Yokoyama Hiroki, Araki Shin-Ichi, Kawai Koichi, Yamazaki Katsuya, Tomonaga Osamu, Shirabe Shin-Ichiro, Maegawa Hiroshi
Internal Medicine, Jiyugaoka Medical Clinic, Obihiro, Japan.
Department of Medicine, Shiga University of Medical Science, Otsu, Japan.
BMJ Open Diabetes Res Care. 2018 May 29;6(1):e000521. doi: 10.1136/bmjdrc-2018-000521. eCollection 2018.
We examined changes in prevalence of diabetic microvascular/macrovascular complications and diabetes care indicators for adults in Japan with type 2 and type 1 diabetes over one decade.
Two independent cohorts were recruited with the same inclusion criteria in 2004 (cohort 1: 3319 with type 2 and 286 with type 1 diabetes) and in 2014 (cohort 2: 3932 with type 2 and 308 with type 1 diabetes). Prevalence of complications and care indicators including achieving treatment targets for glycemia, blood pressure, lipid control, body mass index (BMI), and smoking were compared. In addition, patients in cohort 1 were re-examined in 2014 and their data were compared with the baseline data of each cohort.
In type 2 diabetes, the prevalence of nephropathy, retinopathy, neuropathy, chronic kidney disease, current smoking and stroke significantly decreased, with improvements in achieving treatment target rates in cohort 2 two as compared with cohort 1. In type 1 diabetes, the prevalence of nephropathy, retinopathy, chronic kidney disease, and hemoglobin Avalues significantly decreased. Decreases in prevalence of microvascular complications in type 2 diabetes were similarly found in each age-matched and sex-matched group, whereas younger patients exhibited marked increase in BMI and lower treatment target achieving rates compared with elderly patients. Regarding normoalbuminuric renal impairment, only a slight increase in the prevalence was observed both in type 2 and type 1 diabetes. In cohort 1, re-examined in 2014, care indicators were significantly improved from 2004, while complications increased with getting 10 years older.
We observed declining trends of diabetic microvascular complications with improvement in diabetes care indicators in type 2 and type 1 diabetes. Younger patients with type 2 diabetes exhibited marked increase in BMI and lower rates of achieving treatment targets compared with elderly patients, which remains a concern.
我们研究了日本1型和2型糖尿病成年人在十年间糖尿病微血管/大血管并发症患病率及糖尿病护理指标的变化。
在2004年（队列1：3319例2型糖尿病患者和286例1型糖尿病患者）和2014年（队列2：3932例2型糖尿病患者和308例1型糖尿病患者）按照相同纳入标准招募了两个独立队列。比较了并发症患病率及护理指标，包括血糖、血压、血脂控制、体重指数（BMI）和吸烟情况是否达到治疗目标。此外，对队列1中的患者在2014年进行了重新检查，并将他们的数据与每个队列的基线数据进行了比较。
在2型糖尿病中，肾病、视网膜病变、神经病变、慢性肾病、当前吸烟率和中风患病率显著下降，与队列1相比，队列2中达到治疗目标率有所改善。在1型糖尿病中，肾病、视网膜病变、慢性肾病和糖化血红蛋白值的患病率显著下降。在2型糖尿病中，各年龄和性别匹配组的微血管并发症患病率均有类似下降，而与老年患者相比，年轻患者的BMI显著增加且治疗目标达成率较低。关于正常白蛋白尿性肾损害，2型和1型糖尿病的患病率均仅略有增加。在2014年重新检查的队列1中，护理指标较2004年有显著改善，而并发症随年龄增长10岁而增加。
我们观察到1型和2型糖尿病患者的糖尿病微血管并发症呈下降趋势，同时糖尿病护理指标有所改善。与老年患者相比，2型糖尿病年轻患者的BMI显著增加且治疗目标达成率较低，这仍是一个值得关注的问题。
