Tuppin P, Cuerq A, Torre S, Couchoud C, Fagot-Campagna A
Caisse nationale de l'assurance maladie des travailleurs salariés, direction de la stratégie des études et des statistiques, 26-50, avenue du Professeur-André-Lemierre, 75986 Paris cedex 20, France.
Caisse nationale de l'assurance maladie des travailleurs salariés, direction de la stratégie des études et des statistiques, 26-50, avenue du Professeur-André-Lemierre, 75986 Paris cedex 20, France.
Diabetes Metab. 2017 Jun;43(3):265-268. doi: 10.1016/j.diabet.2016.09.006. Epub 2016 Oct 28.
This study looked at the management of diabetes patients during the year prior to the initiation of dialysis.
For this observational study, data were extracted from the National Health Insurance database for general-scheme beneficiaries (77% of the French population). Diabetes patients were identified by at least three reimbursements for antidiabetic drugs in 2012, while the initiation of dialysis was identified by specific refunds in 2013.
Of the 6412 patients initiating dialysis, 37% (n=2378) had diabetes (men: 61%, median age: 71 years, haemodialysis: 92%). Six months prior to dialysis, 68% had filled at least one prescription for insulin, 38% for other antidiabetics (25% glinides, 8% sulphonylureas, 8% metformin, 6% DPP-4 inhibitors), 69% for three or more classes of antihypertensive drugs and 55% for erythropoiesis-stimulating agents. Within 12 months to 1 month of dialysis, 81% were hospitalized, 28% with a main diagnosis of kidney disease. No nephrologist referral or hospitalization was identified at 6-0 months before dialysis in 6% of patients or in 24% at 12-7 months. One in five patients with diabetes consulted a private endocrinologist within 6 months of dialysis. An arteriovenous fistula was created 1 month before haemodialysis in 43% of patients.
The quality of preparation for dialysis was variable despite frequent hospitalizations. These data illustrate the need to mobilize patients with diabetes, and for healthcare professionals to more effectively anticipate and coordinate dialysis.
本研究观察了糖尿病患者在开始透析前一年的管理情况。
在这项观察性研究中，数据取自国家健康保险数据库中普通医保受益人群（占法国人口的77%）。通过2012年至少三次抗糖尿病药物报销记录来确定糖尿病患者，而通过2013年的特定报销记录来确定透析开始时间。
在6412例开始透析的患者中，37%（n = 2378）患有糖尿病（男性：61%，中位年龄：71岁，血液透析：92%）。透析前六个月，68%的患者至少开具过一次胰岛素处方，38%开具过其他抗糖尿病药物处方（25%为格列奈类，8%为磺脲类，8%为二甲双胍，6%为二肽基肽酶-4抑制剂），69%开具过三种或更多类别的抗高血压药物处方，55%开具过促红细胞生成素。在透析前12个月至1个月内，81%的患者住院治疗，其中28%的主要诊断为肾脏疾病。在透析前6 - 0个月，6%的患者未被肾病专家转诊或住院，在12 - 7个月时这一比例为24%。五分之一的糖尿病患者在透析后6个月内咨询过私人内分泌科医生。43%的患者在血液透析前1个月建立了动静脉内瘘。
尽管频繁住院，但透析准备的质量参差不齐。这些数据表明需要动员糖尿病患者，并且医疗保健专业人员要更有效地预测和协调透析。
