Hadjadj Samy, Cariou Bertrand, Fumeron Frederic, Gand Elise, Charpentier Guillaume, Roussel Ronan, Kasmi Ahmed-Amine, Gautier Jean-François, Mohammedi Kammel, Gourdy Pierre, Saulnier Pierre-Jean, Feigerlova Eva, Marre Michel
Université de Poitiers, UFR Médecine Pharmacie, Centre d'Investigation clinique, Poitiers, France.
CHU de Poitiers, Service d'Endocrinologie-Diabetologie, Rue de la milétrie, 86000, Poitiers, France.
Diabetologia. 2016 Jan;59(1):208-216. doi: 10.1007/s00125-015-3785-3.
AIMS/HYPOTHESIS: Microvascular complications are a common feature of diabetes but additional research is needed regarding diabetic nephropathy endpoints in type 1 and type 2 diabetes.
We compared 277 type 1 diabetes patients with 942 type 2 diabetes patients, with clinical proteinuria and no endstage renal disease (ESRD) at baseline, prospectively followed for death, ESRD and decline in estimated glomerular filtration rate (eGFR, all available measures).
The incidence rate of death was 67.0 (95% CI 59.2, 74.8) vs. 24.6 (95% CI, 19.0, 30.2) per 1,000 patient-years, in type 2 diabetes and type 1 diabetes, respectively. Unadjusted risk for death was greater for type 2 diabetes patients (HR 3.423; 95% CI, 2.501, 4.683; p<0.0001), but the difference did not persist after adjustment for age (HRage-adj 0.859; 95% CI 0.581, 1.269; p=0.445). The incidence rate of ESRD was 18.4 (95% CI 14.2, 22.5) vs. 47.1 (95%CI 38.4, 55.9) per 1,000 patient-years, in type 2 diabetes and type 1 diabetes, respectively. Unadjusted risk for ESRD was lower in type 2 diabetes (HR 0.399; 95% CI 0.287, 0.554; p<0.0001), but the difference did not persist after adjustment for sex, age and baseline serum creatinine (HRadj 0.989; 95% CI 0.597, 1.639; p=0.965). In a mixed linear model, eGFR decline was not significantly different in type 2 vs. type 1 diabetes (difference in slope −0.19 [0.28] ml min(−1) 1.73 m(−2) year(−1); p=0.512).
CONCLUSIONS/INTERPRETATION: In diabetic nephropathy, once baseline risk factors were taken into account the risk for death, ESRD and renal function decline did not significantly differ between type 1 diabetes and type 2 diabetes.
目的/假设：微血管并发症是糖尿病的常见特征，但对于1型和2型糖尿病患者糖尿病肾病终点仍需进一步研究。
我们比较了277例1型糖尿病患者和942例2型糖尿病患者，这些患者在基线时均有临床蛋白尿且无终末期肾病（ESRD），对其进行前瞻性随访，观察死亡、ESRD以及估计肾小球滤过率（eGFR，所有可用指标）下降情况。
2型糖尿病患者和1型糖尿病患者的年死亡率分别为每1000患者年67.0（95%CI 59.2，74.8）和24.6（95%CI 19.0，30.2）。2型糖尿病患者未调整的死亡风险更高（HR 3.423；95%CI 2.501，4.683；p<0.0001），但在调整年龄后差异不再存在（年龄调整后HR 0.859；95%CI 0.581，1.269；p=0.445）。2型糖尿病患者和1型糖尿病患者的ESRD年发病率分别为每1000患者年18.4（95%CI 14.2，22.5）和47.1（95%CI 38.4，55.9）。2型糖尿病患者未调整的ESRD风险较低（HR 0.399；95%CI 0.287，0.554；p<0.0001），但在调整性别、年龄和基线血清肌酐后差异不再存在（调整后HR 0.989；95%CI 0.597，1.639；p=0.965）。在混合线性模型中，2型糖尿病和1型糖尿病患者的eGFR下降无显著差异（斜率差异为−0.19 [0.28] ml·min−1·1.73 m−2·年−1；p=0.512）。
结论/解读：在糖尿病肾病中，一旦考虑基线风险因素，1型糖尿病和2型糖尿病患者在死亡、ESRD和肾功能下降风险方面无显著差异。
