勃起功能障碍者应进行糖尿病筛检


  【24drs.com】根据发表于7/8月家庭医学志的一篇横断面调查,勃起功能障碍是未诊断糖尿病的一个标记,研究结果认为勃起功能障碍者应进行糖尿病筛检,特别是中年男性。
  
  加拿大温哥华英属哥伦比亚大学人口暨公卫学院健康服务与政策研究中心Sean C. Skeldon医师等人写道,识别容易观察到、与未诊断之心脏代谢有关的风险因素,特别是男性,或许可以改善早期诊断及后续的治疗。
  
  过去十年间,证据显示勃起功能障碍是心血管疾病的一个早期指标。
  
  根据2001-2004年间「全国健康及营养调查报告」之20岁以上男性研究对象的资料,研究者分析了勃起功能障碍是否与未诊断的心脏代谢风险因素有关。
  
  使用单一个有效的调查问题进行逻辑回归分析,以评估勃起功能障碍与未诊断之高血压、高胆固醇血症及糖尿病之间的关联。
  
  多变项校正之后,勃起功能障碍男性的未诊断糖尿病可能性,是没有勃起功能障碍男性的2倍以上(胜算比2.20;95%信赖区间1.10 - 4.37)。不过,该调查并未发现勃起功能障碍与未诊断之高血压或未诊断之高胆固醇血症有关。40- 59岁男性、有未诊断糖尿病的预测可能性是,勃起功能障碍者约为1/10,没有勃起功能障碍者为1/50。
  
  在空腹血糖分析样本中,勃起功能障碍男性的糖尿病盛行率为11.5%,没有勃起功能障碍的男性则是2.8%;40- 59岁男性的差异更大,勃起功能障碍男性的未诊断糖尿病盛行率为19.1%,没有勃起功能障碍的男性则是3.3%。
  
  研究作者写道,勃起功能障碍男性,特别是中年者,应知道他们可能有潜在的糖尿病,并鼓励他们进行筛检。基于相同的精神,医师们应对中年男性的性生活情况有所警觉,并对有勃起功能障碍者进行糖尿病筛检。
  
  作者们指出一些研究限制,包括可能有未报告的勃起功能障碍、有些医师可能意识到勃起功能障碍是个指标而改变了筛检实务,另外,这是横断面研究设计,无法确认勃起功能障碍和未诊断风险因素之间的因果关系。
  
  作者们结论表示,虽然我们观察到未诊断的糖尿病与更多传统心血管风险因素之间有显著关联,但勃起功能障碍是独特的因素,因为它是常见的症状且有治疗选项。因此,对于男性,它可以作为鼓励男性前往健康照护系统进行筛检的有用指标。
  
  资料来源:http://www.24drs.com/
  
  Native link:Erectile Dysfunction Should Trigger Diabetes Screening

Erectile Dysfunction Should Trigger Diabetes Screening

By Laurie Barclay, MD
Medscape Medical News

Erectile dysfunction (ED) is a marker of undiagnosed diabetes, according to results from a cross-sectional survey published in the July/August issue of the Annals of Family Medicine. The findings suggest ED should be a trigger to begin diabetes screening, especially in middle-aged men.

"Identifying easily observable risk factors associated with undiagnosed cardiometabolic risk factors, particularly in men, may improve early diagnosis and subsequent treatment," write Sean C. Skeldon, MD, from the Centre for Health Services and Policy Research, School of Population and Public Health, the University of British Columbia, Vancouver, Canada, and colleagues.

"Over the past decade, evidence has suggested that [ED] is an early indicator for cardiovascular disease."

Using data from male participants aged 20 years and older in the National Health and Nutrition Examination Survey from 2001 to 2004, the investigators analyzed whether ED was associated with undiagnosed cardiometabolic risk factors.

Logistic regression analyses allowed assessment of the relationship between ED, identified by a single, validated survey question, and undiagnosed hypertension, hypercholesterolemia, and diabetes.

The likelihood of undiagnosed diabetes was more than double in men with ED than in men without ED, after multivariate adjustment (odds ratio, 2.20; 95% confidence interval, 1.10 - 4.37). However, the survey did not detect any association of ED with undiagnosed hypertension or undiagnosed hypercholesterolemia. The predicted probability of having undiagnosed diabetes at age 40 to 59 years was 1 in 10 for men with ED compared with to 1 in 50 for men without ED.

In the fasting glucose analytic sample, the prevalence of undiagnosed diabetes was 11.5% in men with ED compared with 2.8% in men without ED. The difference was most dramatic in men aged 40 to 59 years, in whom the prevalence of undiagnosed diabetes was 19.1% among men with ED and 3.3% among men without ED.

"[M]en with [ED], particularly those who are middle-aged, should be made aware of their potential for having underlying diabetes and be encouraged to obtain screening," the study authors write. "In the same vein, physicians should be vigilant in obtaining sexual histories in middle-aged men and screening those with [ED] for diabetes."

The authors note several study limitations, including possible underreporting of ED, possibly altered screening practices of physicians who were aware of the significance of ED as a marker, and a cross-sectional design, which precludes determination of the temporal relationship between ED and the undiagnosed risk factors.

"Although we observed significant associations between undiagnosed diabetes and more traditional cardiovascular risk factors, [ED] is unique because of its common symptomatology and available treatment options," the authors conclude. "As such, it can act as a useful incentive for men to access the health care system and be readily screened."

Some of the study authors reported receiving funding support from the Canadian Institutes of Health Research, the Western Regional Training Centre for Health Services Research, the Stephen Jarislowski Chair in Urologic Sciences at Vancouver General Hospital, the Michael Smith Foundation for Health Research, and/or Health Canada.

Ann Fam Med. 2015;13:331-335.

    
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