Hou Wen-Hsuan, Li Chung-Yi, Chen Lu-Hsuan, Wang Liang-Yi, Kuo Li-Chieh, Kuo Ken N, Shen Hsiu-Nien, Chiu Chang-Ta
Cochrane Taiwan, Taipei Medical University, Taipei, Taiwan.
Master Program in Long-Term Care, College of Nursing, Taipei Medical University, Taipei, Taiwan.
BMJ Open. 2016 Oct 20;6(10):e012071. doi: 10.1136/bmjopen-2016-012071.
To investigate whether a temporal relationship is present between clinical visits for diabetes-related hand syndromes (DHSs) and subsequent type 2 diabetes mellitus (T2DM) diagnosis and, accordingly, whether DHSs can be used for identifying patients with undiagnosed T2DM.
This study had a case-control design nested within a cohort of 1 million people from the general population, which was followed from 2005 to 2010. The odds of prior clinical visits for DHSs, namely carpal tunnel syndrome (CTS), flexor tenosynovitis, limited joint mobility and Dupuytren's disease, were estimated for cases and controls. We used a conditional logistic regression model to estimate the OR and 95% CI of T2DM in association with a history of DHSs. The validity and predictive value of using the history of DHSs in predicting T2DM diagnosis were calculated.
Taiwan National Health Insurance medical claims.
We identified 33 571 patients receiving a new diagnosis of T2DM (cases) between 2005 and 2010. Each T2DM case was matched with 5 controls who had the same sex and birth year and were alive on the date of T2DM diagnosis.
The primary outcome measure was T2DM diagnosis.
The OR of T2DM in association with prior clinical visits was significantly increased for overall DHS and CTS, being 1.15 (95% CI 1.10 to 1.20) and 1.22 (95% CI 1.16 to 1.29), respectively. Moreover, 11% of patients with T2DM made clinical visits for CTS within 3 months prior to T2DM diagnosis. The history of DHSs had low sensitivity (<0.1% to 5.2%) and a positive predictive value (9.9% to 11.7%) in predicting T2DM.
Despite the unsatisfactory validity and performance of DHSs as a clinical tool for detecting patients with undiagnosed T2DM, this study provided evidence that clinical visits for DHSs, particularly for CTS, can be a sign of undiagnosed T2DM.
研究糖尿病相关手部综合征（DHSs）的临床就诊与随后2型糖尿病（T2DM）诊断之间是否存在时间关系，以及DHSs是否可用于识别未确诊的T2DM患者。
本研究采用病例对照设计，嵌套于2005年至2010年随访的100万普通人群队列中。估计病例组和对照组中既往因DHSs（即腕管综合征（CTS）、屈指肌腱腱鞘炎、关节活动受限和杜普伊特伦挛缩病）进行临床就诊的几率。我们使用条件逻辑回归模型估计与DHSs病史相关联的T2DM比值比（OR）及95%置信区间（CI）。计算了使用DHSs病史预测T2DM诊断的有效性和预测价值。
台湾国民健康保险医疗理赔数据。
我们确定了2005年至2010年间33571例新诊断为T2DM的患者（病例组）。每例T2DM病例与5名性别相同、出生年份相同且在T2DM诊断日期仍存活的对照者匹配。
主要观察指标为T2DM诊断。
总体DHSs和CTS与既往临床就诊相关联的T2DM的OR显著升高分别为1.15（95%CI 1.10至1.20）和1.22（95%CI 1.16至1.29）。此外，11%的T2DM患者在T2DM诊断前3个月内因CTS进行了临床就诊。DHSs病史在预测T2DM方面敏感性较低（<0.1%至5.2%），阳性预测值为（9.9%至11.7%）。
尽管DHSs作为检测未确诊T2DM患者临床工具的有效性和性能不尽人意，但本研究提供了证据表明，因DHSs尤其是CTS进行的临床就诊可能是未确诊T2DM的一个迹象。
