Department of Public Health, Section of General Practice, Aarhus University, Aarhus, Denmark.
Danish Diabetes Academy, Odense University Hospital, Odense, Denmark.
Diabetologia. 2017 Nov;60(11):2192-2199. doi: 10.1007/s00125-017-4299-y. Epub 2017 Aug 23.
AIMS/HYPOTHESIS: There is continuing debate about the net benefits of population screening for type 2 diabetes. We compared the risk of cardiovascular disease (CVD) and mortality among incident cases of type 2 diabetes in a screened group with those in an unscreened group. METHODS: In this register-based non-randomised controlled trial, eligible individuals were all men and women aged 40-69 years without known diabetes, 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 family doctor for assessment of diabetes status and cardiovascular risk (screening group). The 1,759,285 individuals registered with all other practices in Denmark constituted the retrospectively constructed no-screening (control) group. In this post hoc analysis, we identified individuals from the screening and no-screening groups who were diagnosed with diabetes between 2001 and 2009 (n = 139,075), and compared risk of CVD and mortality in these groups between 2001 and 2012. RESULTS: In the screening group, 27,177/153,107 (18%) individuals attended for screening, of whom 1533 were diagnosed with diabetes. Between 2001 and 2009, 13,992 people were newly diagnosed with diabetes in the screening group (including those diagnosed by screening) and 125,083 in the no-screening group. Between 2001 and 2012, the risks of CVD and mortality were lower among individuals with diabetes in the screening group compared with individuals with diabetes in the no-screening (control) group (CVD HR 0.84, 95% CI 0.80, 0.89; mortality HR 0.79, 95% CI 0.74, 0.84). CONCLUSIONS/INTERPRETATION: A single round of diabetes screening and cardiovascular risk assessment in middle-aged Danish adults in general practice was associated with a significant reduction in risk of all-cause mortality and CVD events in those diagnosed with diabetes.
目的/假设：关于 2 型糖尿病人群筛查的净收益仍存在争议。我们比较了筛查组和未筛查组中 2 型糖尿病新发病例的心血管疾病（CVD）风险和死亡率。
方法：在这项基于登记的非随机对照试验中，合格的参与者均为年龄在 40-69 岁之间、无已知糖尿病且在丹麦注册的男性和女性，他们登记在 181 个参与丹麦初级保健中筛查发现的糖尿病强化治疗的英荷丹研究（ADDITION-丹麦）的实践中（n=1912392）。2001 年至 2006 年期间，有 153107 名登记在 181 个实践中的个体收到了糖尿病风险评分问卷。具有中高危风险的个体被邀请去家庭医生处评估糖尿病状态和心血管风险（筛查组）。在丹麦所有其他实践中登记的 1759285 名个体构成了回顾性构建的无筛查（对照组）组。在本事后分析中，我们从筛查和无筛查组中确定了 2001 年至 2009 年期间被诊断为糖尿病的个体（n=139075），并比较了这两组在 2001 年至 2012 年期间 CVD 和死亡率的风险。
结果：在筛查组中，153107 名个体中有 27177 人（18%）接受了筛查，其中 1533 人被诊断患有糖尿病。在 2001 年至 2009 年期间，筛查组中有 13992 人（包括通过筛查诊断出的）和 125083 人被新诊断为糖尿病。在 2001 年至 2012 年期间，与无筛查（对照组）组相比，筛查组中糖尿病患者的 CVD 和死亡率风险较低（CVD HR 0.84，95%CI 0.80，0.89；死亡率 HR 0.79，95%CI 0.74，0.84）。
结论/解释：在丹麦普通实践中对中年成年人进行一轮糖尿病筛查和心血管风险评估与那些被诊断为糖尿病的患者的全因死亡率和 CVD 事件风险显著降低相关。
Diabetologia. 2017-8-23
AJPM Focus. 2024-10-15
Jt Comm J Qual Patient Saf. 2023-12
J Pharm Pharmacol. 2017-6
Clin Epidemiol. 2014-12-18
Zotero 插件
