社区无症状2型糖尿病人群早期筛选方法研究

Early screening method on asymptomatic type 2 diabetes in a community population

目的:通过评价单一指标和联合指标筛查早期糖尿病的效果,提出适用于社区无症状T2DM人群的筛查策略。方法:基于"2013年慢性病危险因素监测"2 605例人群资料及空腹血糖(FPG)、糖负荷2小时血糖(2 h PG)值。分别以新诊断糖尿病或糖尿病前期为阳性事件,通过ROC曲线分析,探讨无创指标(风险评分)及实验室指标(FPG、2 h PG)单独使用或联合使用时筛查糖尿病及糖尿病前期的最佳切点和效果。结果:风险评分工具筛查无症状糖尿病的最佳切点为30分,ROC曲线下面积0.808,灵敏度和特异度分别为76%、72%。风险评分使32%的人群进行实验室检测可筛查出76%的无症状糖尿病患者,每例糖尿病患者的发现费用从219元降至92元。风险评分联合2 h PG筛查后,灵敏度和特异度的提升使漏诊率和误诊率大大降低,每例糖尿病的发现费用降至79元。结论:风险评分有助于高效、经济、简便地筛查出社区高风险人群,可采取"风险评分+2 h PG"的简化方法,缩小社区OGTT检查样本量,提高社区糖尿病筛查效率。

Objective：To evaluate the effectiveness single index and combined index on early screening diabetes and to offer a suitable strategy for screening type 2 diabetes and pre-diabetes in a community.Methods：Based on apopulationof 2013 Chronic Disease Risk Factor Surveillance,information on sex,age,height,weight,waist circumference,blood pressure,FPG（fasting plasma glucose）,2 h PG（2 h postprandial glucose）were collected.Individuals diagnosed as diabetes at the time of survey and individuals missing information were excluded.A total of2 642 individuals were involved in a supplementary investigation on family history and diagnosis of diabetes.The response rate was 98.6%（2 605/2 642）.Newly diagnosed diabetes or pre-diabetes were considered as positive events,Receiver Operating Characteristic Curve（ROC）analysis was used to explore the optimal cut-off point and efficacy for screening asymptomatic diabetes and pre-diabetes when noninvasive method（risk score）as well as lab testing method（FPG,2 h PG）were used alone or combined.Results：The optimal cut-off point of risk score for screening diabetes was 30 point.The area under the ROC was 0.808.The sensitivity and specificity were 76% and72%,respectively.By using risk score,at least 76% of individuals could be identified as diabetes and the number of subsequent blood tests was reduced to 32%,and the cost for detecting every single diabetic reduced from RMB219（OGTT for all people）to 92.Combined method had a higher sensitivity and specificity than single index method for screening DM,and also had a lower rate of missed diagnosis and misdiagnosis,and the cost for detecting every single case reduced to RMB 79.Conclusion：Risk score is much helpful for screening high risk population in the community with its high efficiency,economy and simplicity,thus reducing sample size for OGTT and increasing DM screening efficiency in the community.We can use a simplified method combing risk score and 2 h PG for screening asymptomatic patients with diabetes,to achieve the target of improving compliance of the subjects,reducing screening cost and increasing screening efficiency.