Gendius Ltd, Alderley Edge, United Kingdom.
Clinic Specialized in the Diabetes Management of the Mexico City Government, Public Health Services of the Mexico City Government, Mexico, City, Mexico.
Front Endocrinol (Lausanne). 2024 Mar 22;15:1253492. doi: 10.3389/fendo.2024.1253492. eCollection 2024.
Patients with type 2 diabetes are at an increased risk of chronic kidney disease (CKD) hence it is recommended that they receive annual CKD screening. The huge burden of diabetes in Mexico and limited screening resource mean that CKD screening is underperformed. Consequently, patients often have a late diagnosis of CKD. A regional minimal-resource model to support risk-tailored CKD screening in patients with type 2 diabetes has been developed and globally validated. However, population heath and care services between countries within a region are expected to differ. The aim of this study was to evaluate the performance of the model within Mexico and compare this with the performance demonstrated within the Americas in the global validation.
We performed a retrospective observational study with data from primary care (Clinic Specialized in Diabetes Management in Mexico City), tertiary care (Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán) and the Mexican national survey of health and nutrition (ENSANUT-MC 2016). We applied the minimal-resource model across the datasets and evaluated model performance metrics, with the primary interest in the sensitivity and increase in the positive predictive value (PPV) compared to a screen-everyone approach.
The model was evaluated on 2510 patients from Mexico (primary care: 1358, tertiary care: 735, ENSANUT-MC: 417). Across the Mexico data, the sensitivity was 0.730 (95% CI: 0.689 - 0.779) and the relative increase in PPV was 61.0% (95% CI: 52.1% - 70.8%). These were not statistically different to the regional performance metrics for the Americas (sensitivity: p=0.964; relative improvement: p=0.132), however considerable variability was observed across the data sources.
The minimal-resource model performs consistently in a representative Mexican population sample compared with the Americas regional performance. In primary care settings where screening is underperformed and access to laboratory testing is limited, the model can act as a risk-tailored CKD screening solution, directing screening resources to patients who are at highest risk.
2 型糖尿病患者患慢性肾脏病（CKD）的风险增加，因此建议他们每年进行 CKD 筛查。墨西哥的糖尿病负担巨大，筛查资源有限，导致 CKD 筛查不足。因此，患者通常会被延迟诊断出 CKD。已经开发了一种针对 2 型糖尿病患者的基于风险的 CKD 筛查的区域资源节约模型，并在全球范围内得到验证。然而，一个地区内各国的人群健康和医疗服务预计会有所不同。本研究的目的是评估该模型在墨西哥的表现，并将其与全球验证中在美洲的表现进行比较。
我们进行了一项回顾性观察研究，数据来自初级保健（墨西哥城糖尿病管理专科诊所）、三级保健（萨尔瓦多·祖比兰国家医学和营养研究所）和墨西哥国家健康和营养调查（ENSANUT-MC 2016）。我们在数据集上应用了最小资源模型，并评估了模型性能指标，主要关注敏感性和阳性预测值（PPV）的增加，与筛查所有人的方法相比。
该模型在来自墨西哥的 2510 名患者中进行了评估（初级保健：1358 名，三级保健：735 名，ENSANUT-MC：417 名）。在墨西哥的数据中，敏感性为 0.730（95%CI：0.689-0.779），PPV 的相对增加为 61.0%（95%CI：52.1%-70.8%）。这些与美洲地区的性能指标没有统计学差异（敏感性：p=0.964；相对改善：p=0.132），但在不同数据源之间观察到相当大的差异。
与美洲地区的区域表现相比，该最小资源模型在具有代表性的墨西哥人群样本中表现一致。在初级保健环境中，由于筛查不足且实验室检测有限，该模型可以作为基于风险的 CKD 筛查解决方案，将筛查资源引导至风险最高的患者。
