Ballotari Paola, Roncaglia Francesca, Chiatamone Ranieri Sofia, Greci Marina, Manicardi Valeria, Giorgi Rossi Paolo
Servizio Interaziendale di Epidemiologia, Local Health Authority of Reggio Emilia, Via Amendola 2, 42122 Reggio Emilia, Italy.
IRCCS, Arcispedale Santa Maria Nuova, Viale Umberto I 50, 42123 Reggio Emilia, Italy.
J Clin Transl Endocrinol. 2016 Jan 13;3:21-25. doi: 10.1016/j.jcte.2016.01.001. eCollection 2016 Mar.
The aim of this study was to investigate whether subjects included in the diabetes register solely because their HbA1c was over the diagnostic threshold received a diagnosis of diabetes from their general practitioner (GP).
The study included all registered cases in 2009-2010 aged 18 or over that were identified only by the laboratory database because they had one or more HbA1c over the 6.5% threshold and for whom we did not find any information in the search of full electronic clinical records. Multilevel logistic regression was used to examine the influence of GP and patient characteristics.
There were 228 participating GPs (76.3% of those invited) and 832 assessed subjects (68.8% of study population). There was a strong clustering among the GPs (residual intraclass correlation = 0.52, 95% CI 0.40-0.64). About one in two (55.5%) subjects with two or more HbA1c > =6.5% has been diagnosed as diabetic and the percentage declined - unless zeroing - in case the abnormal value was only one (28.3%). The likelihood of being labelled 'no diabetes' was greater in subjects aged less than 65 or over 74 with respect to the reference age group (OR 1.89, 95% CI 1.13-3.15; OR 1.55 95% CI 0.94-2.53). The same likelihood consistently decreased when HbA1c test was accompanied by abnormal fasting plasma glucose (FPG) assay (OR 0.20, 95% CI 0.12-0.32).
A permanent exchange of information between the diabetes register and GPs should be maintained to improve the care of patients and the awareness of criteria for diabetes diagnosis among GPs.
本研究旨在调查那些仅因糖化血红蛋白（HbA1c）超过诊断阈值而被纳入糖尿病登记册的受试者是否从其全科医生（GP）处获得了糖尿病诊断。
该研究纳入了2009年至2010年所有年龄在18岁及以上的登记病例，这些病例仅通过实验室数据库识别，因为他们有一项或多项HbA1c超过6.5%的阈值，并且我们在全面的电子临床记录搜索中未找到任何相关信息。采用多水平逻辑回归分析来检验全科医生和患者特征的影响。
有228名参与的全科医生（占受邀者的76.3%）和832名评估受试者（占研究人群的68.8%）。全科医生之间存在很强的聚集性（组内剩余相关系数=0.52，95%可信区间0.40 - 0.64）。约二分之一（55.5%）的HbA1c两项或更多项≥6.5%的受试者被诊断为糖尿病，而如果异常值只有一项，该百分比会下降（除非为零，降至28.3%）。与参考年龄组相比，年龄小于65岁或大于74岁的受试者被标记为“无糖尿病”的可能性更大（比值比1.89，95%可信区间1.13 - 3.15；比值比1.55，95%可信区间0.94 - 2.53）。当HbA1c检测伴有空腹血糖（FPG）检测异常时，同样的可能性持续降低（比值比0.20，95%可信区间0.12 - 0.32）。
应保持糖尿病登记册与全科医生之间的信息永久交换，以改善患者护理并提高全科医生对糖尿病诊断标准的认识。
