尽管有现代糖尿病管理手段，但肾病迹象仍可能在患有糖尿病的年轻成年人中早期出现：瑞典全国性基于人群的糖尿病发病率研究（DISS）的结果。

Signs of nephropathy may occur early in young adults with diabetes despite modern diabetes management: results from the nationwide population-based Diabetes Incidence Study in Sweden (DISS).

作者信息

Svensson Maria, Sundkvist Göran, Arnqvist Hans J, Björk Elisabeth, Blohmé Göran, Bolinder Jan, Henricsson Marianne, Nyström Lennarth, Torffvit Ole, Waernbaum Ingeborg, Ostman Jan, Eriksson Jan W

机构信息

Department of Medicine, Umeå University Hospital, Umeå, Sweden.

出版信息

Diabetes Care. 2003 Oct;26(10):2903-9. doi: 10.2337/diacare.26.10.2903.

DOI:10.2337/diacare.26.10.2903

PMID:14514599

Abstract

OBJECTIVE

To estimate the occurrence of early-onset renal involvement in a nationwide population-based cohort of young adults with diabetes in Sweden and relate the findings to glycemic control, type of diabetes, sex, smoking, and blood pressure.

RESEARCH DESIGN AND METHODS

The Diabetes Incidence Study in Sweden aims to register all incident cases of diabetes in the age-group 15-34 years. In 1987-1988, 806 patients were reported and invited to participate in a follow-up study focusing on microvascular complications. Of them, 469 subjects participated. The assessment was based on questionnaires (n = 469), blood samples (n = 424), urine samples (n = 251) and, when appropriate, medical records (n = 186).

RESULTS

During the follow-up time, median 9 years (range 6-12), 31 of 469 patients (6.6%) with incipient or overt diabetic nephropathy (i.e., micro- or macroalbuminuria) were found, 24 of 426 (5.6%) in type 1 and 7 of 43 (16%) in type 2 diabetic subjects (P = 0.016). Additionally, 24 of 31 patients (77%) had microalbuminuria and 7 (23%) had macroalbuminuria, which mainly occurred in patients with type 2 diabetes. In a Cox regression analysis, high mean HbA(1c) during the follow-up period and high blood pressure at follow-up increased the risk of developing signs of nephropathy (P = 0.020 and P = 0.003, respectively). Compared with patients with type 1 diabetes, those with type 2 diabetes tended to have an increased risk of renal involvement (P = 0.054) when adjusting for sex, tobacco use, glycemic control, and blood pressure.

CONCLUSIONS

Despite modern treatment and self-monitoring of blood glucose, young adult patients with diabetes may still develop renal involvement during the first 10 years of diabetes duration. Inadequate HbA(1c), high blood pressure, and type 2 diabetes appear to be risk markers for early occurrence of diabetic nephropathy.

摘要

目的

评估瑞典全国范围内以人群为基础的年轻糖尿病患者队列中早发性肾脏受累的发生率，并将研究结果与血糖控制、糖尿病类型、性别、吸烟和血压相关联。

研究设计与方法

瑞典糖尿病发病率研究旨在登记15 - 34岁年龄组中所有新发糖尿病病例。1987 - 1988年，报告了806例患者并邀请他们参加一项聚焦微血管并发症的随访研究。其中，469名受试者参与。评估基于问卷（n = 469）、血液样本（n = 424）、尿液样本（n = 251），并在适当情况下参考医疗记录（n = 186）。

结果

在随访期间，中位时间为9年（范围6 - 12年），469例患者中有31例（6.6%）出现早期或显性糖尿病肾病（即微量或大量蛋白尿），1型糖尿病患者中426例有24例（5.6%），2型糖尿病患者中43例有7例（16%）（P = 0.016）。此外，31例患者中有24例（77%）出现微量蛋白尿，7例（23%）出现大量蛋白尿，主要发生在2型糖尿病患者中。在Cox回归分析中，随访期间高平均糖化血红蛋白（HbA1c）和随访时高血压增加了出现肾病迹象的风险（分别为P = 0.020和P = 0.003）。在对性别、吸烟、血糖控制和血压进行调整后，与1型糖尿病患者相比，2型糖尿病患者肾脏受累风险有增加趋势（P = 0.054）。