characterize factors that affect testing practices in an ambulatory population.
In this retrospective analysis, we reviewed a database of 46,991 nondiabetic patients aged 20 years and older who were seen at a large Midwestern academic physician practice from January 1, 2005, through December 31, 2007. Patients were included in the sample if they were currently being treated by the physician group according to Wisconsin Collaborative for Healthcare Quality criteria. Pregnant patients, diabetic patients, and patients who died during the study years were excluded. The prevalence of patients who met the American Diabetes Association (ADA) and/or US Preventive Services Task Force (USPSTF) criteria for diabetes screening, percentage of these patients screened, and number of new diabetes diagnoses per guideline were evaluated. Screening rates were assessed by number of high-risk factors, primary care specialty, and insurance status.
A total of 33,823 (72.0%) of 46,991 patients met either the ADA or the USPSTF screening criteria, and 28,842 (85.3%) of the eligible patients were tested. More patients met the ADA criteria than the 2008 USPSTF criteria (30,790 [65.5%] vs 12,054 [25.6%]), and the 2008 USPSTF guidelines resulted in 460 fewer diagnoses of diabetes (33.1%). By single high-risk factor, prediabetes (15.8%) and polycystic ovarian syndrome (12.6%) produced the highest rates of diagnosis. The number of ADA high-risk factors predicted diabetes, with 6 (23%) of 26 patients with 6 risk factors diagnosed as having diabetes. Uninsured patients were tested significantly less often than insured patients (54.9% vs 85.4%).
Compared with the ADA recommendations, the new USPSTF guidelines result in a lower number of patients eligible for screening and decrease case finding significantly. The number and type of risk factors predict diabetes, and lack of health insurance decreases testing.
比较现行国家糖尿病筛查指南的病例发现能力，并描述影响门诊人群检测实践的因素。
在这项回顾性分析中，我们对 2005 年 1 月 1 日至 2007 年 12 月 31 日期间在中西部一家大型学术医师诊所就诊的 46991 例非糖尿病患者的数据库进行了回顾。如果患者符合威斯康星州合作医疗质量标准，且正在由医师组进行治疗，则将其纳入样本。排除妊娠患者、糖尿病患者和研究期间死亡的患者。评估符合美国糖尿病协会（ADA）和/或美国预防服务工作组（USPSTF）糖尿病筛查标准的患者比例、筛查这些患者的比例以及符合每个指南的新诊断糖尿病患者人数。通过高危因素数量、初级保健专业和保险状况评估筛查率。
共有 33823 例（72.0%）患者符合 ADA 或 USPSTF 的筛查标准，其中 28842 例（85.3%）符合条件的患者接受了检测。符合 ADA 标准的患者多于符合 2008 年 USPSTF 标准的患者（30790[65.5%]比 12054[25.6%]），2008 年 USPSTF 指南减少了 460 例糖尿病诊断（33.1%）。按单一高危因素计算，前驱糖尿病（15.8%）和多囊卵巢综合征（12.6%）的诊断率最高。ADA 高危因素的数量预测糖尿病，6 个风险因素的 26 例患者中有 6 例被诊断为糖尿病（23%）。未参保患者的检测频率明显低于参保患者（54.9%比 85.4%）。
与 ADA 建议相比，新的 USPSTF 指南导致符合筛查条件的患者人数减少，且显著降低病例发现率。危险因素的数量和类型预测糖尿病，而缺乏健康保险则会降低检测率。
