在初级卫生保健机构中，2型糖尿病患者对肾病临床实践建议的遵循频率如何？

How frequently the clinical practice recommendations for nephropathy are achieved in patients with type 2 diabetes mellitus in a primary health-care setting?

作者信息

Martínez-Ramírez Héctor R, Cortés-Sanabria Laura, Rojas-Campos Enrique, Barragán Graciela, Alfaro Gilberto, Hernández Moisés, Canales-Muñoz José L, Cueto-Manzano Alfonso M

机构信息

Unidad de Investigación Social, Epidemiología y en Servicios de Salud.

出版信息

Rev Invest Clin. 2008 May-Jun;60(3):217-26.

PMID:18807734

Abstract

OBJECTIVE

To determine the proportion of DM2 patients in primary health-care setting who meet clinical practice recommendations for nephropathy.

MATERIAL AND METHODS

735 patients were included in this cross-sectional study. Nephropathy was defined as glomerular filtration rate < 60 mL/min/1.73 m2 or albuminuria > or = 30 mg/day. To estimate the proportion of patients meeting clinical practice recommendations, the achieved level was classified according to NKF -K/DOQI, ADA, IDF, JNC 7 report, and NCEP-ATPIII.

RESULTS

A high frequency of kidney disease and cardiovascular risk factors (smoking, alcoholism, obesity) was observed. Adequate levels were attained in 13% for fasting glucose, 45% for blood pressure, 71% for albuminuria, and 30% for lipids. Nephropathy was diagnosed in 41%. Adequate systolic blood pressure was observed in 40% of patients with nephropathy vs. 49% without nephropathy (p = 0.03). In both groups, body mass index was acceptable in one fifth of patients, and waist circumference in two thirds of men and one third of women (p = NS). Patients with nephropathy used more antihypertensives, particularly angiotensin converting enzyme inhibitors (nephropathy 49% vs. no nephropathy 38%, p = 0.004). Subjects with nephropathy received more frequently (p = 0.05) insulin (11%) than those without nephropathy (7%). In both groups, there was low use of statins (nephropathy 14% vs. no nephropathy 17%, p = 0.23), and aspirin (nephropathy 7% vs. no nephropathy 5%, p = 0.39).

CONCLUSIONS

Recommended goals for adequate control of DM2 patients attending primary health-care units are rarely achieved, and this was independent of the presence of nephropathy. These findings are disturbing, as poor clinical and metabolic control may eventually cause that patients without nephropathy develop renal damage, and those subjects already with renal disease progress to renal insufficiency.

摘要

目的

确定基层医疗卫生机构中符合肾病临床实践建议的2型糖尿病（DM2）患者比例。

材料与方法

本横断面研究纳入了735例患者。肾病定义为肾小球滤过率<60 mL/（min·1.73 m²）或蛋白尿≥30 mg/天。为了估计符合临床实践建议的患者比例，根据美国国家肾脏基金会（NKF）-肾脏疾病预后质量倡议（K/DOQI）、美国糖尿病协会（ADA）、国际糖尿病联盟（IDF）、美国国家高血压教育计划（JNC）7报告以及美国国家胆固醇教育计划成人治疗专家组第三次报告（NCEP-ATPIII）对达标水平进行分类。

结果

观察到肾病和心血管危险因素（吸烟、酗酒、肥胖）的高发生率。空腹血糖达标率为13%，血压达标率为45%，蛋白尿达标率为71%，血脂达标率为30%。41%的患者被诊断为肾病。肾病患者中40%的患者收缩压达标，无肾病患者中这一比例为49%（p = 0.03）。在两组中，五分之一的患者体重指数可接受，三分之二的男性和三分之一的女性腰围可接受（p = 无显著性差异）。肾病患者使用更多的抗高血压药物，尤其是血管紧张素转换酶抑制剂（肾病患者为49%，无肾病患者为38%，p = 0.004）。肾病患者使用胰岛素的频率（11%）高于无肾病患者（7%）（p = 0.05）。两组中他汀类药物的使用率都较低（肾病患者为14%，无肾病患者为17%，p = 0.23），阿司匹林的使用率也较低（肾病患者为7%，无肾病患者为5%，p = 0.39）。