我国胰岛功能评估方法和应用的初步调查

A preliminary investigation study of islet function assessment

目的以网络线上问卷调查方式,分析我国胰岛功能评估的不同方法和使用的差异和认知。方法2021年9~10月进行网络线上问卷调查,内容包括一般信息、检查项目、检测方法、糖耐量时间点、试剂盒种类及随访频率等,对不同地区、不同级别医院、不同专业及不同职称医生的选择情况进行比较。结果在所有调查对象中,认为需同时检测Ins和C-P来评估新诊断和复诊DM患者胰岛功能医生占79.2%及85.1%。内分泌科医生更倾向于同时检测Ins和C-P(P<0.05)。选择馒头餐和75 g葡萄糖粉的医生对T1DM患者比例为56.0%、28.5%,对T2DM患者为54.7%、31.9%。相较于T2DM患者,内分泌科医生更倾向于对T1DM患者进行馒头餐试验(61.4%vs 41.0%,P<0.05)。在评估新诊断DM患者胰岛功能方法上,7.6%的医生选择六点法(0、30、60、90、120、180 min),27.3%选择五点法Ⅰ(0、30、60、120、180 min),8.5%选择五点法Ⅱ(0、30、60、90、120 min),9.8%选择四点法Ⅰ(0、30、60、120 min),10.3%选择四点法Ⅱ(0、60、120、180 min),13.8%选择三点法(0、60、120 min),13.4%选择两点法(0及120 min)。在评估复诊DM患者时,上述比例为5.3%、20.4%、6.4%、6.6%、9.4%、15.8%及24.1%。在评估频率上,建议每年评估1次的医生比例为39.2%,半年1次比例为24.7%,而评估频率不固定的比例为31.1%。内分泌科医生更倾向于每年评估1次胰岛功能(P<0.05)。与初/中级职称医生比较,高级职称医生选择评估胰岛功能的频率更不固定(P<0.05)。结论我国胰岛功能评估方法的选择和使用存在较大差异,评估策略缺乏统一标准及完善的临床数据。充分了解我国不同地区、专业及职称的临床医生对胰岛功能评估方法的选择和认识的差异性,对临床诊治有重要意义。

Objective To investigate doctors'knowledge and differences in islet function assessment methods in China.Methods This is a cross-sectional study that conducted by online questionnaire survey.Demographic data,examination items,blood collection point of OGTT,detection method,kit type and follow-up frequency were collected and compared among doctors in different regions,different levels of hospitals,different specialties and different titles.Results 79.2%and 85.1%of physicians believed that the levels of insulin and C-peptide should be measured at the same time to assess islet function in patients with newly diagnosed and follow-up diabetes mellitus patients.Endocrinologists preferred to access insulin and C-peptide at the same time(P<0.05).56.0%of physicians chose bread meal test for T1DM patients and 54.7%for T2DM patients.Compared with non-specialists,endocrinologists preferred to commit bread meal test to T1DM patients(61.4%vs 41.0%,P<0.05).In addition,for the islet function assessment of new-onset diabetes patients,7.6%of physicians chose the six-point method(0,30,60,90,120,180min),27.3%selected the five-point method I(0,30,60,120,180 min),8.5%selected the five-point method II(0,30,60,90,120 min),9.8%selected the four-point method I(0,30,60,120 min),10.3%selected the four-point method II(0,60,120,180 min),13.8%chose the three-point method(0,60,120 min)and 13.4%chose the two-point method(0,120 min).At the time of follow-up assessment,the above selection rates were 5.3%,20.4%,6.4%,6.6%,9.4%,15.8%and 24.1%,respectively.In terms of the frequency of assessment,39.2%of doctors assessed islet function once a year and 24.7%once every six months.Specialists preferred to assess islet function once a year,and physicians with senior titles chose to assess islet function more variably.Conclusion At present,there are still great differences in assessment methods of islet function in China.It is of great significance for the clinical diagnosis and treatment of diabetes to understand the differences in the selection of islet function assessment methods among doctors in different regions,specialties and job titles.