Zusammenfassung
Hintergrund
In den letzten Jahren ist eine Vielzahl von Prädiktionsmodellen für den Typ-2-Diabetes entwickelt worden. Die Frage, wie Scores am besten in der Praxis eingesetzt werden können, ist bislang wenig untersucht worden.
Ziel
Es werden Einsatzbereiche von Risikoscores vorgestellt, Barrieren für die Nutzung von Scores diskutiert und Möglichkeiten erörtert, ihre Akzeptanz bei Ärzten und Patienten zu erhöhen. Schließlich werden Score-basierte und ärztliche Prognosen miteinander verglichen.
Ergebnisse
Scores sind im Internet für die breite Öffentlichkeit verfügbar und lassen sich in der betrieblichen Gesundheitsvorsorge sowie in der Primärversorgung einsetzen. Bislang werden prognostische Scores von Patienten und Ärzten wenig genutzt. Daher muss für die Nutzung von Diabetesscores als Selbsttest auf den ersten Blick deutlich sein, dass der Test wenig Zeit beansprucht und einfach zu bearbeiten ist. Um die Akzeptanz bei Ärzten zu erhöhen, sollten die Scores mit der vorhandenen Praxissoftware verbunden, in verfügbare Parameter der Praxis einbezogen und Ergebnisse direkt mit Lebensstilempfehlungen und Therapieentscheidungen verknüpft werden. Während für Diabetesscores Vergleiche zwischen der Score-basierten und der ärztlichen Risikoschätzung noch ausstehen, ist für Scores mit anderen Endpunkten gezeigt worden, dass die ärztlichen Risikoschätzungen nur wenig übereinstimmen und zudem stark von der Score-basierten Prognose abweichen.
Diskussion
Durch eine bessere Ansprache der Patienten, eine Integration von Scores in die Praxissoftware und die Nutzung bereits vorhandener Parameter sollte es möglich sein, Scores als eine Ergänzung der ärztlichen Risikoschätzung besser in der Praxis zu verankern.
Abstract
Background
In the past few years, numerous prediction models for type 2 diabetes have been developed. So far, little research has been done to examine how best to implement these scores in clinical practice.
Objective
The purpose of this work is to present areas where diabetes risk scores can be used, to identify barriers for their application, and to discuss ways of increasing acceptance of scores by physicians and patients. Finally, score-based prognoses and intuitive prognoses by physicians are compared.
Results
Web-based versions of diabetes risk scores like FINDRISK and the German Diabetes Risk Score have been developed. Moreover, risk scores are suitable for workplace health promotion and for primary care. So far, diabetes prediction models have rarely been used by patients and physicians. For use of diabetes risk scores as a self-test, it is crucial to point out that the test is not time consuming and can be easily used, and that there are promising interventions and treatment options for those at high risk. To increase acceptance by physicians, prediction models should be integrated into practice software, they should be based on parameters available in clinical practice, and results should be combined with lifestyle recommendations. So far, score-based prognoses and intuitive prognoses of diabetes by physicians have not yet been compared for the case of diabetes, but for other endpoints it has been shown that risk estimates by physicians differ strongly and hardly agree with score-based prognoses.
Conclusion
By better addressing patients’ perceived barriers to fill in diabetes risk tests, by integrating scores into practice software and using readily accessible parameters, it should be possible to establish diabetes risk scores into practice as a complement to risk assessments by physicians.
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Einhaltung ethischer Richtlinien
Interessenkonflikt. B. Kowall, W. Rathmann und R. Landgraf geben an, dass kein Interessenkonflikt besteht. Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.
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Kowall, B., Rathmann, W. & Landgraf, R. Einsatz von Risikoscores für den Typ-2-Diabetes in der Praxis. Diabetologe 10, 547–553 (2014). https://doi.org/10.1007/s11428-014-1212-x
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DOI: https://doi.org/10.1007/s11428-014-1212-x