Effects Of Strict Follow-up Intervention On Outcome Of Early Diabetic Nephropathy In Type2Diabetic Mellitus And Related Factor Analysis

Objective: To investigate the effects of strict follow-up intervention on outcome ofearly diabetic nephropathy (DN) in type2diabetic patients and analyze the relatedfactors affecting the progression of early DN.Methods:87patients with type2diabetes mellitus admitted in Endocrinology andfirst diagnosed as early DN from2008to2010were selected as the objects of study.The follow-up intervention was started after discharge. According to patients’ voluntarychoice on whether to accept outpatient or inpatient follow-up every three months, thepatients were divided into the strict follow-up group (n=35) and the non-strict follow-upgroup (n=52). After four years of follow-up, the control of early DN risk factors and DNoutcome conditions were strictly observed in the follow-up group and non-strictlyfollow-up group. According to the progression of DN and urinary albumin to creatinineratio (UACR) after follow-up for four years, the patients were divided into the DNprogression group and the DN non-progression group, the microalbuminuria (MAU)progression group and the MAU non-progression group. The related factors affectingthe progressions of early DN and MAU were analyzed.Results:1. After four years of follow-up, there were63cases of DNnon-progression group (including15cases turned to normal without proteinuriaaccounting for17.2%and48cases maintained in DN stage Ⅲ accounting for55.2%)and24cases of DN progression group (22cases developed to stage IV accounting for25.3%and2cases progressed to stage V accounting for2.3%).2. There were not significant changes in UACR levels before and after follow-up in the strict follow-up group (P>0.05), but the UACR levels before and after follow-upwere significantly increased in the non-strict follow-up group; the differences werestatistically significant (P<0.05). The compliance rates of blood glucose, blood pressureand blood lipids in the strict follow-up group were all higher than those in the non-strictfollow-up group, but the differences were not statistically significant. There were nosignificant differences in the radios of DN progress, MAU progress, diabeticretinopathy (DR) progress, newly diagnosed DR and newly diagnosed peripheralneuropathy between the two groups (P>0.05).3. The DN combined DR groups was with a higher rate of female, longer durationof diabetes mellitus, higher glycated hemoglobin level, and lower fasting C-peptidelevel; the differences were statistically significant (P<0.05). In the DN combined DRsubgroups, the radio of DN progress in the strict follow-up group was significantlylower than the non-strict follow-up group (7.1%vs47.8%), and the difference wasstatistically significant (P<0.05).4. After four years of follow-up, compared with the DN non-progression group, theincidence of DR, systolic blood pressure, serum creatinine and UACR level were higherin the DN progression group, but the glomerular filtration rate was lower in the DNprogression group, and the differences were statistically significant (P<0.05). Theresults of logistic regression analysis showed that systolic blood pressure was anindependent risk factor in the progression of early DN (OR=1.027,95%CI1.002-1.052,P<0.05).5. After four years of follow-up, compared with the MAU non-progression group,the ratio of smoking history, the incidence of DR, serum creatinine and UACR levelwere higher in the MAU progression group, but the glomerular filtration rate was lowerin the MAU progression group, and the differences were statistically significant(P<0.05). The results of logistic regression analysis showed that the presence of diabeticretinopathy (OR=4.878,95%CI1.395-17.059, P<0.05) and a history of smoking(OR=3.284,95%CI1.272-8.482, P<0.05) were independent risk factors in theprogression of MAU. Conclusions:1. Strict follow-up intervention are conducive to the control of bloodglucose, blood pressure and blood lipid in type2diabetic patients with early diabeticnephropathy.2. Strict follow-up intervention can delay the progression of early DN, especially inpatients with diabetic nephropathy combined diabetic retinopathy.3. Systolic blood pressure is an independent risk factor in the progression of earlydiabetic nephropathy.4. The presence of diabetic retinopathy and a history of smoking are independentrisk factors in the progression of microalbuminuria.