Department of Internal Medicine, Nephrology and Dialysis, Military Institute of Medicine-National Research Institute, Szaserów 128, 04-141 Warsaw, Poland.
Nutrients. 2023 Mar 23;15(7):1549. doi: 10.3390/nu15071549.
Diabetes mellitus is currently the leading cause of end-stage renal disease. Assessing nutritional status is an important component of care in this group. This prospective observational study aimed to assess the nutritional status of type 1 and type 2 diabetes patients on hemodialysis or peritoneal dialysis and its relationship with hospitalizations and all-cause death. Adult patients with end-stage renal disease, treated with dialysis, and suffering from type 1 or type 2 diabetes, being treated with insulin, were included in the study. Exclusion criteria comprised other types of diabetes, the patient's refusal to participate in the study, and severe disorders impacting verbal-logical communication. The nutritional status based on the Nutritional Risk Index, the Geriatric Nutritional Risk Index, fat distribution measures, and the Charlson Comorbidity Index was estimated for 95 Caucasian dialysis patients with type 1 (n = 25) or type 2 (n = 70) diabetes. Patients with type 1 diabetes exhibited significantly inferior nutritional status and increased nutritional risk than those with type 2 diabetes. Lower values of nutritional indices significantly differentiated patients with type 1 from those with type 2 diabetes, with ≥84% sensitivity and specificity. Inferior nutritional status was related to all-cause hospitalizations, whereas higher comorbidity was associated with a greater likelihood of cardiovascular hospitalizations and all-cause death. The significant difference between patients with type 1 and type 2 diabetes being treated with dialysis indicates that these patients should not be considered as a homogeneous group, while also considering the greater age of patients with type 2 diabetes.
目前，糖尿病是终末期肾病的主要病因。评估营养状况是该类患者护理的重要组成部分。本前瞻性观察研究旨在评估血液透析或腹膜透析的 1 型和 2 型糖尿病患者的营养状况及其与住院和全因死亡的关系。纳入研究的对象为终末期肾病、接受透析治疗且患有 1 型或 2 型糖尿病（正在接受胰岛素治疗）的成年患者。排除标准包括其他类型的糖尿病、患者拒绝参与研究以及严重影响言语逻辑沟通的疾病。对 95 名接受透析治疗的白种人 1 型（n = 25）或 2 型（n = 70）糖尿病患者进行基于营养风险指数、老年营养风险指数、脂肪分布测量和 Charlson 合并症指数的营养状况评估。1 型糖尿病患者的营养状况明显较差，营养风险较高。营养指数值较低可显著区分 1 型和 2 型糖尿病患者，其灵敏度和特异性均≥84%。较差的营养状况与全因住院有关，而较高的合并症与心血管住院和全因死亡的可能性增加有关。接受透析治疗的 1 型和 2 型糖尿病患者之间存在显著差异，表明这些患者不应被视为同质群体，同时也应考虑到 2 型糖尿病患者的年龄较大。
