Borch-Johnsen K
Glostrup Hospital, University of Copenhagen, Denmark.
Pharmacoeconomics. 1995;8 Suppl 1:40-5. doi: 10.2165/00019053-199500081-00009.
Diabetic nephropathy was first described in patients with non-insulin-dependent diabetes mellitus (NIDDM, type II diabetes) by Kimmelstiel and Wilson in 1936. It is a classical, late diabetic complication, diagnosed by measurement of the urinary albumin or total protein excretion, and typically develops after more than 15 years of diabetes. As most studies of patients with type II diabetes have been performed in White, European or North American populations in which the highest incidence of this disease is recorded in individuals aged over 70 years, a low prevalence has generally been found in these patients. Nephropathy has been considered a rare complication in type II diabetes patients. Other ethnic groups such as Pima Indians in the USA or Pacific Islanders have totally different incidence patterns of type II diabetes, with a high incidence in the 20- to 50-year age group. These patients live long enough to develop nephropathy, and they do so at the same rate as insulin-dependent diabetes mellitus (IDDM, type I diabetes) patients. Since the prevalence of type II diabetes is increasing worldwide, particularly in the developing world, diabetic nephropathy will be a growing problem in patients with this disease. From our experience in the treatment of type I diabetes patients, we know that prevention of end-stage renal failure is possible in most patients, but that treatment of end-stage renal disease is very expensive. In this paper, some of the major risk factors for the development of nephropathy are discussed together with the potential for treatment. It is shown that, in type I diabetes patients, early detection by screening for microalbuminuria and immediate recourse to antihypertensive treatment are likely to increase life-expectancy significantly while at the same time reducing the total costs to healthcare. Whether this is also the case in patients with type II diabetes is less clear, as most of the controlled clinical trials of the effect of strict metabolic control or antihypertensive treatment have been performed in patients with type I diabetes. Thus, clinical trials in patients with type II diabetes should be performed, and further epidemiological data relating to these patients are needed.
1936年，金梅尔施泰因和威尔逊首次在非胰岛素依赖型糖尿病（NIDDM，II型糖尿病）患者中描述了糖尿病肾病。它是一种典型的晚期糖尿病并发症，通过测量尿白蛋白或总蛋白排泄量来诊断，通常在患糖尿病超过15年后出现。由于大多数针对II型糖尿病患者的研究是在白种人、欧洲人或北美人群中进行的，在这些人群中，该疾病的最高发病率记录在70岁以上的个体中，因此在这些患者中普遍发现患病率较低。肾病一直被认为是II型糖尿病患者中的一种罕见并发症。其他种族群体，如美国的皮马印第安人或太平洋岛民，II型糖尿病的发病模式完全不同，在20至50岁年龄组中发病率很高。这些患者寿命足够长，会发展为肾病，而且他们患肾病的几率与胰岛素依赖型糖尿病（IDDM，I型糖尿病）患者相同。由于II型糖尿病在全球范围内，尤其是在发展中国家的患病率正在上升，糖尿病肾病将成为这种疾病患者中日益严重的问题。根据我们治疗I型糖尿病患者的经验，我们知道大多数患者有可能预防终末期肾衰竭，但终末期肾病的治疗费用非常高昂。在本文中，将讨论肾病发展的一些主要危险因素以及治疗的可能性。结果表明，在I型糖尿病患者中，通过筛查微量白蛋白尿进行早期检测并立即采取抗高血压治疗，可能会显著提高预期寿命，同时降低医疗保健的总成本。在II型糖尿病患者中是否也是如此尚不清楚，因为大多数关于严格代谢控制或抗高血压治疗效果的对照临床试验是在I型糖尿病患者中进行的。因此，应该在II型糖尿病患者中进行临床试验，并且需要与这些患者相关的更多流行病学数据。
