Biotechnology Center, Doctoral School of Life Sciences, Health and Environment, University of Yaoundé I, Yaoundé, Cameroon.
Department of Medicine and Specialties, Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon.
Diabetologia. 2021 Jun;64(6):1246-1255. doi: 10.1007/s00125-021-05406-6. Epub 2021 Feb 16.
AIMS/HYPOTHESIS: Diabetes is the leading cause of kidney disease worldwide. There is limited information on screening, treatment and control of kidney disease in patients with diabetes in low-to-middle-income countries (LMICs).
The International Diabetes Management Practices Study is an ongoing, non-interventional study of clinical profiles and practices among patients receiving outpatient care mainly by internal medicine physicians and endocrinologists in LMICs. We examined screening, prevalence, treatment and control of kidney disease across seven waves (W) of data collection between 2005 and 2017.
Among 15,079 patients with type 1 and 66,088 patients with type 2 diabetes, screening for kidney disease increased between W2 and W3 followed by a plateau (type 1 diabetes: W2, 73.7%; W3, 84.1%; W7, 83.4%; type 2 diabetes: W2, 65.1%; W3, 82.6%; W7, 86.2%). There were also decreasing proportions of patients with microalbuminuria (type 1 diabetes: W1, 27.1%; W3, 14.7%; W7, 13.8%; type 2 diabetes: W1, 24.5%; W3, 12.6%; W7, 11.9%) and proteinuria (type 1 diabetes: W1, 14.2%; W3, 8.7%; W7, 8.2%; type 2 diabetes: W1, 15.6%; W3, 9.3%; W7, 7.6%). Fewer patients were reported as receiving dialysis for both type 1 diabetes (W2, 1.4%; W7, 0.3%) and type 2 diabetes (W2, 0.9%; W7, 0.2%) over time. While there was no change in mean HbA or prevalence of diagnosed hypertension (type 1 diabetes: W1, 22.7%; W7, 19.9%; type 2 diabetes: W1, 60.9%; W7, 66.2%), the use of statins had increased among patients diagnosed with dyslipidaemia (type 1 diabetes: W1, 77.7%; W7, 90.7%; type 2 diabetes: W1, 78.6%; W7, 94.7%). Angiotensin II receptor blockers (type 1 diabetes: W1, 18.0%; W7, 30.6%; type 2 diabetes: W1, 24.2%; W7, 43.6%) were increasingly used over ACE inhibitors after W1 (type 1 diabetes: W1, 65.0%; W7, 55.9%; type 2 diabetes: W1, 55.7%, W7, 41.1%) among patients diagnosed with hypertension.
CONCLUSIONS/INTERPRETATION: In LMICs, real-world data suggest improvement in screening and treatment for kidney disease in patients with type 1 and type 2 diabetes attending non-nephrology clinics. This was accompanied by decreasing proportions of patients with microalbuminuria and proteinuria, with fewer patients who reported receiving dialysis over a 12-year period.
目的/假设：糖尿病是全球范围内导致肾脏疾病的主要原因。在中低收入国家（LMICs），针对糖尿病患者的肾脏疾病的筛查、治疗和控制方面的信息有限。
国际糖尿病管理实践研究是一项正在进行的、非干预性的研究，主要针对接受内科医生和内分泌科医生门诊治疗的 1 型和 2 型糖尿病患者的临床特征和实践。我们在 2005 年至 2017 年的七轮数据收集（W）中检查了肾脏疾病的筛查、患病率、治疗和控制情况。
在 15079 例 1 型糖尿病患者和 66088 例 2 型糖尿病患者中，肾脏疾病的筛查在 W2 和 W3 之间增加，随后趋于平稳（1 型糖尿病：W2，73.7%；W3，84.1%；W7，83.4%；2 型糖尿病：W2，65.1%；W3，82.6%；W7，86.2%）。微量白蛋白尿患者的比例也呈下降趋势（1 型糖尿病：W1，27.1%；W3，14.7%；W7，13.8%；2 型糖尿病：W1，24.5%；W3，12.6%；W7，11.9%）和蛋白尿（1 型糖尿病：W1，14.2%；W3，8.7%；W7，8.2%；2 型糖尿病：W1，15.6%；W3，9.3%；W7，7.6%）。随着时间的推移，1 型（W2，1.4%；W7，0.3%）和 2 型（W2，0.9%；W7，0.2%）糖尿病患者接受透析的比例也有所下降。虽然 1 型（W1，22.7%；W7，19.9%）和 2 型（W1，60.9%；W7，66.2%）糖尿病患者的平均 HbA 和确诊高血压的患病率没有变化，但在诊断为血脂异常的患者中，他汀类药物的使用有所增加（1 型糖尿病：W1，77.7%；W7，90.7%；2 型糖尿病：W1，78.6%；W7，94.7%）。血管紧张素 II 受体阻滞剂（1 型糖尿病：W1，18.0%；W7，30.6%；2 型糖尿病：W1，24.2%；W7，43.6%）在 W1 后在 W1 后（1 型糖尿病：W1，65.0%；W7，55.9%；2 型糖尿病：W1，55.7%，W7，41.1%）逐渐取代了 ACE 抑制剂，用于治疗高血压患者。
结论/解释：在 LMICs 中，真实世界的数据表明，在接受非肾病学诊所治疗的 1 型和 2 型糖尿病患者中，肾脏疾病的筛查和治疗有所改善。这伴随着微量白蛋白尿和蛋白尿患者比例的下降，在 12 年的时间里，接受透析治疗的患者比例也有所下降。
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