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Two-stage, school and community-based population screening successfully identifies individuals and families at high-risk for type 2 diabetes: the Feel4Diabetes-study
BMC Endocrine Disorders ( IF 2.8 ) Pub Date : 2020-03-12 , DOI: 10.1186/s12902-019-0478-9
Yannis Manios , , Christina Mavrogianni , Christina-Paulina Lambrinou , Greet Cardon , Jaana Lindström , Violeta Iotova , Tsvetalina Tankova , Fernando Civeira , Jemina Kivelä , Zoltán Jancsó , Samyah Shadid , Kaloyan Tsochev , Rocío Mateo-Gallego , Sándorné Radó , George Dafoulas , Konstantinos Makrilakis , Odysseas Androutsos

The implementation of population screening and early prevention strategies targeting individuals at high-risk for type 2 diabetes (T2D) seems to be a public health priority. The current work aimed to describe the screening procedure applied in the Feel4Diabetes-study and examine its effectiveness in identifying individuals and families at high risk, primarily for T2D and secondarily for hypertension, among vulnerable populations in low to middle-income countries (LMICs) and high-income countries (HICs) across Europe. A two-stage screening procedure, using primary schools as the entry-point to the community, was applied in low socioeconomic status (SES) regions in LMICs (Bulgaria-Hungary), HICs (Belgium-Finland) and HICs under austerity measures (Greece-Spain). During the first-stage screening via the school-setting, a total of 20,501 parents (mothers and/or fathers) of schoolchildren from 11,396 families completed the Finnish Diabetes Risk Score (FINDRISC) questionnaire, while their children underwent anthropometric measurements in the school setting. Parents from the identified “high-risk families” (n = 4484) were invited to participate in the second-stage screening, including the measurement of fasting plasma glucose (FPG) and blood pressure (BP). In total, 3153 parents participated in the second-stage screening (mean age 41.1 ± 5.6 years, 65.8% females). Among parents who attended the second-stage screening, the prevalence of prediabetes (as defined by impaired fasting glucose; FPG 100-125 mg/dl) and T2D (FPG > 126 mg/dl) was 23.2 and 3.0% respectively, and it was found to be higher in the higher FINDRISC categories. The percentage of undiagnosed T2D among the participants identified with T2D was 53.5%. The prevalence of high normal BP (systolic BP 130-139 mmHg and/ or diastolic BP 85-89 mmHg) and hypertension (systolic BP ≥ 140 mmHg and/ or diastolic BP ≥ 90 mmHg) was 14 and 18.6% respectively, which was also higher in the higher FINDRISC categories. The percentage of cases not receiving antihypertensive treatment among the participants identified with hypertension was 80.3%. The findings of the current study indicate that the two-stage school and community-based screening procedure followed, effectively identified high-risk individuals and families in vulnerable populations across Europe. This approach could be potentially scalable and sustainable and support initiatives for the early prevention of T2D and hypertension. The Feel4Diabetes-intervention is registered at https://clinicaltrials.gov/ (NCT02393872; date of trial registration: March 20, 2015).

中文翻译:

基于学校和社区的两阶段人群筛查成功地确定了2型糖尿病高危人群和家庭:Feel4Diabetes-研究

针对2型糖尿病(T2D)高危人群的人群筛查和早期预防策略的实施似乎是公共卫生的重点。当前的工作旨在描述在Feel4Diabetes研究中应用的筛查程序,并检查其在中低收入国家(LMIC)的弱势人群中识别主要是T2D和次要高血压的高风险个人和家庭的有效性,以及欧洲的高收入国家(HIC)。在紧缩措施(保加利亚-匈牙利),HIC(比利时-芬兰)和HIC(紧缩措施)(希腊)的低社会经济地位(SES)地区,采用了以小学为社区切入点的两阶段筛查程序-西班牙)。在通过学校环境进行的第一阶段筛选中,共有20个,来自11,396个家庭的501名学童的父母(母亲和/或父亲)完成了芬兰糖尿病风险评分(FINDRISC)调查表,而他们的孩子在学校里接受了人体测量。来自确定的“高危家庭”(n = 4484)的父母被邀请参加第二阶段筛查,包括空腹血糖(FPG)和血压(BP)的测量。共有3153名父母参加了第二阶段筛查(平均年龄41.1±5.6岁,女性占65.8%)。在参加第二阶段筛查的父母中,前驱糖尿病(由空腹血糖受损定义; FPG 100-125 mg / dl)和T2D(FPG> 126 mg / dl)的患病率分别为23.2和3.0%,分别为发现在较高的FINDRISC类别中较高。在确定为T2D的参与者中,未被诊断的T2D百分比为53.5%。正常血压高(收缩压130-139 mmHg和/或舒张压BP 85-89 mmHg)和高血压(收缩压≥140 mmHg和/或舒张压BP≥90 mmHg)的患病率分别为14和18.6%,这也是在较高的FINDRISC类别中较高。在确定患有高血压的参与者中,未接受降压治疗的病例百分比为80.3%。当前研究的结果表明,遵循了以学校和社区为基础的两阶段筛查程序,可以有效地确定整个欧洲脆弱人群中的高风险个人和家庭。这种方法可能具有潜在的可扩展性和可持续性,并支持早期预防T2D和高血压的计划。
更新日期:2020-04-22
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