Singer D E, Samet J H, Coley C M, Nathan D M
Massachusetts General Hospital.
Ann Intern Med. 1988 Oct 15;109(8):639-49. doi: 10.7326/0003-4819-109-8-639.
Diabetes mellitus in nonpregnant adults is a chronic affliction that leads to significant vascular and neuropathic disease. Diabetes during pregnancy can lead to perinatal complications. Both of these types of diabetes are common, often asymptomatic, and readily diagnosable by glucose tolerance testing. As a result, screening can identify many previously undiagnosed patients. However there is only limited evidence that screening results in net therapeutic benefit. In the case of gestational diabetes, controlled trials indicate that hypoglycemic therapy decreases the frequency of macrosomia, but has no effect on perinatal mortality. Our analyses indicate that screening for gestational diabetes is a low-cost intervention that produces a small expected benefit. Screening for diabetes in the nonpregnant adult (almost always a type II diabetic) is not recommended, because the link between improving glucose control and reducing diabetic complications is currently too weak. Screening might be reasonable for particular patients, for example, obese persons who would be spurred to lose weight by a demonstration of glucose intolerance. Screening for type I diabetes followed by immunomodulating therapy is still too experimental for confident analysis.
非妊娠成年期糖尿病是一种慢性疾病，可导致严重的血管和神经病变。孕期糖尿病可导致围产期并发症。这两种类型的糖尿病都很常见，通常无症状，通过葡萄糖耐量试验很容易诊断。因此，筛查可以识别出许多以前未被诊断的患者。然而，仅有有限的证据表明筛查能带来净治疗益处。就妊娠期糖尿病而言，对照试验表明降糖治疗可降低巨大儿的发生率，但对围产期死亡率没有影响。我们的分析表明，筛查妊娠期糖尿病是一种低成本的干预措施，产生的预期益处较小。不建议对非妊娠成年人进行糖尿病筛查（几乎都是2型糖尿病患者），因为目前改善血糖控制与减少糖尿病并发症之间的联系还很薄弱。对于特定患者，如肥胖者，若通过葡萄糖不耐受检测促使其减重，筛查可能是合理的。对1型糖尿病进行筛查并随后进行免疫调节治疗，目前仍处于试验阶段，难以进行可靠分析。
