Echouffo-Tcheugui Justin B, Simmons Rebecca K, Prevost A Toby, Williams Kate M, Kinmonth Ann-Louise, Wareham Nicholas J, Griffin Simon J
MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Cambridge, United Kingdom.
Department of Primary Care and Public Health Sciences, School of Medicine, King's College London, London, United Kingdom.
Ann Fam Med. 2015 Mar;13(2):149-57. doi: 10.1370/afm.1737.
There is limited trial evidence concerning the long-term effects of screening for type 2 diabetes on population morbidity. We examined the effect of a population-based diabetes screening program on cardiovascular morbidity, self-rated health, and health-related behaviors.
We conducted a pragmatic, parallel-group, cluster-randomized controlled trial of diabetes screening (the ADDITION-Cambridge study) including 18,875 individuals aged 40 to 69 years at high risk of diabetes in 32 general practices in eastern England (27 practices randomly allocated to screening, 5 to no-screening for control). Of those eligible for screening, 466 (2.9%) were diagnosed with diabetes. Seven years after randomization, a random sample of patients was sent a postal questionnaire: 15% from the screening group (including diabetes screening visit attenders and non-attenders) and 40% from the no-screening control group. Self-reported cardiovascular morbidity, self-rated health (using the SF-8 Health Survey and EQ-5D instrument), and health behaviors were compared between trial groups using an intention-to-screen analysis.
Of the 3,286 questionnaires mailed out, 1,995 (61%) were returned, with 1,945 included in the analysis (screening: 1,373; control: 572). At 7 years, there were no significant differences between the screening and control groups in the proportion of participants reporting heart attack or stroke (OR = 0.90, 95% CI, 0.71-1.15); SF-8 physical health summary score as an indicator of self-rated health status (β -0.33, 95% CI, -1.80 to 1.14); EQ-5D visual analogue score (β: 0.80, 95% CI, -1.28 to 2.87); total physical activity (β 0.50, 95% CI, -4.08 to 5.07); current smoking (OR 0.97, 95% CI, 0.72 to 1.32); and alcohol consumption (β 0.14, 95% CI, -1.07 to 1.35).
Invitation to screening for type 2 diabetes appears to have limited impact on population levels of cardiovascular morbidity, self-rated health status, and health behavior after 7 years.
关于2型糖尿病筛查对人群发病率的长期影响，试验证据有限。我们研究了一项基于人群的糖尿病筛查项目对心血管疾病发病率、自我评估健康状况以及健康相关行为的影响。
我们开展了一项实用的、平行组、整群随机对照的糖尿病筛查试验（ADDITION - 剑桥研究），纳入了英格兰东部32家普通诊所中18875名年龄在40至69岁、糖尿病高危的个体（27家诊所随机分配接受筛查，5家作为无筛查对照组）。在符合筛查条件的人群中，466人（2.9%）被诊断为糖尿病。随机分组7年后，向患者随机样本邮寄了一份问卷：筛查组的15%（包括参加和未参加糖尿病筛查就诊的患者）以及无筛查对照组的40%。使用意向性筛查分析比较试验组之间自我报告的心血管疾病发病率、自我评估健康状况（使用SF - 8健康调查和EQ - 5D工具）以及健康行为。
在寄出的3286份问卷中，1995份（61%）被退回，1945份纳入分析（筛查组：1373份；对照组：572份）。7年后，筛查组和对照组在报告心脏病发作或中风的参与者比例（比值比 = 0.90，95%置信区间，0.71 - 1.15）、作为自我评估健康状况指标的SF - 8身体健康总结评分（β = -0.33，95%置信区间，-1.80至1.14）、EQ - 5D视觉模拟评分（β：0.80，95%置信区间，-1.28至2.87）、总身体活动量（β = 0.50，95%置信区间，-4.08至5.07）、当前吸烟情况（比值比 = 0.97，95%置信区间，0.72至1.32）以及饮酒情况（β = 0.14，95%置信区间，-1.07至1.35）方面均无显著差异。
在7年后，邀请进行2型糖尿病筛查对人群心血管疾病发病率、自我评估健康状况和健康行为水平的影响似乎有限。
