Poor risk factor control in outpatients with diabetes mellitus type 2 in Germany: The DIAbetes COhoRtE (DIACORE) study

Introduction
Patients with diabetes mellitus type 2 (DM2) are at high risk for micro- and macrovascular disease. Here, we explore the degree of traditional risk factor control in the baseline visit of a cohort of DM2 outpatients.
Methods
DIACORE (DIAbetes COhoRtE) is a prospective cohort study of 3000 adult DM2 outpatients. Here, we present results from the baseline visit. Sociodemographic and anthropometric variables, cardiovascular risk factors, comorbidities and medication were assessed by interview and medical exams. Serum-creatinine based estimated glomerular filtration rate (eGFRcrea) and urinary albumin-creatinine ratio (UACR) were determined for classification of chronic kidney disease (CKD). The proportion of patients with adequate control of traditional risk factors (blood pressure<140/90mmHg, HbA1c<7.5%, LDL<100mg/dl) was calculated in 2892 patients with non-missing data in 9 relevant variables within each KDIGO 2012 CKD class.
Results
In the analyzed baseline data (n = 2892, 60.2% men), mean (standard deviation) values for age, DM2 duration and HbA1c were 65.3 (9.3) years, 10.3 (8.4) years and 6.9% (1.1) respectively. Of these 2892 patients, 18.7% had CKD stage 3 or higher, 25.7% had UACR≥30mg/g. Adequate blood pressure, HbA1c and LDL control was achieved in 55.7%, 78.5% and 34.4%, respectively. In 16.4% of patients (473), all three risk factors were below recommended targets. The proportion of adequate risk factor control was similar across KDIGO eGFRcrea classes. Adequate blood pressure and HbA1c control were significantly associated with lower UACR category without and with controlling for other risk factors (p<0.0001, p = 0.0002, respectively).
Conclusion
In our study of patients with diabetes mellitus type 2, we observed a low level of risk factor control indicating potential for risk reduction.

研究背景
2型糖尿病（diabetes mellitus type 2, DM2）患者罹患微血管及大血管病变的风险极高。本研究旨在探究本队列2型糖尿病门诊患者基线访视时的传统危险因素控制情况。

研究方法
DIACORE（糖尿病队列研究，DIAbetes COhoRtE）是一项纳入3000名成年2型糖尿病门诊患者的前瞻性队列研究。本文将呈现其基线访视的研究结果。研究通过访谈与医学检查收集了社会人口学、人体测量学指标、心血管危险因素、合并症及用药情况数据。基于血清肌酐估算的肾小球滤过率（estimated glomerular filtration rate, eGFRcrea）与尿白蛋白肌酐比（urinary albumin-creatinine ratio, UACR）用于慢性肾脏病（chronic kidney disease, CKD）的分期判定。本研究针对各KDIGO 2012慢性肾脏病分期中，9项相关变量无缺失数据的2892名患者，计算了其传统危险因素（血压<140/90mmHg、糖化血红蛋白（HbA1c）<7.5%、低密度脂蛋白（LDL）<100mg/dl）达标患者的占比。

研究结果
本次分析的基线数据共纳入2892名患者，其中男性占比60.2%。患者的年龄、糖尿病病程及糖化血红蛋白的均值（标准差）分别为65.3（9.3）岁、10.3（8.4）年及6.9%（1.1）。在这2892名患者中，18.7%患有3期及以上慢性肾脏病，25.7%的患者尿白蛋白肌酐比≥30mg/g。血压、糖化血红蛋白及低密度脂蛋白的达标率分别为55.7%、78.5%与34.4%。其中16.4%的患者（共473名）三项危险因素均控制在推荐目标范围内。各KDIGO基于血清肌酐估算的肾小球滤过率分期中，危险因素达标率无显著差异。在未校正与校正其他危险因素的分析中，血压与糖化血红蛋白达标均与更低的尿白蛋白肌酐比分层显著相关（p<0.0001，p=0.0002）。

研究结论
本针对2型糖尿病患者的研究显示，当前危险因素控制水平偏低，提示仍存在进一步降低并发症风险的空间。