K.G. Jebsen Center for Genetic Epidemiology, Department of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, Norway.
Clinic of Medicine, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway.
Diabet Med. 2022 Jun;39(6):e14829. doi: 10.1111/dme.14829. Epub 2022 Mar 21.
We investigated the current extent of undiagnosed diabetes and prediabetes and their associated cardiovascular risk profile in a population-based study.
All residents aged ≥20 years in the Nord-Trøndelag region, Norway, were invited to the HUNT4 Survey in 2017-2019, and 54% attended. Diagnosed diabetes was self-reported, and in those reporting no diabetes HbA1c was used to classify undiagnosed diabetes (≥48 mmol/mol [6.5%]) and prediabetes (39-47 mmol/mol [5.7%-6.4%]). We estimated the age- and sex-standardized prevalence of these conditions and their age- and sex-adjusted associations with other cardiovascular risk factors.
Among 52,856 participants, the prevalence of diabetes was 6.0% (95% CI 5.8, 6.2), of which 11.1% were previously undiagnosed (95% CI 10.1, 12.2). The prevalence of prediabetes was 6.4% (95% CI 6.2, 6.6). Among participants with undiagnosed diabetes, 58% had HbA1c of 48-53 mmol/mol (6.5%-7.0%), and only 14% (i.e., 0.1% of the total study population) had HbA1c >64 mmol/mol (8.0%). Compared with normoglycaemic participants, those with undiagnosed diabetes or prediabetes had higher body mass index, waist circumference, systolic blood pressure, triglycerides and C-reactive protein but lower low-density lipoprotein cholesterol (all p < 0.001). Participants with undiagnosed diabetes had less favourable values for every measured risk factor compared with those with diagnosed diabetes.
The low prevalence of undiagnosed diabetes suggests that the current case-finding-based diagnostic practice is well-functioning. Few participants with undiagnosed diabetes had very high HbA1c levels indicating severe hyperglycaemia. Nonetheless, participants with undiagnosed diabetes had a poorer cardiovascular risk profile compared with participants with known or no diabetes.
我们在一项基于人群的研究中调查了目前未确诊的糖尿病和糖尿病前期的流行程度及其相关的心血管风险特征。
挪威特隆赫姆地区所有年龄≥20 岁的居民均受邀参加 2017-2019 年的 HUNT4 调查，有 54%的人参加了调查。糖尿病的诊断是自我报告的，对于没有报告糖尿病的人，使用 HbA1c 来分类未确诊的糖尿病（≥48mmol/mol[6.5%]）和糖尿病前期（39-47mmol/mol[5.7%-6.4%]）。我们估计了这些疾病的年龄和性别标准化患病率，以及它们与其他心血管危险因素的年龄和性别调整关联。
在 52856 名参与者中，糖尿病的患病率为 6.0%（95%CI 5.8,6.2），其中 11.1%为以前未确诊的（95%CI 10.1,12.2）。糖尿病前期的患病率为 6.4%（95%CI 6.2,6.6）。在未确诊的糖尿病患者中，有 58%的人 HbA1c 为 48-53mmol/mol（6.5%-7.0%），只有 14%（即总研究人群的 0.1%）的人 HbA1c 大于 64mmol/mol（8.0%）。与血糖正常的参与者相比，未确诊的糖尿病或糖尿病前期患者的体重指数、腰围、收缩压、甘油三酯和 C 反应蛋白更高，而低密度脂蛋白胆固醇更低（均 P<0.001）。与确诊的糖尿病患者相比，未确诊的糖尿病患者的每个测量风险因素的数值都更差。
未确诊的糖尿病患病率较低表明当前基于病例发现的诊断实践效果良好。少数未确诊的糖尿病患者的 HbA1c 水平非常高，表明存在严重的高血糖。尽管如此，与已知有糖尿病或没有糖尿病的患者相比，未确诊的糖尿病患者的心血管风险状况更差。
