CliCon S.r.l. Health, Economics and Outcomes Research, Ravenna, Italy.
J Nephrol. 2012 May-Jun;25(3):325-31. doi: 10.5301/jn.5000005.
Albuminuria is a powerful predictor of renal and cardiovascular outcomes in type 2 diabetes and a good indicator of the evolution of renal disease. Our aim was to obtain information concerning the identification of albuminuria as well as the utilization of antihypertensive, lipid-lowering and antiplatelet drugs in patients with diabetes.
Subjects were enrolled from individuals registered with 3 Italian local health units by querying the drugs reimbursable, hospital laboratory investigation and hospital discharge databases. The determination of albumin to creatinine ratio (ACR) throughout 2007 and 2008 was defined as the index date. Patients who received at least 2 prescriptions of hypoglycemic drugs in the 12 months before the index date were classified as diabetics. We looked also for prescriptions of antihypertensive, lipid-lowering and antiplatelet drugs.
Among a population of 701,133 subjects, we identified 29,350 patients with diabetes (4.2% of the cohort). ACR had been determined in 5,644 diabetic subjects (19.2% of that cohort). The prevalence of determination of ACR in nontreated subjects was 16.0%, while in treated subjects, it ranged from 13.6% to 34.9% according to different schedules of treatment. Drugs acting on the renin-angiotensin system were prescribed in more then 80% of diabetics. The ratio of angiotensin receptor blockers to angiotensin-converting enzyme inhibitors regimen was 0.64 in subjects without determination of ACR, 0.88 in subjects with normal albuminuria, 1.02 in subjects with microalbuminuria and 1.43 in subjects with macroalbuminuria.
Our methodology can easily be applied to obtain an epidemiological view of albuminuria and pharmacological treatments of diabetics in a general population.
蛋白尿是 2 型糖尿病患者肾脏和心血管结局的有力预测指标，也是肾脏疾病进展的良好指标。我们的目的是获得有关识别蛋白尿以及在糖尿病患者中使用抗高血压、降脂和抗血小板药物的信息。
通过查询可报销药物、医院实验室检查和医院出院数据库，从意大利 3 个地方卫生单位登记的个体中招募受试者。2007 年和 2008 年的白蛋白与肌酐比值（ACR）测定被定义为索引日期。在索引日期前的 12 个月内至少接受 2 次降糖药物处方的患者被归类为糖尿病患者。我们还寻找了抗高血压、降脂和抗血小板药物的处方。
在 701133 名受试者中，我们确定了 29350 名糖尿病患者（队列的 4.2%）。在 5644 名糖尿病患者中测定了 ACR（该队列的 19.2%）。未治疗患者中测定 ACR 的患病率为 16.0%，而在治疗患者中，根据不同的治疗方案，其范围从 13.6%到 34.9%。作用于肾素-血管紧张素系统的药物在超过 80%的糖尿病患者中被开处。在未测定 ACR 的患者中，血管紧张素受体阻滞剂与血管紧张素转换酶抑制剂方案的比值为 0.64，在正常白蛋白尿患者中为 0.88，在微量白蛋白尿患者中为 1.02，在大量白蛋白尿患者中为 1.43。
我们的方法可以很容易地应用于获得一般人群中蛋白尿的流行病学观点和糖尿病患者的药物治疗。
