I. Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
Department of Internal Medicine, Gastroenterology, Hepatology, Endoscopy and Diabetology, Osnabrück, Germany.
Z Gastroenterol. 2022 Sep;60(9):1306-1313. doi: 10.1055/a-1482-8840. Epub 2021 Jun 22.
Diabetes mellitus is a major risk factor for microvascular disease, leading to chronic kidney injury or cardiovascular disease, but there is a tremendous proportion of patients worldwide who suffer from undiagnosed diabetes. Until now, little is known about the prevalence of undiagnosed diabetes in gastroenterology inpatients.
To improve detection of undiagnosed diabetes, a routine screening procedure for gastroenterology inpatients, based on hemoglobin A (HbA) and fasting plasma glucose (FPG) measurement, was established.
We conducted a retrospective analysis of the implemented diabetes screening. Diabetes mellitus was diagnosed according to the guideline of the German Diabetes Association in patients with an HbA of ≥6.5% anld/or fasting plasma glucose (FPG) ≥126 mg/dL. Univariate and multivariate analyses were performed to identify independent risk factors for undiagnosed diabetes.
Within a 3-month period, 606 patients were eligible for a diabetes screening. Pre-existing diabetes was documented in 120 patients (19.8 %), undiagnosed diabetes was found in 24 (3.9%), and 162 patients (26.7%) met the definition for prediabetes. Steroid medication use, age, and liver cirrhosis due to primary sclerosing cholangitis (PSC) were identified as risk factors for undiagnosed diabetes.
The prevalence of undiagnosed diabetes in gastroenterology inpatients is markedly elevated in comparison to the general population, and a substantial number of inpatients are in a prediabetic status, underlining the need for diabetes screening. In addition to previously described risk factors of patient age and steroid medication use, we identified PSC-related liver cirrhosis (but not liver cirrhosis due to another etiology) as an independent risk factor for undiagnosed diabetes.
糖尿病是微血管疾病的一个主要危险因素，导致慢性肾脏损伤或心血管疾病，但全世界有很大一部分患者患有未确诊的糖尿病。到目前为止，人们对胃肠病学住院患者中未确诊糖尿病的患病率知之甚少。
为了提高未确诊糖尿病的检出率，我们建立了一种基于糖化血红蛋白（HbA）和空腹血糖（FPG）测量的胃肠病学住院患者常规筛查程序。
我们对实施的糖尿病筛查进行了回顾性分析。根据德国糖尿病协会的指南，HbA≥6.5%和/或空腹血糖（FPG）≥126mg/dL的患者被诊断为糖尿病。采用单因素和多因素分析确定未确诊糖尿病的独立危险因素。
在 3 个月的时间内，有 606 名患者符合糖尿病筛查条件。120 名（19.8%）患者存在既往糖尿病，24 名（3.9%）患者被发现患有未确诊糖尿病，162 名（26.7%）患者符合糖尿病前期的定义。类固醇药物使用、年龄和原发性硬化性胆管炎（PSC）引起的肝硬化被确定为未确诊糖尿病的危险因素。
与一般人群相比，胃肠病学住院患者中未确诊糖尿病的患病率明显升高，相当数量的住院患者处于糖尿病前期状态，这强调了进行糖尿病筛查的必要性。除了之前描述的患者年龄和类固醇药物使用等危险因素外，我们还发现与 PSC 相关的肝硬化（而非其他病因引起的肝硬化）是未确诊糖尿病的一个独立危险因素。
