Trilling J S
Department of Family Medicine, SUNY, Stony Brook.
Prim Care. 1988 Jun;15(2):285-95.
The major obstacle to a recommendation for screening adults for NIDDM is the conflicting evidence that early detection and treatment reduce future complications. Because obesity is a risk factor for NIDDM, and hypertension in conjunction with NIDDM leads to early atherosclerosis, treatment is indicated for both hypertension and obesity whether or not NIDDM is present concurrently. It is clear that there are those who accept and those that reject the use of oral hypoglycemic agents. Accordingly, there are those who believe that the goal of NIDDM treatment is zealous glycemic control and those who are not so inclined. Whether or not to screen for NIDDM ultimately depends upon which view is adopted. While it may seem prudent to screen for and insist upon "tight" control of NIDDM, we should consider the effect of labeling asymptomatic persons from a positive test result. What are the repercussions regarding status of employment and insurance eligibility as compared to benefits of treatment? What is the psychosocial impact? Although no studies on the effect of labeling patients non-insulin-dependent diabetics could be located, a study of hypertension in an industrial setting demonstrated that patients labeled hypertensive had an increased absenteeism from work. Interestingly, the main factors associated with increased absenteeism were awareness of the condition and low compliance with treatment. Although the parallel to NIDDM is evident, additional studies are needed.
推荐对成年人进行非胰岛素依赖型糖尿病（NIDDM）筛查的主要障碍在于，关于早期检测和治疗能否减少未来并发症的证据相互矛盾。由于肥胖是NIDDM的一个风险因素，并且高血压与NIDDM共同作用会导致早期动脉粥样硬化，所以无论是否同时存在NIDDM，都应对高血压和肥胖进行治疗。显然，有人接受使用口服降糖药，也有人拒绝使用。相应地，有人认为NIDDM治疗的目标是积极控制血糖，而有人则不这么认为。是否对NIDDM进行筛查最终取决于采取哪种观点。虽然对NIDDM进行筛查并坚持“严格”控制似乎是谨慎之举，但我们应该考虑阳性检测结果给无症状者贴上标签的影响。与治疗益处相比，就业状况和保险资格方面会有哪些影响？心理社会影响又是什么？尽管找不到关于给患者贴上非胰岛素依赖型糖尿病标签的影响的研究，但一项在工业环境中对高血压的研究表明，被贴上高血压标签的患者旷工率增加。有趣的是，与旷工率增加相关的主要因素是对病情的知晓和对治疗的低依从性。虽然与NIDDM的相似之处很明显，但还需要更多研究。
