Who is tested for diabetic kidney disease and who initiates treatment - The Translating Research Into Action for Diabetes (TRIAD) study
Who is tested for diabetic kidney disease and who initiates treatment - The Translating Research Into Action for Diabetes (TRIAD) study
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DOI：
10.2337/dc06-0260
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发表时间：
2006-08-01
期刊：
影响因子：
16.2
通讯作者：
Herman, William H.
中科院分区：
文献类型：
--
作者：
Johnson, Susan L.;Tierney, Edward F.;Herman, William H.
目的：我们研究了与糖尿病患者筛查蛋白尿和开始ACE抑制剂或血管紧张素受体阻滞剂（ARB）治疗相关的因素。研究设计和方法：我们在基线（2000-2001年）和随访（2002-2003年）对5378名患者进行了调查和医疗记录回顾，这些患者参与了一项糖尿病管理护理研究。在基线横断面分析中检查与蛋白尿检测相关的因素。前瞻性地确定ARB治疗中启动ACE的相关因素。结果：在基线时，52%未接受ACE抑制剂/ARB治疗且没有已知糖尿病肾病（DKD）的患者进行了蛋白尿筛查。年龄≥65岁、HbA（1C）较高、患有心血管疾病（CVD）和无高脂血症的患者接受筛查的可能性较小。在筛查试验呈阳性的患者中，47%开始了ACE抑制剂/ARB治疗。开始治疗与筛查结果阳性、BMI >= 25 kg/m(2)、胰岛素或口服降糖药治疗、周围神经病变、收缩压>= 140 mmHg和心血管疾病相关。在接受ACE抑制剂/XRB治疗或已知DKD的患者中，63%进行了蛋白尿检测。结论：蛋白尿筛查是不充分的，特别是在老年患者或那些有竞争性医疗问题的患者中。如果更多筛查结果阳性的患者开始ACE抑制剂/ARB治疗，筛查的价值可能会增加。通过将筛查限制在未接受ACE抑制剂/ARB治疗且无已知DKE的糖尿病患者，可以提高筛查的效率。
OBJECTIVE - we examined factors associated with screening for albuminuria and initiation of ACE inhibitor or angiotensin receptor blocker (ARB) treatment in diabetic patients.RESEARCH DESIGN AND METHODS - We conducted surveys and medical record reviews for 5,378 patients participating in a study of diabetes care in managed care at baseline (2000-2001) and follow-up (2002-2003). Factors associated with testing for albuminuria were i examined in cross-sectional analysis at baseline. Factors associated with initiating ACE in ARB therapy were determined prospectively.RESULTS - At baseline, 52% of patients not receiving ACE inhibitor/ARB therapy and without known diabetic kidney disease (DKD) were screened for albuminuria. Patients >= 65 years of age, those With higher HbA(1C), those with cardiovascular disease (CVD), and those without hyperlipidemia were less likely to be screened. Of the patients with positive screening tests, 47% began ACE inhibitor/ARB therapy. Initiation of therapy was associated with positive screening test results, BMI >= 25 kg/m(2), treatment with insulin or oral antidiabetic agents, peripheral neuropathy, systolic blood pressure >= 140 mmHg, and CVD. Of the patients receiving ACE inhibitor/XRB therapy or with known DKD, 63% were tested for albuminuria.CONCLUSIONS - Screening for albuminuria was inadequate, especially in older patients or those with competing medical concerns. The value of screening could be increased if more patients with positive screening tests initiated ACE inhibitor/ARB therapy. The efficiency of screening could be improved by limiting screening to diabetic patients not receiving ACE inhibitor/ARB therapy and without known DKE).