Use of Electronic Instruments for the Opportunistic Screening of Undiagnosed Diabetes and Other Disorders of Glucose Metabolism. The Diabetes Screening Palermo Study “D.S.P.S.”

摘要

Introduction : The Diabetes Screening Palermo Study evaluated, in the general practice setting, the effectiveness of a screening strategy for type 2 diabetes mellitus (T2DM). This study used electronic instruments to identify individuals at a high risk of diabetes and to provide early detection of undiagnosed T2DM and prediabetes. Methods and results : This is an observational study in primary care from Italy. The screening programme was divided into two phases. Phase 1: identification of patients at high risk of diabetes through the analysis of databases of general practitioners. Phase 2: screening to test for diabetes or prediabetes using fasting plasma glucose (FPG) and the 2-h plasma glucose value after a 75-g oral glucose tolerance test (OGTT). The OGTT was a central component of the screening programme and a significant proportion of individuals at high risk for diabetes, which is defined as those with impaired fasting glucose (IFG), had blood glucose levels, after the glucose load that either were compatible with a diagnosis of T2DM or impaired glucose tolerance (IGT). Resultsafter 24 months of the study: the total study was composed of 26 410 subjects, of which 13 319 (50.43%) were at high risk of T2DM. 8174 subjects, representing the 61,37% of those at high-risk, had at least one measurement of fasting plasma glucose (FPG). A total of 5428 subjects equal to 66,41% of those with at least one measurement of fasting blood glucose and equal to 40.75% of all high-risk subjects, had impaired fasting glucose (IFG) A sample of 965 subjects with IFG, were then subjected, at random, to an OGTT, on the basis of which 136 subjects (14.09%) were identified with IGT and 83 subjects (8.60%) gave a response compatible with the diagnosis of T2DM. Conclusion : In a primary care setting, a proactive approach towards diabetes screening, especially performing OGTT in subjects with IFG, facilitated the early diagnosis of T2DM. This reduced the percentage of cases of undiagnosed diabetes and allowed the identification of individuals with prediabetes who required preventive interventions. Through a process of clinical audit, the computerised systems, facilitated the identification of people at high risk for diabetes and led to better management of the screening programme.