糖尿病前期患病率的上升增加了2型糖尿病(T2DM)的人群风险。代谢综合征和心血管疾病。全科医生(GP)的早期识别提供了改变生活方式的机会,可以降低这些风险。
这项研究检查了澳大利亚13岁或以上患者的16年高血糖相关测试,或有诊断T2DM的风险。改善健康评估和护理(BEACH)研究是一项全国性的横断面调查,通过单阶段,整群抽样设计。每年从澳大利亚各地随机选择大约1,000名全科医生(2000/01-20,015/16),每个人都记录了与同意的患者的100次连续临床接触的细节。点估计针对簇内相关性和GP特征进行了调整。
一万五千六百七十九名全科医生记录了与13岁以上患者的1,387,190次临床接触的细节。糖尿病前期和T2DM分别为0.25%(95%CI:0.24-0.27%)和3.68%(95%CI:3.62-3.73%)。在研究结束时,治疗前驱糖尿病的比例高2.3倍,T2DM,高1.5倍。糖尿病前期的比例(55.9%,95%CI:53.9-57.8%)和T2DM(27.3%,95%CI:26.7-27.9%)要求进行一项或多项高血糖相关测试的管理场合相对稳定。然而,观察到测试类型的差异。对于糖尿病前期,糖耐量试验最为常见,但从2014/15年度开始,对HbA1c检测的要求开始增加.对于T2DM,HbA1c检测是最常见的,和一个或多个葡萄糖测试的要求逐渐下降。
观察到的16年年度趋势与糖尿病前期和T2DM发病率的上升相一致。全科医生似乎受到国家保险计划和高血糖相关病理测试临床指南变化的强烈影响。然而,一些全科医生可能已经抢占了政策变化,因为也有证据表明“未经认可”的测试,尤其是糖尿病前期,这需要进一步调查。糖尿病前期的发病率越来越高,再加上高比例的病理要求的管理场合有大量的资源影响。因此,呼吁降低前驱糖尿病筛查的风险阈值需要进行经济分析。正在进行中,可靠,澳大利亚的临床实践指南和政策需要最新的数据.
The rising prevalence of prediabetes increases the population risk of type 2 diabetes mellitus (T2DM), metabolic syndrome and cardiovascular disease. Early identification by General Practitioners (GPs) provides opportunities for lifestyle modifications that can lower these risks.
This study examined 16 years of hyperglycaemia-related testing for patients in Australia aged 13 years or older with, or at risk of a diagnosis of T2DM. The Bettering the Evaluation and Care of Health (BEACH) study is a national cross-sectional survey, with a single-stage, cluster sampling design. Approximately 1,000 GPs were randomly selected annually (2000/01-20,015/16) from across Australia, who each recorded details of 100 consecutive clinical encounters with consenting patients. Point estimates were adjusted for intracluster correlation and GP characteristics.
Fifteen thousand six hundred seventy nine GPs recorded details of 1,387,190 clinical encounters with patients aged 13 + years. Prediabetes and T2DM were managed at 0.25% (95% CI: 0.24-0.27%) and 3.68% (95% CI: 3.62-3.73%) of encounters respectively. By the end of the study, the proportion of encounters where prediabetes was managed was 2.3 times higher and for T2DM, 1.5 times higher. The proportion of prediabetes (55.9%, 95% CI: 53.9-57.8%) and T2DM (27.3%, 95% CI: 26.7-27.9%) management occasions where one or more hyperglycaemia-related tests were requested were relatively stable. However, differences in the types of tests were observed. For prediabetes, glucose tolerance tests were most common but from 2014/15, requests for HbA1c tests began to increase. For T2DM, HbA1c tests were most common, and requests for one or more glucose tests gradually declined.
The observed 16-year annual trends align with the rising incidence of prediabetes and T2DM. GPs appeared to be strongly influenced by changes to the national insurance scheme and clinical guidelines for hyperglycaemia-related pathology testing. However, some GPs may have been pre-empting policy changes as there was also evidence of \'unendorsed\' testing, notably for prediabetes, that warrants further investigation. The increasing proportion of encounters for prediabetes, coupled with a high proportion of management occasions where pathology was requested have substantial resource implications. Calls to lower the risk threshold for prediabetes screening therefore warrant an economic analysis. Ongoing, reliable, up-to-date data is needed to inform clinical practice guidelines and policy in Australia.