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首页> 外文期刊>BMC Nephrology >Glycaemic control and antidiabetic therapy in patients with diabetes mellitus and chronic kidney disease – cross-sectional data from the German Chronic Kidney Disease (GCKD) cohort
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Glycaemic control and antidiabetic therapy in patients with diabetes mellitus and chronic kidney disease – cross-sectional data from the German Chronic Kidney Disease (GCKD) cohort

机译：糖尿病和慢性肾脏病患者的血糖控制和抗糖尿病治疗–来自德国慢性肾脏病（GCKD）队列的横断面数据

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Background Diabetes mellitus (DM) is the leading cause of end-stage renal disease. Little is known about practice patterns of anti-diabetic therapy in the presence of chronic kidney disease (CKD) and correlates with glycaemic control. We therefore aimed to analyze current antidiabetic treatment and correlates of metabolic control in a large contemporary prospective cohort of patients with diabetes and CKD. Methods The German Chronic Kidney Disease (GCKD) study enrolled 5217 patients aged 18–74 years with an estimated glomerular filtration rate (eGFR) between 30–60?mL/min/1.73?m2 or proteinuria >0.5?g/d. The use of diet prescription, oral anti-diabetic medication, and insulin was assessed at baseline. HbA1c, measured centrally, was the main outcome measure. Results At baseline, DM was present in 1842 patients (35?%) and the median HbA1C was 7.0?% (25th–75th percentile: 6.8–7.9?%), equalling 53?mmol/mol (51, 63); 24.2?% of patients received dietary treatment only, 25.5?% oral antidiabetic drugs but not insulin, 8.4?% oral antidiabetic drugs with insulin, and 41.8?% insulin alone. Metformin was used by 18.8?%. Factors associated with an HbA1C level >7.0?% (53?mmol/mol) were higher BMI (OR?=?1.04 per increase of 1?kg/m2, 95 % CI 1.02–1.06), hemoglobin (OR?=?1.11 per increase of 1?g/dL, 95 % CI 1.04–1.18), treatment with insulin alone (OR?=?5.63, 95 % CI 4.26–7.45) or in combination with oral antidiabetic agents (OR?=?4.23, 95 % CI 2.77–6.46) but not monotherapy with metformin, DPP-4 inhibitors, or glinides. Conclusions Within the GCKD cohort of patients with CKD stage 3 or overt proteinuria, antidiabetic treatment patterns were highly variable with a remarkably high proportion of more than 50?% receiving insulin-based therapies. Metabolic control was overall satisfactory, but insulin use was associated with higher HbA1C levels.
机译：背景技术糖尿病（DM）是终末期肾脏疾病的主要原因。对于存在慢性肾脏病（CKD）的抗糖尿病治疗的实践模式知之甚少，并且与血糖控制相关。因此，我们旨在分析糖尿病和CKD患者的大量当代前瞻性队列中当前的抗糖尿病治疗方法和代谢控制的相关性。方法：德国慢性肾脏病（GCKD）研究招募了5217名18-74岁的患者，其肾小球滤过率（eGFR）估计在30–60？mL / min / 1.73？m 2 或蛋白尿> 0.5微克/天。在基线时评估饮食处方，口服抗糖尿病药物和胰岛素的使用。集中测量的HbA1c是主要的结局指标。结果在基线时，DM存在于1842名患者中（35％），中位数HbA1C为7.0％（25 –75 百分位数：6.8–7.9％ ），等于53？mmol / mol（51，63）;仅24.2％的患者接受饮食治疗，25.5％的口服抗糖尿病药物但未接受胰岛素治疗，8.4 %%的口服胰岛素抗糖尿病药物和41.8％的胰岛素治疗。二甲双胍的使用率为18.8％。 HbA1C水平> 7.0？％（53？mmol / mol）的相关因素是BMI较高（OR？=？1.04，每增加1？kg / m 2 ，95％CI 1.02–1.06） ，血红蛋白（每增加1µg / dL，OR？=？1.11，95％CI 1.04–1.18），单独使用胰岛素治疗（OR？=？5.63，95％CI 4.26–7.45）或与口服降糖药合用（OR？=？4.23，95％CI 2.77–6.46），但不能与二甲双胍，DPP-4抑制剂或格列奈特一起接受单药治疗。结论在CKD 3期或明显蛋白尿患者的GCKD队列中，抗糖尿病治疗模式变化很大，接受胰岛素治疗的比例高于50％以上。代谢控制总体上令人满意，但胰岛素的使用与更高的HbA1C水平相关。

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