Department of Preventive Services, Kyoto University School of Public Health, Kyoto, Japan.
Healthtech Laboratory, Inc., Kyoto, Japan.
Front Endocrinol (Lausanne). 2023 Jul 27;14:1195167. doi: 10.3389/fendo.2023.1195167. eCollection 2023.
Japan has the second highest prevalence of dialysis use in the world. Approximately 40% of patients who begin dialysis have diabetic kidney disease (DKD). Local governments and medical facilities are required to provide preventive measures against worsening diabetes mellitus (DM). However, the percentage of patients with DM who receive such screening or interventions for DKD is unclear. This study aimed to reveal to what extent screening for DKD and preventive measures against worsening DKD are performed in patients with DM, using an administrative database in a municipality.
This was a cross-sectional study that used the Kyoto-city's administrative medical and long-term care database. Patients with a diagnosis of DM and receiving antidiabetic medication between 2013 and 2018 were defined as patients with DM and included. Patients with DKD were defined as those diagnosed with diabetic nephropathy or those with chronic kidney disease. We described the characteristics of patients with DM, diabetic complications, and extent of DKD screenings and preventive efforts against worsening of DM by fiscal year.
Across fiscal years, 25.8% to 27.5% of patient with DM had DKD. More than 3% of patients were on dialysis due DM in each fiscal year; approximately 15% started receiving dialysis that year. The percentage of patients who were regularly prescribed antidiabetic medication and received glycosylated hemoglobin testing ranged from 64.0% to 67.2% and from 30.6% to 36.5%, respectively. Urine microalbuminuria testing at least once a year occurred in 9.3% to 10.0%. The percentage of patients who received nutritional guidance ranged from 19.0% to 21.0%. Approximately 1% of patients received guidance for preventing DM from progressing to a disease that requires dialysis each fiscal year.
This study from Japan, where a super-aging society has developed, using an administrative database in a municipality covering most of the elderly population clearly demonstrated an evidence-practice gap in efforts to prevent worsening of DKD. Strengthening cooperation between government and medical facilities and support for providing preventive measures against DKD are urgently needed.
日本是世界上透析治疗使用率第二高的国家。约有 40%开始透析的患者患有糖尿病肾病（DKD）。地方政府和医疗机构被要求提供针对糖尿病恶化的预防措施。然而，患有 DKD 的糖尿病患者接受此类筛查或干预的比例尚不清楚。本研究旨在使用一个市的行政医疗和长期护理数据库，揭示在多大程度上对糖尿病患者进行 DKD 筛查以及预防 DKD 恶化的措施。
这是一项使用京都市行政医疗和长期护理数据库的横断面研究。2013 年至 2018 年间被诊断患有糖尿病并接受抗糖尿病药物治疗的患者被定义为糖尿病患者并包括在内。患有 DKD 的患者被定义为被诊断为糖尿病肾病或患有慢性肾脏病的患者。我们按财政年度描述了糖尿病患者、糖尿病并发症的特征以及 DKD 筛查和预防 DM 恶化的措施的范围。
各财政年度，25.8%至 27.5%的糖尿病患者患有 DKD。每年都有超过 3%的糖尿病患者因糖尿病接受透析；当年约有 15%的患者开始接受透析。定期开处抗糖尿病药物和接受糖化血红蛋白检测的患者比例分别为 64.0%至 67.2%和 30.6%至 36.5%。每年至少进行一次尿微量白蛋白检测的患者比例为 9.3%至 10.0%。接受营养指导的患者比例为 19.0%至 21.0%。每年约有 1%的患者接受预防 DM 进展为需要透析的疾病的指导。
本研究使用一个覆盖大多数老年人口的市的行政数据库，来自一个老龄化社会已经发展的日本，清楚地表明了在预防 DKD 恶化方面存在实践与证据之间的差距。迫切需要加强政府和医疗机构之间的合作，并支持提供针对 DKD 的预防措施。
