Epidemiology Unit, ASL TO3, Grugliasco (TO), Italy.
Department of Drug Science and Technology, University of Torino, Torino TO, Italy.
PLoS One. 2020 Mar 18;15(3):e0229842. doi: 10.1371/journal.pone.0229842. eCollection 2020.
Given the paucity of symptoms in the early stages of type 2 diabetes, its diagnosis is often made when complications have already arisen. Although systematic population-based screening is not recommended, there is room to experience new strategies for improving early diagnosis of the disease in high risk subjects. We report the results of an opportunistic screening for diabetes, implemented in the setting of community pharmacies.
To identify people at high risk to develop diabetes, pharmacists were trained to administer FINDRISC questionnaire to overweight, diabetes-free customers aged 45 or more. Each interviewee was followed for 365 days, searching in the administrative database whether he/she had a glycaemic or HbA1c test, or a diabetologists consultation, and to detect any new diagnosis of diabetes defined by either a prescription of any anti-hyperglycaemic drug, or the enrolment in the register of patients, or a hospital discharge with a diagnosis of diabetes. Out of 5977 interviewees, 53% were at risk of developing diabetes. An elevated FINDRISC score was associated with higher age, lower education, and living alone. Excluding the number of cases expected, based on the incidence rate of diabetes in the population, 51 new cases were identified, one every 117 interviews. FINDRISC score, being a male and living alone were significantly associated with the diagnosis.
The implementation of a community pharmacy-based screening programme can contribute to reduce the burden of the disease, particularly focusing on people at higher risk, such as the elderly and the socially vulnerable.
由于 2 型糖尿病早期症状很少，因此通常在出现并发症时才被诊断出来。虽然不推荐进行系统的人群筛查，但仍有机会尝试新策略，以提高高危人群对该疾病的早期诊断率。我们报告了在社区药房实施的糖尿病机会性筛查的结果。
为了确定易患糖尿病的高危人群，药剂师接受了培训，以便向 45 岁及以上超重且无糖尿病的顾客发放 FINDRISC 问卷。对每位受访者进行为期 365 天的随访，在行政数据库中搜索他们是否进行了血糖或 HbA1c 检测，或是否咨询了糖尿病专家，并发现任何新诊断的糖尿病，包括任何一种降血糖药物的处方、登记在册的患者，或因糖尿病住院的病例。在 5977 名受访者中，有 53%有患糖尿病的风险。FINDRISC 评分升高与年龄较大、受教育程度较低和独居有关。根据人群中糖尿病的发病率，排除预计的病例数后，共发现 51 例新病例，每 117 次访谈中有 1 例。FINDRISC 评分、男性和独居与诊断显著相关。
实施基于社区药房的筛查计划可以有助于减轻疾病负担，特别是关注那些处于更高风险的人群，如老年人和社会弱势群体。
