Diabetes and Metabolism Information Center, Research Institute, National Center for Global Health and Medicine, 1-21-1, Toyama, Shinjuku-Ku, Tokyo 162-8655, Japan; Department of Diabetes, Endocrinology, and Metabolism, National Center for Global Health and Medicine Hospital, 1-21-1, Toyama, Shinjuku-Ku, Tokyo 162-8655, Japan.
Diabetes and Metabolism Information Center, Research Institute, National Center for Global Health and Medicine, 1-21-1, Toyama, Shinjuku-Ku, Tokyo 162-8655, Japan; Kellogg School of Management, Northwestern University, 2211 Campus Drive, Evanston, IL 60208, USA.
Diabetes Res Clin Pract. 2024 Sep;215:111804. doi: 10.1016/j.diabres.2024.111804. Epub 2024 Jul 30.
Japan started the Diabetic Nephropathy Aggravation Prevention Program. Its early impact was assessed in this study.
This study used the Kokuho Database of patients with type 2 diabetes from program-implementing and non-implementing municipalities (fiscal years [FYs] 2015-2021). Implementing municipalities facilitated clinic visits and provided education to eligible patients. Average treatment effects on the treated in FYs 2016 and 2018 were evaluated using the inverse probability of treatment weighting. Comparison included intervened vs. non-intervened patients in program-implementing municipalities (Comparison A), intervened patients in program-implementing vs. eligible patients in non-implementing municipalities (Comparison B), and eligible patients in implementing and non-implementing municipalities (Comparison C).
Overall, 89,611/89,685 patients from FY 2016/2018 were eligible. Among 68,125/68,170 patients in program-implementing municipalities, 1,470/1,819 were intervened. In Comparison A, the estimated effect of the program on ΔeGFR at 3 years were -0.4 (95 % confidence interval; -1.0, 0.2)/-0.4 (-0.9, 0.1) mL/min/1.73 m in FY 2016/2018. Comparisons B and C demonstrated similar tendency; distribution of %change in eGFR varied between municipalities.
Early in the program, renal function did not improve in the intervened patients or program-implementing municipalities. Diverse eGFR changes across municipalities highlighted diverse intervention outcomes, emphasizing the need of program refinement.
日本启动了糖尿病肾病加重预防计划。本研究评估了其早期影响。
本研究使用了来自实施和未实施该计划的市町村的 2 型糖尿病患者的厚生劳动省数据库（财政年度 2015-2021 年）。实施市町村为符合条件的患者提供了门诊就诊和教育服务。使用倾向评分逆概率加权法（inverse probability of treatment weighting）评估了 2016 财年和 2018 财年的平均处理效果。比较包括实施计划的市町村中的干预组与非干预组患者（比较 A）、实施计划的市町村中的干预组患者与非实施计划的市町村中的符合条件的患者（比较 B）以及实施计划和非实施计划的市町村中的符合条件的患者（比较 C）。
总体而言，2016 财年/2018 财年有 89611/89685 名患者符合条件。在实施计划的市町村的 68125/68170 名患者中，有 1470/1819 名患者接受了干预。在比较 A 中，该计划对 3 年时ΔeGFR 的估计效果为-0.4（95%置信区间；-1.0，0.2）/-0.4（-0.9，0.1）mL/min/1.73 m2 在 2016 财年/2018 财年。比较 B 和 C 显示出类似的趋势；肾小球滤过率变化的%在市町村之间存在差异。
在该计划的早期，干预组和实施计划的市町村患者的肾功能并没有改善。市町村之间肾小球滤过率的不同变化突显了不同的干预结果，强调了计划改进的必要性。
