[Effectiveness of different screening strategies for type 2 diabete on preventing cardiovascular diseases in a community-based Chinese population using a decision-analytic Markov model].

OBJECTIVE: To evaluate the effectiveness of different screening strategies for type 2 diabetes to prevent cardiovascular disease in a community-based Chinese population from economically developed areas based on the Chinese electronic health records research in Yinzhou (CHERRY) study. METHODS: A Markov model was used to simulate different systematic diabetes screening strategies, including: (1) screening among Chinese adults aged 40-70 years recommended by the 2020 Chinese Guideline for the prevention and Treatment of Type 2 Diabetes (Strategy 1); (2) screening among Chinese adults aged 35 to 70 years recommended by the 2022 American Diabetes Association Standard of Medical Care in Diabetes (Strategy 2); and (3) screening among Chinese adults aged 35-70 years with overweight or obesity recommended by the 2021 United States Preventive Services Task Force Recommendation Statement on Screening for Prediabetes and Type 2 Diabetes (Strategy 3). According to the guidelines, individuals who were screened positively (fasting plasma glucose ≥ 7.0 mmol/L) would be introduced to intensive glycemic targets management (glycated hemoglobin < 7.0%).The Markov model simulated different screening scenarios for ten years (cycles) with parameters mainly from the CHERRY study or published literature. Number of cardiovascular disease events or deaths could be prevented and number needed to screen (NNS) were calculated to compare the effectiveness of the different strategies. One-way sensitivity analysis on the sensitivity of screening methods and probabilistic sensitivity analysis on uncertainties of diabetes incidence, the sensitivity of screening methods, and intensive glycemic management effects were conducted. RESULTS: Totally 289 245 Chinese adults aged 35-70 years without cardiovascular diseases or diagnosed diabetes at baseline were enrolled. In terms of the number of cardiovascular disease events could be prevented, Strategy 1 for systematic diabetes screening among the adults aged 35-70 years was 222 (95%UI: 180-264), Strategy 2 for systematic diabetes screening among the adults aged 40-70 years was 227 (95%UI: 185-271), and Strategy 3 for systematic diabetes screening among the adults aged 35-70 years with obesity or overweight (body mass index ≥ 24 kg/m2) was 131 (95%UI: 98-164), compared with opportunistic screening. NNS per cardiovascular disease event for the strategies 1, 2 and 3 were 1 184 (95%UI: 994-1 456), 1 274 (95%UI: 1 067-1 564) and 814 (95%UI: 649-1 091), respectively. Compared with Strategy 1, NNS per cardiovascular disease event for Strategy 2 increased by 90 (95%UI: -197-381) with similar effectiveness of cardiovascular prevention; however, NNS per cardiovascular disease event for Strategy 3 was reduced by 460 (95%UI: 185-724) in contrast to the Strategy 2, suggesting that the Strategy 3 was more efficient. The results were consistent in multiple sensitivity analyses. CONCLUSION: Systematic screening for diabetes based on the latest guidelines in economically developed areas of China can reduce cardiovascular events and deaths. However, merely lowering the starting age of screening from 40 to 35 years seems ineffective for preventing cardiovascular disease, while screening strategy for Chinese adults aged 35-70 years with overweight or obesity is recommended to improve efficiency.

Impact of peritoneal membrane transport on technique failure and patient survival in a population on automated peritoneal dialysis.

The peritoneal equilibration test (PET) is well established as a tool for classifying patients as low (L), low average (LA), high average (HA), or high (H) peritoneal transporters. We performed this retrospective 6 year cohort survey to evaluate the impact of different types of PET results on technique survival and patient survival on automated peritoneal dialysis (APD) therapy. From March 1992 to May 1998, 50 patients (20 men, 30 women) receiving APD were enrolled. The mean follow-up period was 25.2 +/- 9.2 months. Basic data and PET results of each patient at the initiation of APD therapy were retrospectively obtained for analysis. Adequacy of dialysis was estimated by measurement of total weekly urea clearance (Kt) normalized to total body water (V) and total weekly creatinine clearance (Ccr) per 1.73 m2 body surface area. The clinical outcomes evaluated were technique survival and patient survival. For statistical analyses we used the Kruskal-Wallis test, Friedman test, Kaplan-Meier life table analysis, and Cox's proportional hazards regression model. There were no differences in age, gender, prevalence of diabetes mellitus (DM), duration of APD, or the initial value of serum albumin between the four subgroups (H, HA, LA, and L). There were 11 (22%) deaths and 8 (16%) technique failures. The 2 year patient survival probability was significantly higher (100%) in the L subgroup than in the LA (62.6%), HA (48.4%), or H (46.2%) subgroups. Patients with DM had a lower patient survival rate than patients without DM; however, there was no statistical significance in technique survival rate between them. Diabetes mellitus (RR = 2.898) and the final albumin value (RR = 0.2099 per increase of 1 gm/dl) had a significant influence on patient survival. By stepwise regression analysis of final serum albumin levels, we found that patients with lower serum albumin values (< or = 3.0 gm/dl vs. >3.0 gm/dl) had a significantly lower probability of patient survival (p = 0.0156). We conclusively demonstrate four important findings in this work: 1) patients with H peritoneal transport had a lower probability of patient survival, but not a decreased rate of technique survival; 2) patients with L peritoneal transport can tolerate APD well; 3) there was no significant difference in technique survival rate between the different PET subgroups; and 4) DM and a lower serum albumin, implicating malnutrition, may contribute to the lower probability of patient survival among H peritoneal transporters.

Renal abnormalities in schoolchildren.

To establish prevalence of some renal abnormalities in schoolchildren, an epidemiologic study of 132,686 schoolchildren, including 69,903 boys and 62,783 girls, was conducted from March 1987 to May 1988 in the city of Taipei. At the health station of each school, the students were screened quickly by a physician with portable real-time ultrasound equipment. When a renal abnormality was detected or suspected, the examinee was referred to Taipei Municipal Women and Children's Hospital for further investigation. Radiologic and urologic procedures were then selectively performed to establish the correct diagnosis. Renal abnormalities were detected in 645 students (approximately 0.5% of total population screened). There were 256 cases of hydronephrosis, 103 cases of unilateral renal agenesis, 128 cases of unilateral small kidney, 90 cases of renal cystic disorders, 30 cases of ectopic kidney, and 38 cases of other abnormalities. Surgically correctable lesions were demonstrated in 50 of these students. Rapid renal ultrasonography was found to effectively detect some renal abnormalities initially, and prevalence could then be established after further investigations.