DECLINING INCIDENCE OF NEPHROPATHY IN INSULIN-DEPENDENT DIABETES-MELLITUS
DECLINING INCIDENCE OF NEPHROPATHY IN INSULIN-DEPENDENT DIABETES-MELLITUS
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DOI：
10.1056/nejm199401063300103
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发表时间：
1994-01-06
影响因子：
158.5
通讯作者：
LUDVIGSSON, J
中科院分区：
文献类型：
--
作者：
BOJESTIG, M;ARNQVIST, HJ;LUDVIGSSON, J
背景胰岛素依赖型糖尿病患者的高相对死亡率主要由糖尿病肾病引起。从1950年到20世纪80年代初，糖尿病患者25年的肾病累积发病率为25%至30%。 在一项人群研究中，我们评估了糖尿病肾病发病率的近期趋势。我们研究了1961年至1980年瑞典东南部一个地区15岁以前诊断为胰岛素依赖型糖尿病的213例患者。92%的患者从糖尿病发病到1991年或死亡。持续性白蛋白尿（Albustix试验阳性）患者被认为患有糖尿病肾病。从1980年开始，对所有患者定期检测糖化血红蛋白。糖尿病25年后持续性白蛋白尿的累积发病率从1961年至1965年糖尿病患者的30.0%下降到1966年至1970年糖尿病患者的8.9%（P = 0.01）。糖尿病20年后，累积发病率从1961年至1965年糖尿病患者的28.0%降至1971年至1975年糖尿病患者的5.8%（P = 0.01）。在1976年至1980年期间诊断为糖尿病的任何患者中尚未出现持续性白蛋白尿。糖化血红蛋白平均值由1980 ~ 1985年的7.4%下降到1986 ~ 1991年的7.0%（P
Background. The high relative mortality among patients with insulin-dependent diabetes mellitus results mainly from diabetic nephropathy. The cumulative incidence of nephropathy of 25 to 30 percent among patients who had had diabetes for 25 years remained stable from 1950 to the early 1980s. In a population study, we assessed recent trends in the incidence of diabetic nephropathy.Methods. We studied all 213 patients in whom insulin-dependent diabetes mellitus was diagnosed before the age of 15 years between 1961 and 1980 in a district in southeastern Sweden. Ninety-two percent of the patients were followed from the onset of diabetes to 1991 or to death. Patients with persistent albuminuria (positive Albustix test) were considered to have diabetic nephropathy. Glycosylated hemoglobin was measured periodically in all patients, beginning in 1980.Results. The cumulative incidence of persistent albuminuria after 25 years of diabetes decreased from 30.0 percent among the patients in whom diabetes developed in the period 1961 to 1965 to 8.9 percent among those in whom it developed from 1966 to 1970 (P = 0.01). After 20 years of diabetes, the cumulative incidence decreased from 28.0 percent among the patients in whom diabetes developed from 1961 to 1965 to 5.8 percent among those in whom it developed from 1971 to 1975 (P = 0.01). Persistent albuminuria has not yet developed in any patient in whom diabetes was diagnosed in the period 1976 to 1980. The average glycosylated hemoglobin value decreased from 7.4 percent in the period 1980 to 1985 to 7.0 percent from 1986 to 1991 (P