MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Box 285, Institute of Metabolic Science, Cambridge Biomedical Campus, Cambridge, CB2 0QQ, UK.
Steno Diabetes Center, Gentofte, Denmark.
Diabetologia. 2017 Nov;60(11):2183-2191. doi: 10.1007/s00125-017-4323-2. Epub 2017 Aug 23.
AIMS/HYPOTHESIS: Health check programmes for chronic disease have been introduced in a number of countries. However, there are few trials assessing the benefits and harms of these screening programmes at the population level. In a post hoc analysis, we evaluated the effect of population-based screening for type 2 diabetes and cardiovascular risk factors on mortality rates and cardiovascular events.
This register-based, non-randomised, controlled trial included men and women aged 40-69 years without known diabetes who were registered with a general practice in Denmark (n = 1,912,392). Between 2001 and 2006, 153,107 individuals registered with 181 practices participating in the Anglo-Danish-Dutch Study of Intensive Treatment in People with Screen-Detected Diabetes in Primary Care (ADDITION)-Denmark study were sent a diabetes risk score questionnaire. Individuals at moderate-to-high risk were invited to visit their GP for assessment of diabetes status and cardiovascular risk (screening group). The 1,759,285 individuals registered with all other general practices in Denmark constituted the retrospectively constructed no-screening (control) group. Outcomes were mortality rate and cardiovascular events (cardiovascular disease death, non-fatal ischaemic heart disease or stroke). The analysis was performed according to the intention-to-screen principle.
Among the screening group, 27,177 (18%) individuals attended for assessment of diabetes status and cardiovascular risk. Of these, 1,533 were diagnosed with diabetes. During a median follow-up of 9.5 years, there were 11,826 deaths in the screening group and 141,719 in the no-screening group (HR 0.99 [95% CI 0.96, 1.02], p = 0.66). There were 17,941 cardiovascular events in the screening group and 208,476 in the no-screening group (HR 0.99 [0.96, 1.02], p = 0.49).
CONCLUSIONS/INTERPRETATION: A population-based stepwise screening programme for type 2 diabetes and cardiovascular risk factors among all middle-aged adults in Denmark was not associated with a reduction in rate of mortality or cardiovascular events between 2001 and 2012.
目的/假设：一些国家已经推出了针对慢性病的健康检查计划。然而，很少有试验在人群水平上评估这些筛查计划的益处和危害。在一项事后分析中，我们评估了基于人群的 2 型糖尿病和心血管危险因素筛查对死亡率和心血管事件的影响。
这是一项基于登记的、非随机的、对照试验，纳入了丹麦年龄在 40-69 岁之间、无已知糖尿病且在普通诊所登记的男性和女性（n=1912392）。在 2001 年至 2006 年期间，参加英国、丹麦和荷兰基于初级保健的强化筛查人群中发现的糖尿病（ADDITION-Denmark）研究的 181 个实践中的 153107 名参与者被发送了糖尿病风险评分问卷。中高危人群被邀请到他们的全科医生处评估糖尿病状况和心血管风险（筛查组）。丹麦所有其他普通诊所登记的 1759285 人构成了回顾性构建的无筛查（对照组）组。结局为死亡率和心血管事件（心血管疾病死亡、非致命性缺血性心脏病或中风）。分析按照意向筛查原则进行。
在筛查组中，27177（18%）人接受了糖尿病状况和心血管风险评估。其中，1533 人被诊断为糖尿病。在中位数为 9.5 年的随访期间，筛查组有 11826 人死亡，对照组有 141719 人死亡（HR 0.99 [95%CI 0.96，1.02]，p=0.66）。筛查组有 17941 例心血管事件，对照组有 208476 例（HR 0.99 [0.96，1.02]，p=0.49）。
结论/解释：在丹麦所有中年人群中开展的基于人群的 2 型糖尿病和心血管危险因素的逐步筛查计划，与 2001 年至 2012 年间死亡率或心血管事件发生率的降低无关。
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