Medical Subspecialty/Endocrinology, Atlanta VA Medical Center, Decatur, Ga; Division of Endocrinology, Metabolism and Lipids, Department of Medicine, Emory University School of Medicine, Atlanta, Ga.
Medical Subspecialty/Endocrinology, Atlanta VA Medical Center, Decatur, Ga; Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, Ga.
Am J Med. 2018 Apr;131(4):443.e11-443.e24. doi: 10.1016/j.amjmed.2017.09.021. Epub 2017 Oct 6.
Many individuals with diabetes remain undiagnosed, leading to delays in treatment and higher risk for subsequent diabetes complications. Despite recommendations for diabetes screening in high-risk groups, the optimal approach is not known. We evaluated the utility of inpatient glucose levels as an opportunistic screening tool for identifying patients at high risk for diabetes.
We retrospectively examined 462,421 patients in the US Department of Veterans Affairs healthcare system, hospitalized on medical/surgical services in 2000-2010, for ≥3 days, with ≥2 inpatient random plasma glucose (RPG) measurements. All had continuity of care: ≥1 primary care visit and ≥1 glucose measurement within 2 years before hospitalization and yearly for ≥3 years after discharge. Glucose levels during hospitalization and incidence of diabetes within 3 years after discharge in patients without diabetes were evaluated.
Patients had a mean age of 65.0 years, body mass index of 29.9 kg/m, and were 96% male, 71% white, and 18% black. Pre-existing diabetes was present in 39.4%, 1.3% were diagnosed during hospitalization, 8.1% were diagnosed 5 years after discharge, and 51.3% were never diagnosed (NonDM). The NonDM group had the lowest mean hospital RPG value (112 mg/dL [6.2 mmol/L]). Having at least 2 RPG values >140 mg/dL (>7.8 mmol/L), the 95th percentile of NonDM hospital glucose, provided 81% specificity for identifying incident diabetes within 3 years after discharge.
Screening for diabetes could be considered in patients with at least 2 hospital glucose values at/above the 95th percentile of the nondiabetic range (141 mg/dL [7.8 mmol/L]).
许多糖尿病患者未被诊断，导致治疗延迟，随后发生糖尿病并发症的风险更高。尽管建议对高危人群进行糖尿病筛查，但最佳方法尚不清楚。我们评估了住院血糖水平作为识别糖尿病高危患者的机会性筛查工具的效用。
我们回顾性地检查了 2000 年至 2010 年间在美国退伍军人事务部医疗保健系统中住院治疗的 462421 名患有内科/外科疾病的患者，这些患者住院时间超过 3 天，且有≥2 次住院随机血浆葡萄糖（RPG）测量值。所有患者均有连续护理：在住院前 2 年内至少有 1 次初级保健就诊和≥1 次血糖测量值，出院后每年至少有 3 次。评估了无糖尿病患者住院期间的血糖水平和出院后 3 年内的糖尿病发病率。
患者的平均年龄为 65.0 岁，体重指数为 29.9kg/m2，96%为男性，71%为白人，18%为黑人。39.4%的患者存在糖尿病前期，1.3%的患者在住院期间被诊断，8.1%的患者在出院后 5 年内被诊断，51.3%的患者从未被诊断（非糖尿病患者）。非糖尿病患者的平均住院 RPG 值最低（112mg/dL[6.2mmol/L]）。至少有 2 次 RPG 值＞140mg/dL（＞7.8mmol/L），即非糖尿病住院血糖的第 95 百分位数，可在 3 年内识别出 81%的糖尿病发病情况。
可以考虑对至少有 2 次血糖值在非糖尿病范围（141mg/dL[7.8mmol/L]）的第 95 百分位数以上的患者进行糖尿病筛查。
