Health Economics, RTI Health Solutions, Research Triangle Park, NC 27709, USA.
Postgrad Med. 2011 May;123(3):133-43. doi: 10.3810/pgm.2011.05.2291.
To assess rates of diagnosis and antihyperglycemic dose adjustment in patients with moderate to end-stage renal impairment (RI) and type 2 diabetes mellitus (T2DM).
Retrospective database analysis using GE Centricity Outpatient Electronic Medical Records. Patients aged ≥ 18 years with evidence of T2DM (International Classification of Diseases, Ninth Edition, Clinical Modification codes 250.x0 and 250.x2) between January 1, 2000 and June 30, 2009, and ≥ 12 months of data after identification were selected. Moderate to end-stage RI was evaluated using a formula-derived estimated glomerular filtration rate (eGFR) based on serum creatinine (SCr). Patients were classified as moderate (eGFR, 30-59 mL/min/1.73 m(2)), severe (eGFR, 15-29 mL/min/1.73 m(2)), or end-stage (eGFR, < 15 mL/min/1.73 m(2)), per the National Kidney Foundation guidelines, based on the first-observed SCr test. Among patients with a physician diagnosis, the time to diagnosis was reported. Dose adjustment was reported for patients receiving metformin and sitagliptin. Predictors of progression to end-stage RI based on logistic regressions were examined.
35.2% of patients with T2DM had evidence of moderate to end-stage RI. Of these patients, 20% had a chart-documented physician diagnosis (range, 16% [moderate RI] to 66% [end-stage RI]). Patients with moderate or severe RI had a physician diagnosis mean of 253.4 (standard deviation [SD], 584.5) and 86.9 (SD, 417.4) days, respectively, after the eGFR calculation indicating RI. Patients with end-stage RI had a physician diagnosis mean of 83.6 (SD, 399.2) days before the eGFR calculation. After the eGFR calculation, 15.1% and 0.1% of patients with orders for sitagliptin and metformin, respectively, received doses of the drug appropriate for their degree of RI. Among patients with moderate or severe RI, appropriate diagnosis of RI was associated with significantly lower odds of progressing to end-stage RI (odds ratio, 0.200; 95% confidence interval, 0.188-0.213).
Renal impairment is common but often undetected in patients with T2DM. Patients with a documented RI diagnosis have lower odds of progression to end-stage RI. Metformin and sitagliptin are frequently used at inappropriate doses in patients with RI. Further analyses to understand the clinical and economic consequences of these findings are needed.
评估中度至终末期肾功能损害（RI）和 2 型糖尿病（T2DM）患者的诊断率和抗高血糖剂量调整。
使用 GE Centricity 门诊电子病历进行回顾性数据库分析。选择 2000 年 1 月 1 日至 2009 年 6 月 30 日期间年龄≥18 岁且有 T2DM 证据（国际疾病分类，第九版，临床修正码 250.x0 和 250.x2）的患者，并且在识别后至少有 12 个月的数据。根据血清肌酐（SCr）的公式推导的估计肾小球滤过率（eGFR）评估中度至终末期 RI。根据国家肾脏基金会的指南，根据首次观察到的 SCr 测试，将患者分为中度（eGFR，30-59 mL/min/1.73 m²）、重度（eGFR，15-29 mL/min/1.73 m²）或终末期（eGFR，<15 mL/min/1.73 m²）。对于有医生诊断的患者，报告诊断时间。对于接受二甲双胍和西他列汀治疗的患者，报告剂量调整情况。使用逻辑回归检查了基于终末期 RI 进展的预测因素。
35.2%的 T2DM 患者有中度至终末期 RI 的证据。这些患者中有 20%有医生诊断记录（范围，16%[中度 RI]至 66%[终末期 RI]）。中度或重度 RI 患者的 eGFR 计算表明 RI 后平均有 253.4（标准差[SD]，584.5）和 86.9（SD，417.4）天的医生诊断，终末期 RI 患者在 eGFR 计算前平均有 83.6（SD，399.2）天的医生诊断。在 eGFR 计算后，分别有 15.1%和 0.1%接受西他列汀和二甲双胍治疗的患者开具了适合其 RI 程度的药物剂量。在中度或重度 RI 患者中，适当诊断 RI 与进展为终末期 RI 的几率显著降低相关（比值比，0.200；95%置信区间，0.188-0.213）。
肾功能损害在 T2DM 患者中很常见，但经常未被发现。有 RI 诊断记录的患者进展为终末期 RI 的几率较低。在 RI 患者中，经常使用不合适剂量的二甲双胍和西他列汀。需要进一步分析以了解这些发现的临床和经济后果。
