最近的欧洲心脏病学会(ESC)/欧洲糖尿病研究协会(EASD)指南为检测和治疗糖尿病患者的慢性肾脏疾病(CKD)提供了建议。我们将临床实践与指南进行了比较,以确定需要改进的地方。
对675,628名1型或2型糖尿病患者的德国数据库分析,本分析中包括134,395。将数据与ESC/EASD建议进行比较。
这项分析包括17,649和116,747名1型和2型糖尿病患者。分别。分析结果显示,1型和2型糖尿病患者分别为44.1和49.1%,分别,每年进行CKD筛查。尽管抗糖尿病治疗,只有27.2%的1型患者和43.5%的2型患者实现了目标HbA1c<7.0%.钠-葡萄糖转运蛋白2抑制剂(1.5%1型/8.7%2型糖尿病)和胰高血糖素样肽-1受体激动剂(0.6%1型/5.2%2型糖尿病)的使用受到限制。41.1和67.7%的18-65岁的1型和2型糖尿病患者根据指南控制高血压,分别,(62.4vs.68.4%的患者>65岁)。肾素血管紧张素醛固酮抑制剂用于24.0%和40.9%的1型糖尿病患者(微量与大量白蛋白尿)和39.9%和47.7%,分别,2型糖尿病。
数据表明在肾脏疾病诊断和治疗方面对糖尿病患者的护理存在改进的空间。虽然存在不合规的具体和潜在临床合理原因,这些数据可以很好地用于临床实践决策的关键评估.
Recent European Society of Cardiology (ESC)/European Association for the Study of Diabetes (EASD)
guidelines provide recommendations for detecting and treating chronic kidney disease (CKD) in diabetic patients. We compared clinical practice with
guidelines to determine areas for improvement.
German database analysis of 675,628 patients with type 1 or type 2 diabetes, with 134,395 included in this analysis. Data were compared with ESC/EASD recommendations.
This analysis included 17,649 and 116,747 patients with type 1 and type 2 diabetes, respectively. The analysis showed that 44.1 and 49.1 % patients with type 1 and type 2 diabetes, respectively, were annually screened for CKD. Despite anti-diabetic treatment, only 27.2 % patients with type 1 and 43.5 % patients with type 2 achieved a target HbA1c of < 7.0 %. Use of sodium-glucose transport protein 2 inhibitors (1.5 % type 1/8.7 % type 2 diabetes) and glucagon-like peptide-1 receptor agonists (0.6 % type 1/5.2 % type 2 diabetes) was limited. Hypertension was controlled according to
guidelines in 41.1 and 67.7 % patients aged 18-65 years with type 1 and 2 diabetes, respectively, (62.4 vs. 68.4 % in patients > 65 years). Renin angiotensin aldosterone inhibitors were used in 24.0 and 40.9 % patients with type 1 diabetes (micro- vs. macroalbuminuria) and 39.9 and 47.7 %, respectively, in type 2 diabetes.
Data indicate there is room for improvement in caring for diabetic patients with respect to renal disease diagnosis and treatment. While specific and potentially clinically justified reasons for non-compliance exist, the data may serve well for a critical appraisal of clinical practice decisions.