中国糖尿病风险评分表在南昌社区中老年人群糖尿病筛查中的运用及改进
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摘要
目的探讨中国糖尿病风险评分表在南昌社区中老年人群糖尿病筛查中的运用效果及改进。方法对纳入的南昌15个社区,年龄40-74岁8714人,进行问卷调查、体格检查及生化检测,分别采用中国糖尿病风险评分表及其改进表(在中国糖尿病风险评分表中用颈围替换腰围构建的预测模型⑴在中国糖尿病风险评分表中加入颈围构建的预测模型⑵筛查入选人群,并用口服葡萄糖耐量试验(OGTT)作为诊断糖尿病的金标准,用受试者工作曲线对3种方法进行比较。结果 3种方法评估糖尿病发生风险的AUC分别为0.781(95%CI 0.772-0.790)、0.791(95%CI 0.783-0.800)、0.772(95%CI 0.763-0.780),三种方法最佳切点,及其灵敏度和特异度分别为25分86.5%、49.5%,28分、71.5%、70.9%,35分、71.3%和68.9%,3种方法ROC曲线下面积比较,差异均有统计学意义,且预测模型1>中国糖尿病风险评分表>预测模型2。结论中国糖尿病风险评分表适用于南昌社区中老年人群的糖尿病风险筛查,颈围替换评分表中的腰围可以提高筛查效果。
Objective To explore the application effect and improvement of Chinese Diabetes Risk Score in the middle-agedand elderly population in Nanchang community. Methods The questionnaires,physical examinations,and biochemical tests wereconducted among 15 communities 8714 people in Nanchang,aged 40-74 years old. Chinese diabetes risk score and Improved dia-betes risk score(Predictive model 1 constructed by replacing the waist circumference with neck circumference in the Chinese Di-abetes Risk Score Table. Predictive model 2 constructed by neck circumference in the Chinese Diabetes Risk Score Table) wereused to screen all selected people. The Oral glucose tolerance test(OGTT) was used as the gold standard for the diagnosis of dia-betes. the Area under the receiver operating curve(AUC) of the three methods at the best cut-0 ff point were calculated and com-pared. Results The AUC of the three methods for assessing the risk of diabetes was 0.781(95%CI 0.772 to 0.790),0.791(95%CI0.783 to 0.800) and 0.772(95%CI 0.763～0.780) respectively,The sensitivity and specificity were 25 points,86.5%,49.5%,28 point,71.5%,70.9%,35 point,71.3%,68.9%,respectively. The AUC of the three methods were statistically significant,and theprediction model 1> Chinese Diabetes Risk Score > Predictive Model 2. Conclusion The Chinese Diabetes Risk Score apply todiabetes risk screening in the middle-aged and elderly population in Nanchang community. by replacing the waist circumferencewith the neck circumference In The Chinese Diabetes Risk Score may improve the screening effect.
Objective To explore the application effect and improvement of Chinese Diabetes Risk Score in the middle-agedand elderly population in Nanchang community. Methods The questionnaires,physical examinations,and biochemical tests wereconducted among 15 communities 8714 people in Nanchang,aged 40-74 years old. Chinese diabetes risk score and Improved dia-betes risk score(Predictive model 1 constructed by replacing the waist circumference with neck circumference in the Chinese Di-abetes Risk Score Table. Predictive model 2 constructed by neck circumference in the Chinese Diabetes Risk Score Table) wereused to screen all selected people. The Oral glucose tolerance test(OGTT) was used as the gold standard for the diagnosis of dia-betes. the Area under the receiver operating curve(AUC) of the three methods at the best cut-0 ff point were calculated and com-pared. Results The AUC of the three methods for assessing the risk of diabetes was 0.781(95%CI 0.772 to 0.790),0.791(95%CI0.783 to 0.800) and 0.772(95%CI 0.763～0.780) respectively,The sensitivity and specificity were 25 points,86.5%,49.5%,28 point,71.5%,70.9%,35 point,71.3%,68.9%,respectively. The AUC of the three methods were statistically significant,and theprediction model 1> Chinese Diabetes Risk Score > Predictive Model 2. Conclusion The Chinese Diabetes Risk Score apply todiabetes risk screening in the middle-aged and elderly population in Nanchang community. by replacing the waist circumferencewith the neck circumference In The Chinese Diabetes Risk Score may improve the screening effect.
引文
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[6]刘丽华.糖脂代谢紊乱与多囊卵巢综合征相关性分析[J].江西医药,2016,51(8):808-810.
[7]詹雪梅.2型糖尿病患者的空腹血糖控制水平的相关因素分析[J].江西医药,2015,50(9):921-922.
[8]Yang GR,Yuan SY,Fu HJ,et al. Beijing Community DiabetesStudy Group. Neck circumference positively related with centralobesity,overweight,and metabolic syndrome in Chinese subjectswith type 2 diabetes:Beijing Community Diabetes Study 4[J].Diabetes Care,2010,33(11):2465-2467.
[9]Liang J,Teng F,Li Y,et al. Neck circumference and insulinresistance in Chinese adults:the Cardiometabolic Risk in Chinese(CRC)Study[J]. Diabetes Care,2013,36(9):e145.
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[14]Hanley JA,Mcneil BJ. A method of comparing the areas underreceiver operating characteristic curves derived from the samecases[J]. Radiology,1983,148:839.
[15]SATHISH T,KANNAN S,SARMA SP,et al. Screeningperformance of diabetes risk scores among Asians and Whites inRural Kerala,India[J]. Prev Chronic Dis,2013,10(1):80-87.
[16]Zhou XH,Qiao Q,Ji LN,et al. Nonlaboratory-based riskassessment algorithm for undi agnosed type 2 diabetes developedon a nation-wide diabetes survey[J]. Diabetes Care,2013,36(12):3944-3952.
[17]查彦红,王菊芳.风险评分方法预测2型糖尿病的临床应用评价[J].浙江预防医学,2015,27(7):669-672.
[18]何婷超,刘爱萍,王东平,伍思佳,宋,菲,王浩杰,宋阳,王培玉.“中国糖尿病风险评分表”在内蒙古乌海市糖尿病筛查中的应用及其改进[J].卫生研究,2017,46(1):46-51+56.
[19]Preis SR,Massaro JM,Hoffmann U,et al. Neck Circumference asa Novel Measure of Cardiometabolic Risk:The Framingham HeartStudy[J]. The Journal of Clinical Endocrinology and Metabolism,2010,95(8):3701-3710.
[20]葛凤.2型糖尿病患者颈围与代谢及胰岛素抵抗相关性研究[D].VIP,2016.
[2]Guariguata L,Whiting DR,Hambleton I,et al. Global estimates ofdiabetes prevalence for 2013 and projections for 2035[J]. DiabetesRes Clin Pract,2014,103:137-149.
[3]Duncan WE,Linville N,Clement S,et al. Assessing risk factorswhen screening for diabetes mellitus[J]. Diabetes Care,1993,16(10):1403-1404.
[4]中华医学会糖尿病学分会.中国2型糖尿病防治指南(2013版)[J].中国糖尿病杂志,2014,22(7):447-498.
[5]Laakso M,Matilainen V,Kein?nen-Kiukaanniemi S. Association ofneck circumference with insulin resistance-related factors[J]. Int JObes Relat Metab Disord,2002,26(6):873-875.
[6]刘丽华.糖脂代谢紊乱与多囊卵巢综合征相关性分析[J].江西医药,2016,51(8):808-810.
[7]詹雪梅.2型糖尿病患者的空腹血糖控制水平的相关因素分析[J].江西医药,2015,50(9):921-922.
[8]Yang GR,Yuan SY,Fu HJ,et al. Beijing Community DiabetesStudy Group. Neck circumference positively related with centralobesity,overweight,and metabolic syndrome in Chinese subjectswith type 2 diabetes:Beijing Community Diabetes Study 4[J].Diabetes Care,2010,33(11):2465-2467.
[9]Liang J,Teng F,Li Y,et al. Neck circumference and insulinresistance in Chinese adults:the Cardiometabolic Risk in Chinese(CRC)Study[J]. Diabetes Care,2013,36(9):e145.
[10]WHO. Definition,diagnosis and classification of diabetesmellitusand its complication. Report of a WHO consultation.Part1:diagnosis and classification of diabetes mellitus[R]. Geneva:WorldHealth organization,1999.
[11]Lindstrom J,Tuomilehto J. The diabetes risk score:a practical toolto predict type 2 diabetes risk[J]. Diabetes Care,2003,26(3):725-731.
[12]Al-Lawati JA,Tuomilehto J. Diabetes risk score in Oman:a toolto identify prevalent type 2 diabetes among Arabs of the MiddleEast[J]. Diabetes Res Clin Pract,2007,77:438.
[13]Glumer C,Carstensen B,Sandback A,et al. A Danish diabetesrisk score for targeted screening[J]. Diabetes Care,2004,27:727-733.
[14]Hanley JA,Mcneil BJ. A method of comparing the areas underreceiver operating characteristic curves derived from the samecases[J]. Radiology,1983,148:839.
[15]SATHISH T,KANNAN S,SARMA SP,et al. Screeningperformance of diabetes risk scores among Asians and Whites inRural Kerala,India[J]. Prev Chronic Dis,2013,10(1):80-87.
[16]Zhou XH,Qiao Q,Ji LN,et al. Nonlaboratory-based riskassessment algorithm for undi agnosed type 2 diabetes developedon a nation-wide diabetes survey[J]. Diabetes Care,2013,36(12):3944-3952.
[17]查彦红,王菊芳.风险评分方法预测2型糖尿病的临床应用评价[J].浙江预防医学,2015,27(7):669-672.
[18]何婷超,刘爱萍,王东平,伍思佳,宋,菲,王浩杰,宋阳,王培玉.“中国糖尿病风险评分表”在内蒙古乌海市糖尿病筛查中的应用及其改进[J].卫生研究,2017,46(1):46-51+56.
[19]Preis SR,Massaro JM,Hoffmann U,et al. Neck Circumference asa Novel Measure of Cardiometabolic Risk:The Framingham HeartStudy[J]. The Journal of Clinical Endocrinology and Metabolism,2010,95(8):3701-3710.
[20]葛凤.2型糖尿病患者颈围与代谢及胰岛素抵抗相关性研究[D].VIP,2016.