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Analysis of Guidelines for Screening Diabetes Mellitus in an Ambulatory Population

机译:流动人口中糖尿病筛查指南的分析

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摘要

OBJECTIVES: To compare the case-finding ability of current national guidelines for screening diabetes mellitus and characterize factors that affect testing practices in an ambulatory population.PATIENTS AND METHODS: In this retrospective analysis, we reviewed a database of 46,991 nondiabetic patients aged 20 years and older who were seen at a large Midwestern academic physician practice from January 1, 2005, through December 31, 2007. Patients were included in the sample if they were currently being treated by the physician group according to Wisconsin Collaborative for Healthcare Quality criteria. Pregnant patients, diabetic patients, and patients who died during the study years were excluded. The prevalence of patients who met the American Diabetes Association (ADA) and/or US Preventive Services Task Force (USPSTF) criteria for diabetes screening, percentage of these patients screened, and number of new diabetes diagnoses per guideline were evaluated. Screening rates were assessed by number of high-risk factors, primary care specialty, and insurance status.RESULTS: A total of 33,823 (72.0%) of 46,991 patients met either the ADA or the USPSTF screening criteria, and 28,842 (85.3%) of the eligible patients were tested. More patients met the ADA criteria than the 2008 USPSTF criteria (30,790 [65.5%] vs 12,054 [25.6%]), and the 2008 USPSTF guidelines resulted in 460 fewer diagnoses of diabetes (33.1%). By single high-risk factor, prediabetes (15.8%) and polycystic ovarian syndrome (12.6%) produced the highest rates of diagnosis. The number of ADA high-risk factors predicted diabetes, with 6 (23%) of 26 patients with 6 risk factors diagnosed as having diabetes. Uninsured patients were tested significantly less often than insured patients (54.9% vs 85.4%).CONCLUSION: Compared with the ADA recommendations, the new USPSTF guidelines result in a lower number of patients eligible for screening and decrease case finding significantly. The number and type of risk factors predict diabetes, and lack of health insurance decreases testing.
机译:目的:为了比较当前国家筛查糖尿病的国家指南的病例发现能力,并确定影响非卧床人群测试实践的因素。在这项回顾性分析中,我们回顾了一个数据库,该数据库包含46991例年龄在20岁及以下的非糖尿病患者。从2005年1月1日至2007年12月31日在中西部大型学术医师诊所就诊的年龄较大的患者。如果患者组目前根据Wisconsin Collaborative for Healthcare Quality标准进行的治疗,则将其包括在样本中。在研究期间不包括孕妇,糖尿病患者和死亡患者。评估了符合美国糖尿病协会(ADA)和/或美国预防服务工作队(USPSTF)进行糖尿病筛查标准的患者患病率,筛查的这些患者的百分比以及每个指南中新诊断的糖尿病人数。结果:共有ADA或USPSTF筛查标准的46991例患者中有33,823例(72.0%),符合ADA或USPSTF筛查标准的患者,有28,842例(85.3%)对合格的患者进行了测试。与2008年USPSTF标准相比,符合ADA标准的患者更多(30,790 [65.5%]比12,054 [25.6%]),而2008 USPSTF指南导致的糖尿病诊断减少了460(33.1%)。按单一的高危因素,糖尿病前期(15.8%)和多囊卵巢综合征(12.6%)产生最高的诊断率。 ADA高危因素的数量可预测糖尿病,在26位患者中有6位(23%)被诊断为患有糖尿病的6种危险因素。结论:与ADA建议相比,新的USPSTF指南导致合格筛查的患者数量减少,并且显着减少了病例发现的频率,因此未保险患者的检查频率明显低于保险患者(54.9%vs 85.4%)。危险因素的数量和类型可预测糖尿病,而缺乏健康保险会降低测试水平。

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