Department of Nephrology, University Hospital Regensburg, Regensburg, Germany.
Diabetologische Schwerpunktpraxis Dres. Segiet, Gleixner und Bode, Speyer, Germany.
PLoS One. 2019 Mar 21;14(3):e0213157. doi: 10.1371/journal.pone.0213157. eCollection 2019.
Patients with diabetes mellitus type 2 (DM2) are at high risk for micro- and macrovascular disease. Here, we explore the degree of traditional risk factor control in the baseline visit of a cohort of DM2 outpatients.
DIACORE (DIAbetes COhoRtE) is a prospective cohort study of 3000 adult DM2 outpatients. Here, we present results from the baseline visit. Sociodemographic and anthropometric variables, cardiovascular risk factors, comorbidities and medication were assessed by interview and medical exams. Serum-creatinine based estimated glomerular filtration rate (eGFRcrea) and urinary albumin-creatinine ratio (UACR) were determined for classification of chronic kidney disease (CKD). The proportion of patients with adequate control of traditional risk factors (blood pressure<140/90mmHg, HbA1c<7.5%, LDL<100mg/dl) was calculated in 2892 patients with non-missing data in 9 relevant variables within each KDIGO 2012 CKD class.
In the analyzed baseline data (n = 2892, 60.2% men), mean (standard deviation) values for age, DM2 duration and HbA1c were 65.3 (9.3) years, 10.3 (8.4) years and 6.9% (1.1) respectively. Of these 2892 patients, 18.7% had CKD stage 3 or higher, 25.7% had UACR≥30mg/g. Adequate blood pressure, HbA1c and LDL control was achieved in 55.7%, 78.5% and 34.4%, respectively. In 16.4% of patients (473), all three risk factors were below recommended targets. The proportion of adequate risk factor control was similar across KDIGO eGFRcrea classes. Adequate blood pressure and HbA1c control were significantly associated with lower UACR category without and with controlling for other risk factors (p<0.0001, p = 0.0002, respectively).
In our study of patients with diabetes mellitus type 2, we observed a low level of risk factor control indicating potential for risk reduction.
2 型糖尿病（DM2）患者存在微血管和大血管疾病的高风险。在这里，我们探讨了一组 DM2 门诊患者基线就诊时的传统危险因素控制程度。
DIACORE（糖尿病队列研究）是一项对 3000 例成年 DM2 门诊患者的前瞻性队列研究。在这里，我们呈现基线就诊时的结果。通过访谈和体检评估社会人口统计学和人体测量学变量、心血管危险因素、合并症和药物。通过血清肌酐估计肾小球滤过率（eGFRcrea）和尿白蛋白肌酐比（UACR）确定慢性肾脏病（CKD）的分类。在 KDIGO 2012 CKD 各分类中，对 2892 例无缺失 9 项相关变量的患者，计算了传统危险因素（血压<140/90mmHg、HbA1c<7.5%、LDL<100mg/dl）控制充分的患者比例。
在分析的基线数据（n=2892，60.2%为男性）中，年龄、DM2 病程和 HbA1c 的平均值（标准差）分别为 65.3（9.3）岁、10.3（8.4）年和 6.9%（1.1）。在这 2892 例患者中，18.7%患有 CKD 3 期或更高阶段，25.7%患者 UACR≥30mg/g。血压、HbA1c 和 LDL 控制充分的患者分别占 55.7%、78.5%和 34.4%。在 16.4%（473 例）患者中，所有三种危险因素均低于推荐目标。在 KDIGO eGFRcrea 分类中，适当危险因素控制的比例相似。在不考虑其他危险因素和考虑其他危险因素的情况下，血压和 HbA1c 控制充分与较低的 UACR 类别显著相关（p<0.0001，p=0.0002）。
在我们对 2 型糖尿病患者的研究中，我们观察到危险因素控制水平较低，表明存在降低风险的潜力。
