Tanabe Hayato, Saito Haruka, Machii Noritaka, Kudo Akihiro, Tanaka Kenichi, Asahi Koichi, Kazama Junichiro James, Shimabukuro Michio
Department of Diabetes, Endocrinology and Metabolism, Fukushima Medical University, Fukushima 960-1295, Japan.
Department of Internal Medicine, Ohara General Hospital, Fukushima 960-8611, Japan.
J Clin Med. 2020 Jun 28;9(7):2028. doi: 10.3390/jcm9072028.
The risk of developing diabetic kidney disease (DKD) in patients with undiagnosed diabetes mellitus (UD) has never been evaluated. We studied the burden of UD on the risk of developing DKD in the Japanese population in a single-center retrospective cohort study. The patients with type 2 diabetes mellitus, but without DKD (estimated glomerular filtration rate (eGFR) < 60 mL/min/1.73 m or proteinuria), were recruited from January 2018 to January 2019; medical records were scrutinized retrospectively from January 2003 until May 2019. The individuals, with diabetes that could not be denied based on past and current records, comprised the undiagnosed diabetes (UD) group whereas those with confirmed diagnosis comprised the diagnosed diabetes (DD) group. The group differences were tested using a Kaplan-Meier curve and Cox proportional hazards model. Among the 408 participants, 164 (40.2%) and 244 (59.8%) comprised the DD and UD groups, respectively. The baseline parameters, including age, male gender, and BMI were comparable between the groups, but the plasma glucose, HbA1c levels, and diabetic retinopathy prevalence were higher in the UD group. The risk of developing DKD (log rank test, < 0.001), an eGFR of < 60 mL/min/1.73 m ( = 0.001) and proteinuria ( = 0.007) were also higher in the UD group. The unadjusted and adjusted hazard ratios for DKD were 1.760 ((95% CI: 1.323-2.341), < 0.001) and 1.566 ((95% CI: 1.159-2.115), = 0.003), respectively, for the UD group. In conclusion, this is the first report showing that UD is a strong risk factor for DKD. The notion that a longer duration of untreated diabetes mellitus is involved strongly in the risk of developing DKD warrants the need for the identification and monitoring of UD patients.
未诊断糖尿病（UD）患者发生糖尿病肾病（DKD）的风险从未得到评估。我们在一项单中心回顾性队列研究中，研究了日本人群中UD对发生DKD风险的影响。2018年1月至2019年1月招募了2型糖尿病但无DKD（估计肾小球滤过率（eGFR）<60 mL/min/1.73 m²或蛋白尿）的患者；对2003年1月至2019年5月的病历进行了回顾性审查。根据过去和当前记录无法排除糖尿病的个体组成未诊断糖尿病（UD）组，而确诊的个体组成已诊断糖尿病（DD）组。使用Kaplan-Meier曲线和Cox比例风险模型检验组间差异。在408名参与者中，分别有164名（40.2%）和244名（59.8%）组成DD组和UD组。两组间的基线参数，包括年龄、男性性别和BMI具有可比性，但UD组的血糖、糖化血红蛋白水平和糖尿病视网膜病变患病率更高。UD组发生DKD的风险（对数秩检验，P<0.001）、eGFR<60 mL/min/1.73 m²（P = 0.001）和蛋白尿（P = 0.007）也更高。UD组DKD的未调整和调整后风险比分别为1.760（95%CI：1.323 - 2.341，P<0.001）和1.566（95%CI：1.159 - 2.115，P = 0.003）。总之，这是第一份表明UD是DKD的强风险因素的报告。未治疗的糖尿病持续时间较长与发生DKD的风险密切相关这一观点，使得有必要识别和监测UD患者。
