GlaxoSmithKline, Worldwide Epidemiology, Collegeville, Pennsylvania 19426, USA.
Clin Ther. 2009 Nov;31(11):2608-17. doi: 10.1016/j.clinthera.2009.10.020.
The aims of this study were to estimate the proportion of patients with type 2 diabetes mellitus (DM) in the United States with different stages of chronic kidney disease (CKD) and to describe glycemic control and antidiabetic drug use among them.
Using data from the Fourth National Health and Nutrition Examination Survey (NHANES IV) for the years 1999 through 2004, we performed a cross-sectional analysis of patients with type 2 DM aged >or=20 years at the time of the survey interview. CKD stages were categorized according to the classification system established by the National Kidney Foundation Kidney Disease Outcomes Quality Initiative. Anti-diabetic medication use among these patients was described using self-reported survey responses as well as survey medication files.
A total of 1462 patients with type 2 DM were included in the analysis. Men and women constituted 48.3% and 51.7% of the study sample, respectively; 15.6% received a DM diagnosis <2 years ago, and 36.2% received their diagnosis >10 years ago. CKD was present in 39.7% of patients with DM. Mean (SE) glycosylated hemoglobin was lower in more advanced CKD stages, from stage 1 (8.35% [0.23%]) to combined stages 4 and 5 (6.63% [0.15%]). Based on the medication file data, the proportion of patients with CKD using 1 antidiabetic medication was higher as CKD progressed, from 36.3% at stage 1 to 62.9% at stages 4 and 5 (P = 0.007). By self-report, the proportion of patients with CKD using insulin alone was 6.7% at stage 1 and 38.8% at stages 4 and 5 (P < 0.001). The proportion of patients using oral antidiabetic agents alone was 69.0% at stage 1 and 43.4% at stages 4 and 5 (P < 0.001).
Our results indicate that 39.7% of adult patients with type 2 DM in the United States had some degree of CKD, as measured in NHANES IV for the years 1999 through 2004. This finding reinforces the need to screen patients with type 2 DM for CKD and to prevent the cascade of events leading to nephropathy by implementing adequate glycemic and blood pressure controls, especially in the early stages of CKD. Our data also reinforce the need for developing more oral antidiabetic therapies for patients with advanced CKD and type 2 DM, because treatment options for this group are limited.
本研究旨在估计美国患有 2 型糖尿病（DM）的患者中不同阶段慢性肾脏病（CKD）的比例，并描述他们的血糖控制和抗糖尿病药物使用情况。
利用 1999 年至 2004 年第四次全国健康和营养检查调查（NHANES IV）的数据，我们对当时接受调查采访的年龄>20 岁的 2 型 DM 患者进行了横断面分析。根据国家肾脏基金会肾脏病结局质量倡议建立的分类系统对 CKD 阶段进行分类。使用自我报告的调查回复以及调查用药文件描述了这些患者的抗糖尿病药物使用情况。
共有 1462 名 2 型 DM 患者纳入分析。男性和女性分别占研究样本的 48.3%和 51.7%；15.6%的患者在<2 年前被诊断为 DM，36.2%的患者在>10 年前被诊断为 DM。39.7%的 DM 患者存在 CKD。在更严重的 CKD 阶段，糖化血红蛋白的平均值（SE）较低，从第 1 阶段（8.35%[0.23%]）到合并第 4 和第 5 阶段（6.63%[0.15%]）。根据用药文件数据，随着 CKD 的进展，使用 1 种抗糖尿病药物的患者比例更高，从第 1 阶段的 36.3%到第 4 和第 5 阶段的 62.9%（P=0.007）。通过自我报告，第 1 阶段单独使用胰岛素的患者比例为 6.7%，第 4 和第 5 阶段为 38.8%（P<0.001）。单独使用口服抗糖尿病药物的患者比例在第 1 阶段为 69.0%，在第 4 和第 5 阶段为 43.4%（P<0.001）。
我们的结果表明，在 1999 年至 2004 年 NHANES IV 中，美国 39.7%的成年 2 型 DM 患者存在某种程度的 CKD。这一发现强调了需要对 2 型 DM 患者进行 CKD 筛查，并通过实施适当的血糖和血压控制来预防导致肾病的级联事件，尤其是在 CKD 的早期阶段。我们的数据还强调了需要为患有晚期 CKD 和 2 型 DM 的患者开发更多的口服抗糖尿病治疗方法，因为该组患者的治疗选择有限。
