Screening for Chronic Complications in Type 1 Diabetes

摘要

Diabetes is associated with significant morbidity and mortality. The majority of disease burden is attributed to long-term complications. Screening tests to detect and therapies to treat early forms of diabetes complications are available, but few diabetes patients receive screening at the recommended levels. This report investigated the prevalence and correlates of screening in a cohort of type 1 diabetes patients. The study population was the Pittsburgh Epidemiology of Diabetes Complications study cohort. Screening tests assessed included the HbA1c test, dilated eye exam, foot exam, fasting lipid profile, and urine protein screen. The aims were to: 1) identify the frequency and trends in screening; 2) identify general correlates of screening as well as to evaluate the influence of patient behavior and health care access factors on receipt of screening tests and examine the association between clinical risk of developing complications and receipt of screening tests to detect complications. Reported screening rates varied widely between individual tests, and optimal screening, the use of all tests, was reported by the fewest subjects. Overall, screening in this population is improving over time. The strongest general correlates of screening were specialist care, weekly blood sugar testing, and gender. A more in depth analysis of screening predictors was aimed at determining whether patient or health care access level factors have a stronger influence on screening was conducted. Health care access factors that specifically included specialist care, intensive insulin therapy, and number of physician visits were found to have a stronger influence on screening compared to patient level factors. Finally, this study found that overall, screening does not appear to be associated with clinical risk of developing complications.Based upon this research, areas in need of improvement include optimal screening rates and targeting screening endeavors towards patients at clinical risk for developing complications, and interventions that incorporate access factors may have the strongest impact. The findings of this report have public health significance and have implications for diabetes preventive care. The data from this research can be used to design interventions and policies that improve screening rates, and reduce subsequent morbidity and mortality associated with chronic complications.