Yamada Kota, Ohsugi Mitsuru, Ito Yuichiro, Uchida Hiroki, Lee Takumi, Ueki Kohjiro
Department of Diabetes, Endocrinology and Metabolism, Center Hospital, National Center for Global Health and Medicine, Tokyo, Japan.
Department of Diabetes and Metabolic Diseases, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
J Diabetes Investig. 2025 Jan;16(1):120-128. doi: 10.1111/jdi.14341. Epub 2024 Oct 30.
AIMS/INTRODUCTION: This study aimed to investigate the risk factors for diabetic retinopathy (DR) and diabetic kidney disease (DKD) in Japanese patients with diabetes mellitus (DM). Identifying these factors could provide insights into the shared and distinct mechanisms contributing to these complications in the diabetic population.
We conducted a retrospective analysis using the J-DREAMS (Japan Diabetes compREhensive database project based on an Advanced electronic Medical record System) database, which is directly linked to electronic medical records. The study included Japanese people aged 18 years and older with diabetes, who were registered at a referral center between December 1, 2015, and March 31, 2021, and had simultaneous measurements of serum creatinine and hemoglobin A1c (HbA1c). The presence or absence of DR and DKD was determined for 8,794 and 8,770 patients, respectively. Multivariable logistic regression analyses were used to identify risk factors, considering patient characteristics, comorbid conditions, and laboratory data as explanatory variables.
Common risk factors for both DR and DKD included hypertension, anemia, diabetic neuropathy, cerebrovascular disease, chronic heart failure, low serum albumin levels, and elevated HbA1c. The contributions of age, duration of DM, and body mass index (BMI) differed between the DR and DKD groups.
In addition to poor glycemic control and hypertension, anemia, low serum albumin, cerebrovascular disease, and heart failure were identified as independent common risk factors for DR and DKD, suggesting the existence of cardio-renal anemia syndrome in patients with DM.
目的/引言：本研究旨在调查日本糖尿病（DM）患者发生糖尿病视网膜病变（DR）和糖尿病肾病（DKD）的危险因素。识别这些因素有助于深入了解糖尿病患者发生这些并发症的共同和独特机制。
我们使用J-DREAMS（基于先进电子病历系统的日本糖尿病综合数据库项目）数据库进行了一项回顾性分析，该数据库与电子病历直接相连。研究纳入了2015年12月1日至2021年3月31日期间在转诊中心登记的18岁及以上的日本糖尿病患者，这些患者同时测量了血清肌酐和糖化血红蛋白（HbA1c）。分别确定了8794例和8770例患者是否存在DR和DKD。多变量逻辑回归分析用于识别危险因素，将患者特征、合并症和实验室数据作为解释变量。
DR和DKD的共同危险因素包括高血压、贫血、糖尿病神经病变、脑血管疾病、慢性心力衰竭、低血清白蛋白水平和HbA1c升高。年龄、DM病程和体重指数（BMI）对DR组和DKD组的影响有所不同。
除血糖控制不佳和高血压外，贫血、低血清白蛋白、脑血管疾病和心力衰竭被确定为DR和DKD的独立共同危险因素，这表明DM患者存在心肾贫血综合征。
