高血壓患者有三分之一未做血糖篩檢


【24drs.com】根據美國的一篇調查結果,有高血壓而無糖尿病的成人,有將近三分之一在過去3年沒有接受血糖篩檢。
  
  明尼蘇達公衛系Renee SM Kidney醫師等作者表示,高血壓與第2型糖尿病是最常見的慢性病共病症;若無法瞭解高血壓患者的篩檢重要性,意謂著可能錯過及早發現、臨床處理與預防糖尿病的機會。
  
  他們的研究結果得自2011年的「明尼蘇達行為風險因素監控系統(BRFSS)」資料,線上發表於11月26日的預防慢性病期刊。
  
  研究者試圖評估對2008年美國預防服務工作小組(USPSTF)所建議-對診斷有高血壓者進行血糖篩檢-之遵從性。
  
  這篇研究包括了3,847名居住於明尼蘇達州的成年人,自我報告表示有高血壓,其中1,247人表示也有糖尿病或糖尿病前期的診斷;其他的2,600人中,66%(1,727人)表示曾接受血糖篩檢,顯示為糖尿病陰性,其餘的33%(873人)在最近3年內皆未曾篩檢。
  
  懷孕時診斷為糖尿病的婦女則是未納入此次調查。
  
  在過去3年內未曾檢測的機率,18-44歲成人是65歲以上者的2.64倍(45-64歲與65歲以上者之間沒有顯著差異),沒有服用高血壓藥物者是有服用者的2.94倍,沒有加入健康計畫者是有加入者的1.97倍,過去2年未做體檢者是有做體檢者的3.70倍。
  
  身體質量指數較低、沒有大學學歷、現在有抽菸習慣者也比較不會進行血糖檢測,但是,在多變項分析中,抽菸與加入健康計畫的影響都不顯著。
  
  雖然這些研究結果只來自一個州,BRFSS的16州資料顯示,明尼蘇達州高血壓成年人的血糖篩檢率居於中間值,Kidney醫師等人認為,這些結果與美國其他地方應是不會有太大差異。
  
  他們認為,USPSTF和各醫學會之間在指引內容的差異,可能是造成無法明確釐清哪些成年人要篩檢糖尿病的原因。
  
  有一個動作可能可以解決這個問題,USPSTF在2014年10月發表新版指引草案,呼籲對45歲以上與更年輕但是有風險因素者進行血糖篩檢,這個建議大致上與美國糖尿病協會和其他團體一致。
  
  資料來源:

Blood Glucose Screening Missed in a Third With Hypertension

By Miriam E Tucker
Medscape Medical News

Nearly a third of adults with hypertension who didn't have diabetes had not received blood glucose screening in the prior 3 years, according to survey results in a US state.

The findings are concerning, given that high blood pressure and type 2 diabetes are one of the most common chronic disease combinations, say the authors, led by Dr Renee SM Kidney (Minnesota Department of Public Health, St Paul).

"Failure to...understand the importance of screening among individuals with hypertension may mean missed opportunities for early detection, clinical management, and prevention of diabetes," she and her colleagues write.

Their findings, from the 2011 Minnesota Behavioral Risk Factor Surveillance System (BRFSS), were published online November 26 in Preventing Chronic Disease.

Results Likely Representative of US Population

The researchers set out to assess adherence to the 2008 US Preventive Services Task Force (USPSTF) recommendation for blood glucose screening among people with diagnosed hypertension.

The study included 3847 adult Minnesota residents with self-reported hypertension, of whom 1247 also reported having received a diagnosis of diabetes or prediabetes.

Of the remaining 2600, 66% (1727) reported having received blood glucose screening, which was negative for diabetes. The other 33% (873) had not been screened in the prior 3 years.

Women who reported only receiving a diagnosis of diabetes while pregnant were excluded from the survey.

The odds of not being tested within the past 3 years were 2.64-fold greater for adults aged 18 to 44 compared with those aged 65 and older (with no significant difference between those aged 45–64 versus ? 65 years), 2.94-fold for those not taking antihypertensive medication versus those who were, 1.97-fold for those not enrolled in a health plan versus those who were, and 3.70-fold for lack of a check-up in the past 2 years versus those who had one.

People with lower body mass index, without a college degree, and current smokers were also less likely to have had a blood glucose test, but both smoking and health plan enrolment were no longer significant in the multivariate analysis.

Although these findings are from just one state, BRFSS data for 16 states show that Minnesota's rates of blood glucose screening among adults with hypertension falls midrange, suggesting that these results would not be "highly divergent" from elsewhere in the US, Dr Kidney and colleagues note.

They suggest that differences among screening guidelines between USPSTF and various medical societies may have contributed to a lack of clarity about who should be screened for diabetes.

In a move that could address the problem, the USPSTF issued new draft guidelines in October 2014 calling for blood glucose screening among all adults aged 45 and older and those who are younger with risk factors, a recommendation generally in line with that of the American Diabetes Association and other groups.

The study was funded by a grant from the Centers for Disease Control and Prevention.

Prev Chronic Dis. 2014;11:E207.

    
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