Department of Primary and Community Care, Centre for Family Medicine, Geriatric Care and Public Health, Radboud University Nijmegen Medical Centre, The Netherlands.
Ann Fam Med. 2013 Jan-Feb;11(1):20-7. doi: 10.1370/afm.1460.
Screening guidelines for type 2 diabetes recommend targeting high-risk individuals. Our objective was to assess whether diagnosis of type 2 diabetes based on opportunistic targeted screening results in lower vascular event rates compared with diagnosis on the basis of clinical signs or symptoms.
In a prospective, nonrandomized, observational study, we enrolled patients aged 45 to 75 years from 10 family practices in the Netherlands with a new diagnosis of type 2 diabetes, detected either by (1) opportunistic targeted screening (n = 359) or (2) clinical signs or symptoms (n = 206). Patients in both groups received the same guideline-concordant diabetes care. The main group outcome measure was a composite of death from cardiovascular disease (CVD), nonfatal myocardial infarction, and nonfatal stroke.
Baseline vascular disease was more prevalent in the opportunistic targeted screening group, mainly ischemic heart disease (12.3% vs 3.9%, P = .001) and nephropathy (16.9% vs 7.1%, P = .002). After a mean follow-up of 7.7 years (SD = 2.4 years) and 7.1 years (SD = 2.7 years) for the opportunistic targeted screening and clinical diagnosis groups, respectively, composite primary event rates did not differ significantly between the 2 groups (9.5% vs 10.2%, P = .78; adjusted hazard ratio 0.67, 95% confidence interval, 0.36-1.25; P = .21). There were also no significant differences in the separate event rates of deaths from CVD, nonfatal myocardial infarction, and nonfatal strokes.
Opportunistic targeted screening for type 2 diabetes detected patients with higher CVD morbidity at baseline when compared with clinical diagnosis but showed similar CVD mortality and major CVD morbidity after 7.7 years. Opportunistic targeted screening and guided care appears to improve vascular outcomes in type 2 diabetes in primary care.
2 型糖尿病的筛查指南建议针对高危人群。我们的目的是评估基于机会性靶向筛查的 2 型糖尿病诊断与基于临床症状或体征的诊断相比，是否会导致更低的血管事件发生率。
在一项前瞻性、非随机、观察性研究中，我们从荷兰的 10 个家庭诊所招募了年龄在 45 至 75 岁之间的新诊断为 2 型糖尿病的患者，这些患者是通过（1）机会性靶向筛查（n = 359）或（2）临床症状或体征（n = 206）检测出来的。两组患者均接受相同的符合指南的糖尿病护理。主要的组间结局指标是心血管疾病（CVD）死亡、非致死性心肌梗死和非致死性卒中的复合结局。
机会性靶向筛查组的基线血管疾病更为常见，主要是缺血性心脏病（12.3%对 3.9%，P =.001）和肾病（16.9%对 7.1%，P =.002）。在平均 7.7 年（SD = 2.4 年）和 7.1 年（SD = 2.7 年）的随访后，机会性靶向筛查组和临床诊断组的复合主要事件发生率没有显著差异（9.5%对 10.2%，P =.78；调整后的危险比 0.67，95%置信区间 0.36-1.25；P =.21）。CVD 死亡、非致死性心肌梗死和非致死性卒中的单独事件发生率也没有显著差异。
与临床诊断相比，机会性靶向筛查检测到的 2 型糖尿病患者在基线时具有更高的 CVD 发病率，但在 7.7 年后，CVD 死亡率和主要 CVD 发病率没有差异。机会性靶向筛查和有指导的护理似乎可以改善初级保健中 2 型糖尿病的血管结局。
