Department of Medicine, University of Toronto, Toronto, ON, Canada.
Department of Medicine, Toronto General Hospital, University Health Network, Toronto, ON, Canada.
Cardiovasc Diabetol. 2023 Aug 28;22(1):227. doi: 10.1186/s12933-023-01952-y.
Outcomes of diabetes screening in contemporary, multi-ethnic populations are unknown. We examined the association of prior outpatient diabetes screening with the risks of cardiovascular events and mortality in Ontario, Canada.
We conducted a population-based cohort study using administrative databases among adults aged ≥ 20 years with incident diabetes diagnosed during 2014-2016. The exposure was outpatient diabetes screening performed within 3 years prior to diabetes diagnosis. The co-primary outcomes were (1) a composite of all-cause mortality and hospitalization for myocardial infarction, stroke, coronary revascularization, and (2) all-cause mortality (followed up until 2018). We calculated standardized rates of each outcome and conducted cause-specific hazard modelling to determine the adjusted hazard ratio (HR) of the outcomes, adjusting for prespecified confounders and accounting for the competing risk of death.
We included 178,753 Ontarians with incident diabetes (70.2% previously screened). Individuals receiving prior screening were older (58.3 versus 53.4 years) and more likely to be women (49.6% versus 40.0%) than previously unscreened individuals. Individuals receiving prior screening had relatively lower standardized event rates than those without prior screening across all outcomes (composite: 12.8 versus 18.1, mortality: 8.2 versus 11.1 per 1000 patient-years). After multivariable adjustment, prior screening was associated with 34% and 32% lower risks of the composite (HR 0.66, 0.63-0.69) and mortality (0.68, 0.64-0.72) outcomes. Among those receiving prior screening, a result in the prediabetes range was associated with lower risks of the composite (0.82, 0.77-0.88) and mortality (0.71, 0.66-0.78) outcomes than a result in the normoglycemic range.
Previously screened individuals with diabetes had lower risks of cardiovascular events and mortality versus previously unscreened individuals. Better risk assessment tools are needed to support wider and more appropriate uptake of diabetes screening, especially among young adults.
目前尚不清楚在当代多民族人群中进行糖尿病筛查的结果。我们研究了在加拿大安大略省，既往门诊糖尿病筛查与心血管事件和死亡风险的相关性。
我们使用 2014-2016 年期间诊断为新发糖尿病的年龄≥20 岁的成年人的行政数据库进行了一项基于人群的队列研究。暴露因素是在糖尿病诊断前 3 年内进行的门诊糖尿病筛查。主要复合结局为（1）全因死亡率和因心肌梗死、中风、冠状动脉血运重建住院的复合结局，（2）全因死亡率（随访至 2018 年）。我们计算了每种结局的标准化发生率，并进行了特定病因的风险比（HR）建模，以确定调整混杂因素后的结局调整 HR，并考虑死亡的竞争风险。
我们纳入了 178753 名患有新发糖尿病的安大略省居民（70.2%之前接受过筛查）。与未接受过筛查的个体相比，接受过既往筛查的个体年龄更大（58.3 岁 vs. 53.4 岁），女性更多（49.6% vs. 40.0%）。在所有结局中，接受过既往筛查的个体的标准化事件发生率均低于未接受过筛查的个体（复合结局：12.8 例 vs. 18.1 例，死亡率：每 1000 患者年 8.2 例 vs. 11.1 例）。多变量调整后，既往筛查与复合结局（HR 0.66，0.63-0.69）和死亡率（0.68，0.64-0.72）风险降低 34%和 32%相关。在接受过既往筛查的个体中，与正常血糖范围相比，糖尿病前期范围的筛查结果与复合结局（0.82，0.77-0.88）和死亡率（0.71，0.66-0.78）风险降低相关。
与未接受过筛查的个体相比，既往接受过筛查的糖尿病患者发生心血管事件和死亡的风险较低。需要更好的风险评估工具来支持更广泛和更恰当的糖尿病筛查，尤其是在年轻人中。
