Bullard Kai McKeever, Ali Mohammed K, Imperatore Giuseppina, Geiss Linda S, Saydah Sharon H, Albu Jeanine B, Cowie Catherine C, Sohler Nancy, Albright Ann, Gregg Edward W
Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America.
St. Luke's-Roosevelt Hospital Center, Department of Medicine, Columbia University, New York, New York, United States of America.
PLoS One. 2015 Apr 30;10(4):e0125249. doi: 10.1371/journal.pone.0125249. eCollection 2015.
Screening guidelines are used to help identify prediabetes and diabetes before implementing evidence-based prevention and treatment interventions. We examined screening practices benchmarking against two US guidelines, and the capacity of each guideline to identify dysglycemia.
Using 2007-2012 National Health and Nutrition Examination Surveys, we analyzed nationally-representative, cross-sectional data from 5,813 fasting non-pregnant adults aged ≥20 years without self-reported diabetes. We examined proportions of adults eligible for diagnostic glucose testing and those who self-reported receiving testing in the past three years, as recommended by the American Diabetes Association (ADA) and the US Preventive Services Task Force (USPSTF-2008) guidelines. For each screening guideline, we also assessed sensitivity, specificity, and positive (PPV) and negative predictive values in identifying dysglycemia (defined as fasting plasma glucose ≥100 mg/dl or hemoglobin A1c ≥5.7%).
In 2007-2012, 73.0% and 23.7% of US adults without diagnosed diabetes met ADA and USPSTF-2008 criteria for screening, respectively; and 91.5% had at least one major risk factor for diabetes. Of those ADA- or USPSTF-eligible adults, about 51% reported being tested within the past three years. Eligible individuals not tested were more likely to be lower educated, poorer, uninsured, or have no usual place of care compared to tested eligible adults. Among adults with ≥1 major risk factor, 45.7% reported being tested, and dysglycemia yields (i.e., PPV) ranged from 45.8% (high-risk ethnicity) to 72.6% (self-reported prediabetes). ADA criteria and having any risk factor were more sensitive than the USPSTF-2008 guideline (88.8-97.7% vs. 31.0%) but less specific (13.5-39.7% vs. 82.1%) in recommending glucose testing, resulting in lower PPVs (47.7-54.4% vs. 58.4%).
Diverging recommendations and variable performance of different guidelines may be impeding national diabetes prevention and treatment efforts. Efforts to align screening recommendations may result in earlier identification of adults at high risk for prediabetes and diabetes.
筛查指南用于在实施循证预防和治疗干预措施之前，帮助识别糖尿病前期和糖尿病。我们对照两项美国指南检查了筛查实践，以及每项指南识别血糖异常的能力。
利用2007 - 2012年国家健康和营养检查调查，我们分析了来自5813名年龄≥20岁、未自我报告患糖尿病的空腹非妊娠成年人的具有全国代表性的横断面数据。我们检查了符合诊断性血糖检测条件的成年人比例，以及那些按照美国糖尿病协会（ADA）和美国预防服务工作组（USPSTF - 2008）指南建议在过去三年中自我报告接受检测的成年人比例。对于每项筛查指南，我们还评估了其在识别血糖异常（定义为空腹血糖≥100mg/dl或糖化血红蛋白≥5.7%）方面的敏感性、特异性、阳性预测值（PPV）和阴性预测值。
在2007 - 2012年，未被诊断出糖尿病的美国成年人中，分别有73.0%和23.7%符合ADA和USPSTF - 2008筛查标准；91.5%至少有一项糖尿病主要危险因素。在符合ADA或USPSTF标准的成年人中，约51%报告在过去三年中接受了检测。与接受检测的符合条件的成年人相比，未接受检测的符合条件个体更可能受教育程度较低、贫困、未参保或没有固定的医疗场所。在有≥1项主要危险因素的成年人中，45.7%报告接受了检测，血糖异常检出率（即PPV）范围从45.8%（高危种族）到72.6%（自我报告的糖尿病前期）。ADA标准和有任何危险因素在推荐血糖检测方面比USPSTF - 2008指南更敏感（88.8 - 97.7%对31.0%），但特异性较低（13.5 - 39.
