糖尿病合并慢性肾脏病患者的血糖控制与抗糖尿病治疗——来自德国慢性肾脏病（GCKD）队列的横断面数据
Glycaemic control and antidiabetic therapy in patients with diabetes mellitus and chronic kidney disease - cross-sectional data from the German Chronic Kidney Disease (GCKD) cohort.
作者信息
Busch Martin, Nadal Jennifer, Schmid Matthias, Paul Katharina, Titze Stephanie, Hübner Silvia, Köttgen Anna, Schultheiss Ulla T, Baid-Agrawal Seema, Lorenzen Johan, Schlieper Georg, Sommerer Claudia, Krane Vera, Hilge Robert, Kielstein Jan T, Kronenberg Florian, Wanner Christoph, Eckardt Kai-Uwe, Wolf Gunter
机构信息
Department of Internal Medicine III, University Hospital Jena - Friedrich Schiller University, Erlanger Allee 101, D - 07747, Jena, Germany.
Institute of Medical Biometry, Informatics and Epidemiology, University of Bonn, Bonn, Germany.
出版信息
BMC Nephrol. 2016 Jun 11;17(1):59. doi: 10.1186/s12882-016-0273-z.
BACKGROUND
Diabetes mellitus (DM) is the leading cause of end-stage renal disease. Little is known about practice patterns of anti-diabetic therapy in the presence of chronic kidney disease (CKD) and correlates with glycaemic control. We therefore aimed to analyze current antidiabetic treatment and correlates of metabolic control in a large contemporary prospective cohort of patients with diabetes and CKD.
METHODS
The German Chronic Kidney Disease (GCKD) study enrolled 5217 patients aged 18-74 years with an estimated glomerular filtration rate (eGFR) between 30-60 mL/min/1.73 m(2) or proteinuria >0.5 g/d. The use of diet prescription, oral anti-diabetic medication, and insulin was assessed at baseline. HbA1c, measured centrally, was the main outcome measure.
RESULTS
At baseline, DM was present in 1842 patients (35 %) and the median HbA1C was 7.0 % (25(th)-75(th) percentile: 6.8-7.9 %), equalling 53 mmol/mol (51, 63); 24.2 % of patients received dietary treatment only, 25.5 % oral antidiabetic drugs but not insulin, 8.4 % oral antidiabetic drugs with insulin, and 41.8 % insulin alone. Metformin was used by 18.8 %. Factors associated with an HbA1C level >7.0 % (53 mmol/mol) were higher BMI (OR = 1.04 per increase of 1 kg/m(2), 95 % CI 1.02-1.06), hemoglobin (OR = 1.11 per increase of 1 g/dL, 95 % CI 1.04-1.18), treatment with insulin alone (OR = 5.63, 95 % CI 4.26-7.45) or in combination with oral antidiabetic agents (OR = 4.23, 95 % CI 2.77-6.46) but not monotherapy with metformin, DPP-4 inhibitors, or glinides.
CONCLUSIONS
Within the GCKD cohort of patients with CKD stage 3 or overt proteinuria, antidiabetic treatment patterns were highly variable with a remarkably high proportion of more than 50 % receiving insulin-based therapies. Metabolic control was overall satisfactory, but insulin use was associated with higher HbA1C levels.
背景
糖尿病（DM）是终末期肾病的主要病因。对于慢性肾脏病（CKD）患者的抗糖尿病治疗模式及其与血糖控制的相关性知之甚少。因此，我们旨在分析当代一个大型前瞻性糖尿病和CKD患者队列中的当前抗糖尿病治疗情况及其代谢控制的相关因素。
方法
德国慢性肾脏病（GCKD）研究纳入了5217例年龄在18 - 74岁之间、估计肾小球滤过率（eGFR）在30 - 60 mL/min/1.73 m²或蛋白尿>0.5 g/d的患者。在基线时评估饮食处方、口服抗糖尿病药物和胰岛素的使用情况。主要结局指标是中心测量的糖化血红蛋白（HbA1c）。
结果
基线时，1842例患者（35%）患有DM，HbA1c中位数为7.0%（第25 - 75百分位数：6.8 - 7.9%），相当于53 mmol/mol（51, 63）；24.2%的患者仅接受饮食治疗，25.5%使用口服抗糖尿病药物但未使用胰岛素，8.4%使用口服抗糖尿病药物联合胰岛素，41.8%仅使用胰岛素。18.8%的患者使用二甲双胍。与HbA1c水平>7.0%（53 mmol/mol）相关的因素包括较高的体重指数（BMI每增加1 kg/m²，OR = 1.04，95% CI 1.02 - 1.06）、血红蛋白（每增加1 g/dL，OR = 1.11，95% CI 1.04 - 1.18）、仅使用胰岛素治疗（OR = 5.63，95% CI 4.26 - 7.45）或与口服抗糖尿病药物联合使用（OR = 4.23，95% CI 2.77 - 6.46），但不包括二甲双胍、二肽基肽酶 - 4抑制剂或格列奈类药物的单药治疗。
结论
在GCKD队列的3期CKD或显性蛋白尿患者中，抗糖尿病治疗模式高度可变，超过半数接受胰岛素治疗的比例显著较高。总体代谢控制情况令人满意，但胰岛素使用与较高的HbA1c水平相关。
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