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Diabetes Care 26:2604-2608, 2003
© 2003 by the American Diabetes Association, Inc.

Pathophysiology/Complications
Original Article

Microvascular Complications at Time of Diagnosis of Type 2 Diabetes Are Similar Among Diabetic Patients Detected by Targeted Screening and Patients Newly Diagnosed in General Practice

The Hoorn Screening Study

Annemieke M.W. Spijkerman, PHD1, Jacqueline M. Dekker, PHD1, Giel Nijpels, MD, PHD1, Marcel C. Adriaanse, MSC1, Piet J. Kostense, PHD1,2, Dirk Ruwaard, PHD3, Coen D.A. Stehouwer, MD, PHD1,4, Lex M. Bouter, PHD1 and Robert J. Heine, MD, PHD1,5

1 Institute for Research in Extramural Medicine, Vrije University Medical Center, Amsterdam, the Netherlands
2 Department of Clinical Epidemiology and Biostatistics, Vrije University Medical Center, Amsterdam, the Netherlands
3 Public Health Division, National Institute for Public Health and the Environment, Bilthoven, the Netherlands
4 Department of Internal Medicine, Vrije University Medical Center, Amsterdam, the Netherlands
5 Department of Endocrinology, Vrije University Medical Center, Amsterdam, the Netherlands

Address correspondencereprint requests to A.M.W. Spijkerman, PhD, Institute for Research in Extramural Medicine, Vrije University Medical Center, van der Boechorststraat 7, 1081 BT, Amsterdam, Netherlands. E-mail: amw.spijkerman.emgo{at}med.vu.nl

OBJECTIVE—To investigate whether screening-detected diabetic patients differ from diabetic patients newly diagnosed in general practice with regard to the presence of microvascular complications.

RESEARCH AND DESIGN METHODS—Diabetic patients, identified by a population-based targeted screening procedure consisting of a screening questionnaire and a fasting capillary whole-blood glucose measurement followed by diagnostic testing, were compared with patients newly diagnosed with diabetes in general practice. Retinopathy was assessed with fundus photography, impaired foot sensitivity was assessed with Semmes-Weinstein monofilaments, and the presence of microalbuminuria was measured by means of the albumin-to-creatinine ratio (ACR).

RESULTS—A total of 195 screening-detected type 2 diabetic patients and 60 patients newly diagnosed in general practice participated in the medical examination. The prevalence of retinopathy was higher in screening-detected type 2 diabetic patients than in patients newly diagnosed in general practice, but not significantly higher. The prevalence of retinopathy was 7.6% (95% CI 4.6–12.4) in screening-detected type 2 diabetic patients and 1.9% (0.3–9.8) in patients newly diagnosed in general practice. The prevalence of impaired foot sensitivity was similar in both groups, 48.1% (40.9–55.3) and 48.3% (36.2–60.7), respectively. The ACR was 0.61 (interquartile range 0.41–1.50) in screening-detected type 2 diabetic patients and 0.99 (0.53–2.49) in patients newly diagnosed in general practice. The difference in prevalence of microalbuminuria was not statistically significant. The prevalence of microalbuminuria was 17.2% (95% CI 12.5–23.2) and 26.7% (17.1–39.0) in screening-detected type 2 diabetic patients and patients newly diagnosed in general practice, respectively.

CONCLUSIONS—Targeted screening for type 2 diabetes (with a screening questionnaire as a first step) resulted in the identification of previously undiagnosed diabetic patients with a considerable prevalence of microvascular complications.

Abbreviations: ACR, albumin-to-creatinine ratio • FPG, fasting plasma glucose • OGTT, oral glucose tolerance test • SRQ, symptom risk questionnaire • WHO, World Health Organization


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