Department of Family and Community Medicine, University of Toronto, Ontario, Canada.
BMC Fam Pract. 2011 Aug 24;12:91. doi: 10.1186/1471-2296-12-91.
In January 2010, the American Diabetes Association recommended the use of hemoglobin A1c (Hgb A1c) to screen and diagnose diabetes. This study explored the prevalence and clinical context of Hgb A1c tests done for non-diabetic primary care patients for the three years prior to the release of the new guidelines. We sought to determine the provision of tests in non-diabetic patients age 19 or over, patients age 45 and over (eligible for routine diabetes screening), the annual change in the rate of this screening test, and the patient characteristics associated with the provision of Hgb A1c screening.
We conducted a retrospective study using data routinely collected in Electronic Medical Records. The participants were thirteen community-based family physicians in Toronto, Ontario. We calculated the proportion of non diabetic patients who had at least one Hbg A1c done in three years. We used logistic generalized estimating equation with year treated as a continuous variable to test for a non-zero slope in yearly Hbg A1c provision. We modelled screening using multivariable logistic regression.
There were 11,792 non-diabetic adults. Of these, 1,678 (14.2%; 95%CI 13.6%-14.9%) had at least one Hgb A1c test done; this was higher for patients 45 years of age or older (20.2%; 95% CI 19.3% - 21.2%). The proportion of non-diabetic patients with an A1c test increased from 5.2% in 2007 to 8.8% in 2009 (p < 0.0001 for presence of slope). Factors associated with significantly greater adjusted odds ratios of having the test done included increasing diastolic blood pressure, increasing fasting glucose, increasing body mass index, increasing age, as well as male gender and presence of hypertension, but not smoking status or LDL cholesterol. Patients living in the highest income quintile neighbourhoods had significantly lower odds ratios of having this test done than those in the lowest quintile (p < 0.001).
A large and increasing proportion of the non-diabetic patients we studied have had an Hgb A1c for screening prior to guidelines recommending the test for this purpose. Several risk factors for cardiovascular disease or diabetes were associated with the provision of the Hgb A1c. Early uptake of the test may represent appropriate utilization.
2010 年 1 月，美国糖尿病协会建议使用糖化血红蛋白（Hgb A1c）筛查和诊断糖尿病。本研究探讨了新指南发布前三年中，对非糖尿病初级保健患者进行 Hgb A1c 检测的流行情况和临床背景。我们旨在确定 19 岁及以上非糖尿病患者、45 岁及以上（有常规糖尿病筛查资格）患者接受检查的情况、这种筛查检测的年度变化率以及与 Hgb A1c 筛查提供相关的患者特征。
我们使用电子病历中常规收集的数据进行回顾性研究。参与者是安大略省多伦多的 13 位社区家庭医生。我们计算了三年内至少进行一次 Hbg A1c 检测的非糖尿病患者比例。我们使用对数广义估计方程，将年份作为连续变量进行检验，以测试每年 Hbg A1c 检测率是否为零斜率。我们使用多变量逻辑回归模型进行筛查。
有 11792 名非糖尿病成年人。其中，1678 人（14.2%；95%CI 13.6%-14.9%）至少进行了一次 Hgb A1c 检测；45 岁及以上患者的检测率更高（20.2%；95%CI 19.3%-21.2%）。非糖尿病患者中进行 A1c 检测的比例从 2007 年的 5.2%增加到 2009 年的 8.8%（存在斜率时 p<0.0001）。与检测显著相关的调整后比值比更高的因素包括舒张压升高、空腹血糖升高、体重指数升高、年龄增长，以及男性和高血压，但与吸烟状况或 LDL 胆固醇无关。居住在收入最高五分位数街区的患者进行该检测的可能性显著低于收入最低五分位数街区的患者（p<0.001）。
我们研究的非糖尿病患者中，进行 Hgb A1c 检测以筛查疾病的比例很大且不断增加，这一比例超过了新指南建议用于该目的的检测比例。心血管疾病或糖尿病的一些危险因素与 Hgb A1c 的提供有关。该检测的早期采用可能代表了适当的利用。
