Thomas Merlin C
Danielle Alberti Memorial Centre for Diabetic Complications, Baker Medical Research Institute, P.O. Box 6492, Melbourne, Victoria 8008, Australia.
Diabetes Res Clin Pract. 2008 Apr;80(1):83-8. doi: 10.1016/j.diabres.2007.10.024. Epub 2008 Feb 21.
While CKD is a common finding in patients with type 2 diabetes, the clinical response to its identification is often problematic. This study aims to determine the frequency of albuminuria in patients with type 2 diabetes in the primary care setting and examine the factors which influence its management.
Expressions of interest were invited from all registered GPs across Australia, from whom 500 investigators were randomly selected. Investigators were requested to document the clinical characteristics of 10-15 consecutively presenting patients with type 2 diabetes. Results from the most recent urinalysis were classified according to guidelines, then systematically compared to classifications provided by GPs themselves and their management strategies.
One in three patients had an elevated urinary albumin excretion (UAE, 34.6%, 95% CI, 33.3-35.9%) on their most recent urinalysis. The presence of microalbuminuria or proteinuria, as identified by the GP, was not associated with a perceived increase in cardiovascular risk. In addition, the use of aspirin and the prescribing of agents to block the RAS were not significantly linked to UAE. Similarly, the perceived adequacy of blood pressure control was not significantly different whether or not microalbuminuria or proteinuria was identified to be present.
An elevated UAE is a common finding in general practice. However, it fails to significantly influence their clinical care. Additional education to ensure appropriate case recognition and management of kidney disease is needed, focusing on the significance of albuminuria to the care of patients with type 2 diabetes.
虽然慢性肾脏病（CKD）在2型糖尿病患者中很常见，但对其识别后的临床应对往往存在问题。本研究旨在确定基层医疗环境中2型糖尿病患者蛋白尿的发生率，并探讨影响其管理的因素。
向澳大利亚所有注册全科医生发出意向征集，从中随机选取500名研究者。要求研究者记录10 - 15例连续就诊的2型糖尿病患者的临床特征。根据指南对最近一次尿液分析结果进行分类，然后系统地与全科医生自己提供的分类及其管理策略进行比较。
在最近一次尿液分析中，三分之一的患者尿白蛋白排泄量（UAE）升高（34.6%，95%可信区间，33.3 - 35.9%）。全科医生所识别的微量白蛋白尿或蛋白尿的存在与感知到的心血管风险增加无关。此外，阿司匹林的使用以及开具阻断肾素 - 血管紧张素系统（RAS）药物与UAE无显著关联。同样，无论是否识别出微量白蛋白尿或蛋白尿，所感知到的血压控制充足程度无显著差异。
UAE升高在全科医疗中很常见。然而，它并未显著影响临床治疗。需要进行更多教育以确保对肾脏疾病进行适当的病例识别和管理，重点是白蛋白尿对2型糖尿病患者治疗的重要性。
