非胰岛素依赖型糖尿病（NIDDM）的筛查：应该多久进行一次？

Screening for non-insulin-dependent diabetes mellitus (NIDDM): how often should it be performed?

作者信息

Davies M, Day J

机构信息

Department of Diabetes, Leicester Royal Infirmary, United Kingdom.

出版信息

J Med Screen. 1994 Apr;1(2):78-81. doi: 10.1177/096914139400100202.

DOI:10.1177/096914139400100202

PMID:8790490

Abstract

OBJECTIVES

To examine whether a screening programme for diabetes repeated after an interval of 30 months is worthwhile both in terms of yield of new cases and continued high response rate.

METHODS

Self testing for postprandial glycosuria was used as it has been shown to have a good response rate, a good yield of cases of diabetes, and a sensitivity and specificity which compares favourably with more expensive and invasive screening methods. A total of 3231 subjects aged 45-70 years in one practice were screened on two occasions 30 months apart. Eighty seven subjects known to have diabetes were excluded. This number included five new patients who had presented since the initial screen; two of whom had moved into the practice, one who screened positive at the initial screen but failed to attend for the oral glucose tolerance test (OGTT), and two subjects who had screened negative, the first presenting 24 months after screening.

RESULTS

At repeat screening the return rate was lower than at the first screening (72.5% v 79.2%, P < 0.0001). Glycosuria was detected in 52 subjects (2.3%), at the repeat screening, similar to that at the initial screen. Attendance for the OGTT after a positive screening test was 93.2%. Only six subjects of the 24 with glycosuria but normal glucose tolerance at initial screen were found to have glycosuria again; repeat OGTTs were all normal. Of the remaining 46 subjects, 10 had non-insulin-dependent diabetes mellitus (NIDDM) and five impaired glucose tolerance (IGT). The number of subjects with diabetes was not significantly different from that at the initial screening (0.44% v 0.72%, P = 0.2).

CONCLUSIONS

Repeat screening after 30 months has a high response rate, similar rate of detection of glycosuria, and a further yield of 0.44% of newly diagnosed cases of diabetes. A screening programme detecting postprandial glycosuria identifies additional diabetic subjects 30 months after a previous screening programme.

摘要

目的

从新病例检出率和持续高应答率方面，探讨间隔30个月重复进行糖尿病筛查项目是否值得。

方法

采用餐后尿糖自我检测，因为已证明其应答率良好、糖尿病病例检出率高，且敏感性和特异性与更昂贵且侵入性更强的筛查方法相比具有优势。在一个医疗机构中，对3231名年龄在45至70岁的受试者进行了两次筛查，两次筛查间隔30个月。87名已知患有糖尿病的受试者被排除。这一数字包括自初次筛查以来出现的5名新患者；其中2名已转入该医疗机构，1名在初次筛查时呈阳性但未参加口服葡萄糖耐量试验（OGTT），还有2名初次筛查呈阴性，其中1名在筛查后24个月出现症状。

结果

重复筛查时的返回率低于初次筛查（72.5%对79.2%，P<0.0001）。重复筛查时，52名受试者（2.3%）检测出尿糖，与初次筛查时相似。筛查试验呈阳性后参加OGTT的比例为93.2%。初次筛查时尿糖阳性但葡萄糖耐量正常的24名受试者中，只有6名再次检测出尿糖；重复OGTT均正常。其余46名受试者中，10名患有非胰岛素依赖型糖尿病（NIDDM），5名葡萄糖耐量受损（IGT）。糖尿病患者数量与初次筛查时无显著差异（0.44%对0.72%，P = 0.2）。