Brateanu Andrei, Barwacz Thomas, Kou Lei, Wang Sihe, Misra-Hebert Anita D, Hu Bo, Deshpande Abhishek, Kobaivanova Nana, Rothberg Michael B
Medicine Institute, Cleveland Clinic, Cleveland OH, United States of America.
Department of Medicine, University Hospitals, Cleveland OH, United States of America.
PLoS One. 2017 Nov 14;12(11):e0187695. doi: 10.1371/journal.pone.0187695. eCollection 2017.
Progression to diabetes mellitus (DM) is variable and the screening time interval not well defined. The American Diabetes Association and US Preventive Services Task Force suggest screening every 3 years, but evidence is limited. The objective of the study was to develop a model to predict the probability of developing DM and suggest a risk-based screening interval.
We included non-diabetic adult patients screened for DM in the Cleveland Clinic Health System if they had at least two measurements of glycated hemoglobin (HbA1c), an initial one less than 6.5% (48 mmol/mol) in 2008, and another between January, 2009 and December, 2013. Cox proportional hazards models were created. The primary outcome was DM defined as HbA1C greater than 6.4% (46 mmol/mol). The optimal rescreening interval was chosen based on the predicted probability of developing DM.
Of 5084 participants, 100 (4.4%) of the 2281 patients with normal HbA1c and 772 (27.5%) of the 2803 patients with prediabetes developed DM within 5 years. Factors associated with developing DM included HbA1c (HR per 0.1 units increase 1.20; 95%CI, 1.13-1.27), family history (HR 1.31; 95%CI, 1.13-1.51), smoking (HR 1.18; 95%CI, 1.03-1.35), triglycerides (HR 1.01; 95%CI, 1.00-1.03), alanine aminotransferase (HR 1.07; 95%CI, 1.03-1.11), body mass index (HR 1.06; 95%CI, 1.01-1.11), age (HR 0.95; 95%CI, 0.91-0.99) and high-density lipoproteins (HR 0.93; 95% CI, 0.90-0.95). Five percent of patients in the highest risk tertile developed DM within 8 months, while it took 35 months for 5% of the middle tertile to develop DM. Only 2.4% percent of the patients in the lowest tertile developed DM within 5 years.
A risk prediction model employing commonly available data can be used to guide screening intervals. Based on equal intervals for equal risk, patients in the highest risk category could be rescreened after 8 months, while those in the intermediate and lowest risk categories could be rescreened after 3 and 5 years respectively.
糖尿病（DM）的病情进展因人而异，筛查时间间隔也未明确界定。美国糖尿病协会和美国预防服务工作组建议每3年进行一次筛查，但证据有限。本研究的目的是建立一个模型来预测患糖尿病的概率，并提出基于风险的筛查间隔。
我们纳入了克利夫兰诊所医疗系统中接受糖尿病筛查的非糖尿病成年患者，这些患者至少有两次糖化血红蛋白（HbA1c）测量值，2008年首次测量值低于6.5%（48 mmol/mol），另一次测量在2009年1月至2013年12月之间。建立了Cox比例风险模型。主要结局为定义为HbA1C大于6.4%（46 mmol/mol）的糖尿病。根据预测的患糖尿病概率选择最佳复查间隔。
在5084名参与者中，2281名HbA1c正常的患者中有100名（4.4%），2803名糖尿病前期患者中有772名（27.5%）在5年内发展为糖尿病。与患糖尿病相关的因素包括HbA1c（每增加0.1单位的HR为1.20；95%CI为1.13 - 1.27）、家族史（HR为1.31；95%CI为1.13 - 1.51）、吸烟（HR为1.18；95%CI为1.03 - 1.35）、甘油三酯（HR为1.01；95%CI为1.00 - 1.03）、丙氨酸转氨酶（HR为1.07；95%CI为1.03 - 1.11）、体重指数（HR为1.06；95%CI为1.01 - 1.11）、年龄（HR为0.95；95%CI为0.91 - 0.99）和高密度脂蛋白（HR为0.93；95%CI为0.9）。风险最高三分位数的患者中有5%在8个月内发展为糖尿病，而中等三分位数的患者中有5%需要35个月才发展为糖尿病。最低三分位数的患者中只有2.4%在5年内发展为糖尿病。
采用常用数据的风险预测模型可用于指导筛查间隔。基于同等风险同等间隔的原则，风险最高类别的患者可在8个月后复查，而中等和低风险类别的患者可分别在3年和5年后复查。
