北京市儿童2型糖尿病筛查方法与美国Drobac筛查方案实施情况比较

Comparison of the practicability and operable status of T2DM screening protocols between Beijing study group application and ADA recommendation

目的 比较北京市研究组儿童2型糖尿病（T2DM）筛查方法和美国ADA推荐的Drobac筛查方案的实施结果。方法 北京市研究组采用分层整群随机抽样方法获得17311例北京市8～18岁中小学生，对其中超重／肥胖并具有1个以上危险因素（T2DM家族史、黑棘皮症和青春期发育）者进行T2DM和糖调节异常（IGR）筛查，先用空腹指末梢血糖（FCBG）筛查，对≥5．6mmol／L者再作OGTT进行诊断。将其与Drobac筛查方案的实施结果进行比较。结果 北京市研究组采用先FCBG后OGTT的筛查方法，完成筛查者比率达59．26％，高于Drobac的直接静脉血糖筛查完成者比率33．51％。两种筛查方法的确诊率均较低（6．42／1000和15．5／1000）。与Drobac的筛查研究不同，北京市研究组结果表明完成筛查试验和未完成者在年龄、性别、肥胖发生率、黑棘皮症、T2DM家族史、青春期发育上差异无统计学意义（P〉0．05）。结论 在儿童中行FCBG筛查后再做OGTT的确诊试验简便易行，可操作性强，是值得推荐的筛查T2DM的方法。

Objective To compare the practicability and operable status of T2DM screening protocols between American Diabetes Association （ADA） recommendation and Beijing study group application. Methods A total of 17 311 schoolchildren aged 8-18 years were included in our study for screening T2DM and IGR in overweight/obese children who had more than one risk factor （family history of T2DM, acanthosis nigricans, puberty）. The screening test was fasting capillary blood glucose （FCBG） at first and a diagnostic test of oral glucose tolerance test （OGTT） if necessary. 997 subjects aged 10 to 18 years who were examined in routine health examination were included in Drobac＇s research. ADA recommended protocol for screening type 2 diabetes was applied. Results Beijing study group had much higher call-back rate than did Drobac＇s study （59.62% vs 33.51%）. The final diagnosis rate were both low in two screening programs（6.42/1000 and 15.5/1000）. Distinguished from Drobac＇s study, there were no significant differences in age, gender, obesity ratio, acanthosis nigricans and family history of diabetes between completed and uncompleted groups （P〉0.05） in Beijing research. Conclusions The protocol of FCBG at first and OGTT if necessary should be recommended in screening T2DM and IGR for Beijing Children.