Impact of Population-Based Screening for Diabetes and Prediabetes Among 67-Year-Olds Using Point-of-Care HbA1c on Healthcare Ultilisation, Results from the VISP Cohort.

IF 3.4 2区医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Clinical Epidemiology Pub Date : 2025-02-05 eCollection Date: 2025-01-01 DOI:10.2147/CLEP.S487825

Jesper Winkler Andersen, Annette Høgh, Jes Sanddal Lindholt, Rikke Søgaard, Henrik Støvring, Knud Bonnet Yderstræde, Annelli Sandbæk, Marie Dahl

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引用次数: 0

Abstract

Purpose: The present study aims to evaluate the changes in healthcare utilization following population-based screening for diabetes mellitus (DM) using point-of-care HbA1c measurement in the Viborg Screening Program (VISP) cohort, which invites all 67-year-olds in Viborg, Denmark, for cardiovascular disease (CVD) and DM screening.

Patients and methods: We conducted a cohort study using data from VISP and Danish national health registers. The study included 2386 individuals invited to VISP from August 1, 2014, to May 31, 2017. Exclusion criteria were non-attenders, those with prior DM, and those with missing HbA1c measurements. Pre- and post-screening healthcare utilization was analyzed, stratified by HbA1c levels: <42 mmol/mol (normal), 42-48 mmol/mol (pre-DM), and ≥48 mmol/mol (DM). Statistical analyses were performed using Poisson and logistic regression models to compare ratios of healthcare utilization before and after screening.

Results: Of the participants, 16.5% had pre-DM, and 3.4% had DM. Screening resulted in increased general physician contacts across all HbA1c groups, the highest increase was seen in the DM group with a pre- vs post-screening odds ratio [OR] of 3.25 (95% CI: 1.06-9.95) and a relative odds ratio [ROR] of 2.70 (0.87-8.39). Also, in this group, the OR for having ≥1 HbA1c measurement one year pre- vs post-screening was 5.56 (2.77 -11.14) and 26.8% (17.6-37.9) started glucose-lowering treatment within two years post-screening. Despite expectations, healthcare utilization did not decrease among those with normal HbA1c levels.

Conclusion: Population-based screening for DM and CVD among 67-year-olds resulted in increased healthcare utilization, particularly among those with screen-detected DM and pre-DM. The anticipated reduction in healthcare utilization among individuals with normal HbA1c levels was not observed. These findings highlight the potential for screening to enhance disease management and underscore the need for strategies to optimize healthcare resource use following screening, especially for individuals without DM.

Trial registration: NCT03395509.

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基于人群的67岁糖尿病和前驱糖尿病筛查对医疗保健利用的影响，来自VISP队列的结果

目的：本研究旨在评估在维堡筛查计划（VISP）队列中使用即时HbA1c测量进行糖尿病（DM）基于人群筛查后医疗保健利用的变化，该队列邀请丹麦维堡的所有67岁老年人进行心血管疾病（CVD）和DM筛查。患者和方法：我们使用来自VISP和丹麦国家健康登记册的数据进行了一项队列研究。该研究包括2014年8月1日至2017年5月31日受邀参加VISP的2386人。排除标准为未参加治疗的患者、既往患有糖尿病的患者和HbA1c检测缺失的患者。结果：在参与者中，16.5%的人患有糖尿病前期，3.4%的人患有糖尿病。筛查导致所有HbA1c组的普通医生接触增加，糖尿病组增加最多，筛查前与筛查后的优势比[OR]为3.25 (95% CI: 1.06-9.95)，相对优势比[ROR]为2.70（0.87-8.39）。此外，在该组中，筛查前与筛查后一年HbA1c≥1的OR为5.56(2.77 -11.14)，筛查后两年内开始降糖治疗的OR为26.8%（17.6-37.9）。与预期不同，HbA1c水平正常的患者的医疗利用率并未下降。结论：在67岁的人群中，基于人群的糖尿病和心血管疾病筛查导致医疗保健利用率增加，特别是在筛查检测到糖尿病和糖尿病前期的人群中。在HbA1c水平正常的个体中，没有观察到预期的医疗保健利用率降低。这些发现强调了筛查加强疾病管理的潜力，并强调了筛查后优化医疗资源使用策略的必要性，特别是对于没有dm的个体。试验注册：NCT03395509。

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来源期刊

Clinical Epidemiology Medicine-Epidemiology

CiteScore

6.30

自引率

5.10%

发文量

169

审稿时长

16 weeks

期刊介绍： Clinical Epidemiology is an international, peer reviewed, open access journal. Clinical Epidemiology focuses on the application of epidemiological principles and questions relating to patients and clinical care in terms of prevention, diagnosis, prognosis, and treatment. Clinical Epidemiology welcomes papers covering these topics in form of original research and systematic reviews. Clinical Epidemiology has a special interest in international electronic medical patient records and other routine health care data, especially as applied to safety of medical interventions, clinical utility of diagnostic procedures, understanding short- and long-term clinical course of diseases, clinical epidemiological and biostatistical methods, and systematic reviews. When considering submission of a paper utilizing publicly-available data, authors should ensure that such studies add significantly to the body of knowledge and that they use appropriate validated methods for identifying health outcomes. The journal has launched special series describing existing data sources for clinical epidemiology, international health care systems and validation studies of algorithms based on databases and registries.