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：

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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。