Cao Qiuyu, Zheng Ruizhi, He Ruixin, Wang Tiange, Xu Min, Lu Jieli, Dai Meng, Zhang Di, Chen Yuhong, Zhao Zhiyun, Wang Shuangyuan, Lin Hong, Wang Weiqing, Ning Guang, Bi Yufang, Xu Yu, Li Mian
Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China; Shanghai National Clinical Research Center for Metabolic Diseases, Key Laboratory for Endocrine and Metabolic Diseases of the National Health Commission of the PR China, Shanghai Key Laboratory for Endocrine Tumor, State Key Laboratory of Medical Genomics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China; Shanghai National Clinical Research Center for Metabolic Diseases, Key Laboratory for Endocrine and Metabolic Diseases of the National Health Commission of the PR China, Shanghai Key Laboratory for Endocrine Tumor, State Key Laboratory of Medical Genomics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Metabolism. 2022 Sep;134:155238. doi: 10.1016/j.metabol.2022.155238. Epub 2022 Jun 11.
Young-onset diabetes has been increasingly prevalent in China and most of the young patients with diabetes remain undiagnosed. Recently, the American Diabetes Association (ADA) updated their screening criteria and turned down the age threshold of diabetes screening from 45 years to 35 years, which highlighted the importance of identifying young individuals with diabetes. Herein, we aimed to evaluate the clinical relevance of updated ADA screening recommendations in Chinese adults and the metabolic features and risk factor profiles of these newly diagnosed individuals.
Using a complex, multistage, probability sampling design, we analyzed data from a nationally representative sample of 98,658 Chinese adults in 2010. Participants without previously diagnosed diabetes were included into the present study. We calculated the proportion of individuals with diabetes eligible for screening and the number needed to screen (NNS) to identify one patient with diabetes by age groups.
Setting an earlier age threshold of diabetes screening can identify additional 6.3 million patients with diabetes and 72.3 million individuals with prediabetes, and the proportion of identified individuals increased more in rural, underdeveloped, and central areas. The NNS in Chinese adults dropped significantly from 28 in 30-34 age group to 15 in 35-45 years of age and remained low afterwards. The undiagnosed patients with diabetes who met the new screening age threshold of ADA recommendation were characterized by younger age, lower blood pressure and blood lipids, but higher proportion of overweight and higher level of insulin resistance, and tended to have an unhealthy diet habit, including low intake of fruits and vegetables and high intake of sugar-sweetened beverages, compared to those aged over 45 years.
The new age threshold of 35 years for diabetes screening would reduce the proportion of undiagnosed diabetes with high cost-effectiveness, given the NNS for a positive test result was much lower in 35-45 age group comparing to the lower age group in Chinese adults.
早发型糖尿病在中国的患病率日益上升，大多数年轻糖尿病患者仍未得到诊断。最近，美国糖尿病协会（ADA）更新了其筛查标准，将糖尿病筛查的年龄阈值从45岁降至35岁，这凸显了识别年轻糖尿病患者的重要性。在此，我们旨在评估ADA更新的筛查建议在中国成年人中的临床相关性以及这些新诊断个体的代谢特征和危险因素概况。
采用复杂的多阶段概率抽样设计，我们分析了2010年来自全国代表性的98658名中国成年人样本的数据。本研究纳入了既往未诊断糖尿病的参与者。我们按年龄组计算了符合筛查条件的糖尿病患者比例以及筛查出一名糖尿病患者所需的筛查人数（NNS）。
设定更早的糖尿病筛查年龄阈值可额外识别630万糖尿病患者和7230万糖尿病前期个体，在农村、欠发达和中部地区，识别出的个体比例增加得更多。中国成年人的NNS从30 - 34岁年龄组的28显著降至35 - 45岁的15，此后一直保持在较低水平。与45岁以上的患者相比，符合ADA新筛查年龄阈值的未诊断糖尿病患者具有年龄更小、血压和血脂更低，但超重比例更高和胰岛素抵抗水平更高的特点，并且往往有不健康的饮食习惯，包括水果和蔬菜摄入量低以及含糖饮料摄入量高。
鉴于中国成年人中35 - 45岁年龄组的阳性检测结果的NNS远低于较低年龄组，35岁的糖尿病筛查新年龄阈值将以高成本效益降低未诊断糖尿病的比例。
