Baynes C, Caplan S, Hames P, Swift R, Poole S, Wadsworth J, Touquet R, Elkeles R S
Unit of Metabolic Medicine, St Mary's Hospital, London.
J R Soc Med. 1993 Mar;86(3):148-51. doi: 10.1177/014107689308600311.
Four hundred and eighty-two patients with spontaneous skin and superficial sepsis and 291 controls of similar age and sex underwent random capillary blood glucose measurements in order to assess whether screening for diabetes in patients presenting with skin sepsis to an Accident & Emergency Department detects a greater number of cases than that present in the background population. All subjects with a concentration > 7.8 mmol/l were subsequently followed up with a 75 g oral glucose tolerance test. Forty-two (8.7%) of the 482 skin sepsis patients had a capillary blood glucose > 7.8 mmol/l compared to eight (2.7%) of the 291 without sepsis (chi 2 = 9.71, P < 0.002). Of these, 26 of the skin sepsis group and 7 of the control group attended for follow up. Of those who attended, 13 of the skin sepsis group had an abnormal glucose tolerance test (seven diabetes, six impaired glucose tolerance-IGT) compared to two (one diabetes, one IGT) of the control group (chi 2 = 2.87, P < 0.1). The difference in cases of frank diabetes between the two groups was not statistically significant. Of the total eight diabetic cases identified, five (on direct questioning) had symptoms of hyperglycaemia (thirst, polyuria and/or weight loss) and two of the others were obese, one of whom had documented ischaemic heart disease. Thus, while most cases of diabetes in patients with skin sepsis could be detected by specifically asking about hyperglycaemic symptoms and performing a blood glucose estimation when these are present, we suggest that the screening of patients with skin sepsis over 40 years of age provides an opportunistic method of screening. This strategy should yield clinically significant numbers of abnormal cases.
482例自发性皮肤及浅表脓毒症患者和291例年龄及性别相仿的对照者接受了随机毛细血管血糖测量，以评估在急诊科就诊的皮肤脓毒症患者中筛查糖尿病，是否比在一般人群中能发现更多病例。所有血糖浓度>7.8 mmol/l的受试者随后均接受了75 g口服葡萄糖耐量试验。482例皮肤脓毒症患者中有42例（8.7%）毛细血管血糖>7.8 mmol/l，而291例无脓毒症者中有8例（2.7%）（χ2 = 9.71，P < 0.002）。其中，皮肤脓毒症组有26例、对照组有7例前来接受随访。在前来随访的患者中，皮肤脓毒症组有13例葡萄糖耐量试验异常（7例糖尿病，6例糖耐量受损-IGT），而对照组有2例（1例糖尿病，1例IGT）（χ2 = 2.87，P < 0.1）。两组中显性糖尿病病例数的差异无统计学意义。在确诊的8例糖尿病病例中，5例（经直接询问）有高血糖症状（口渴、多尿和/或体重减轻），另外2例肥胖，其中1例有缺血性心脏病记录。因此，虽然大多数皮肤脓毒症患者的糖尿病病例可通过专门询问高血糖症状并在出现症状时进行血糖估计来检测，但我们建议对40岁以上的皮肤脓毒症患者进行筛查是一种机会性筛查方法。这种策略应能发现临床上有意义数量的异常病例。
