为什么时间这么短？新诊断糖尿病患者发生糖尿病周围神经病变时间的预测因素：埃塞俄比亚医疗机构的一项多中心随访研究。
Why too soon? Predictors of time to diabetic peripheral neuropathy among newly diagnosed diabetes mellitus patients: a multicenter follow-up study at health-care setting of Ethiopia.
作者信息
Debele Gebiso Roba, Kuse Samuel Abdisa, Kefeni Bilisumamulifna Tefera, Geda Abdi, Jifar Wakuma Wakene, Kitila Keno Melkamu, Hajure Mohammedamin
机构信息
Department of Public Health, College of Health Sciences, Mattu University, Mattu, Ethiopia.
Department of Midwifery, College of Health Sciences, Oda Bultum University, Chiro, Ethiopia.
出版信息
Arch Public Health. 2023 Oct 21;81(1):186. doi: 10.1186/s13690-023-01202-3.
BACKGROUND
Due to the rising number of diabetic patients, the burden of diabetic peripheral neuropathy (DPN) is clearly posing a major challenge to the long-term viability of the health-care system. Despite this, most DPN epidemiological research in eastern Africa, including Ethiopia, has so far been limited to survey studies. Thus, we determined the incidence of DPN and its predictors among diabetic patients in tertiary health-care setting of southwest Ethiopia.
METHODS
A multicenter retrospective follow-up study was carried out on 567 randomly selected diabetic patients. Data were entered using Epi-Data v4.6 and analyzed using R v4.0.4. The survival curves were estimated using the Kaplan-Meier, and compared using Log-rank test between groups of categorical variables. The PHA were evaluated using the Schoenfeld residuals test. Multivariable Gompertz proportional hazard model was used to examine the predictors of DPN at 5% level of significance.
RESULTS
Overall, of 567 DM patients 119 developed DPN with an incidence rate of 3.75, 95%CI [3.13, 4.49] per 100 PY. About 15.13% and 69% of DPN cases occurred within 2 and 5 years of DM diagnosis, respectively. In the multivariable Gompertz PH model, being female [AHR = 1.47; 95% CI (1.01, 2.15)], T2DM [AHR = 3.49 95% CI (1.82, 6.71)], having diabetic retinopathy [AHR = 1.9 95% CI (1.25, 2.91)], positive proteinuria [AHR = 2.22 95% CI (1.35, 3.65)], being obese [AHR = 3.94 95% CI (1.2, 12.89)] and overweight [AHR = 3.34 95% CI (1.09, 10.25)] significantly predicts the future risk of DPN.
CONCLUSION
Nearly, 7 in 10 of DPN cases occurred within short period of time (5 year) of DM diagnosis. Being female, T2DM, DR, positive proteinuria, obese and overweight significantly predicts the risk of DPN. Therefore, we recommend screening and early diagnosis of diabetes with its complication. While doing so, attention should be given for DM patients with DR and positive proteinuria at baseline.
背景
由于糖尿病患者数量不断增加，糖尿病周围神经病变（DPN）的负担显然给医疗保健系统的长期生存能力带来了重大挑战。尽管如此，包括埃塞俄比亚在内的东非大多数DPN流行病学研究迄今为止仅限于调查研究。因此，我们确定了埃塞俄比亚西南部三级医疗保健机构中糖尿病患者DPN的发病率及其预测因素。
方法
对567名随机选择的糖尿病患者进行了一项多中心回顾性随访研究。数据使用Epi-Data v4.6录入，并使用R v4.0.4进行分析。使用Kaplan-Meier法估计生存曲线，并使用Log-rank检验对分类变量组之间进行比较。使用Schoenfeld残差检验评估PHA。多变量Gompertz比例风险模型用于在5%的显著性水平下检查DPN的预测因素。
结果
总体而言，在567名糖尿病患者中，119人发生了DPN，发病率为每100人年3.75，95%CI[3.13, 4.49]。分别约有15.13%和69%的DPN病例发生在糖尿病诊断后的2年和5年内。在多变量Gompertz PH模型中，女性[AHR = 1.47；95%CI（1.01, 2.15）]、2型糖尿病[AHR = 3.49，95%CI（1.82, 6.71）]、患有糖尿病视网膜病变[AHR = 1.9，95%CI（1.25, 2.91）]、蛋白尿阳性[AHR = 2.22，95%CI（1.35, 3.65）]、肥胖[AHR = 3.94，95%CI（1.2, 12.89）]和超重[AHR = 3.34，95%CI（1.09, 10.25）]显著预测了未来发生DPN的风险。
结论
近十分之七的DPN病例发生在糖尿病诊断后的短时间内（5年）。女性、2型糖尿病、糖尿病视网膜病变、蛋白尿阳性、肥胖和超重显著预测了DPN的风险。因此，我们建议对糖尿病及其并发症进行筛查和早期诊断。在此过程中，应关注基线时患有糖尿病视网膜病变和蛋白尿阳性的糖尿病患者。
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