The Influence Of Intensified Multifactorial Intervention On The Newly Diagnosed Diabetic Kidney Disease Stage â…£

Purpose: To investigate the effect of intensified multifactorial intervention on the newly diagnosed of diabetic kidney disease stage Ⅳ.Method: Prospective and randomized study 277 patients,the newly diagnosed type 2 diabetes mellitus and diabetic kidney disease stage Ⅳin Endocrinology Department of the First Affiliated Hospital of Henan University of Science and Technology from November 2013 to July 2013 were selected. All patients are accord with DKD diagnosis standard and CKD Installment Method according to GFR. Samples was divided into two groups, strengthen group and standard group, randomly according to 2:1.While 185 in strengthen group achieved the standard treatment goal according to the multifactorial intervention treatment strictly,92 in standard group met the goal according to treatment standard of the 2010 edition type 2 diabetes and medication.Results: 1. Comparing the levels of metabolites before the treatment with after 1 year between the both groups: Hb AIc was decreased significantly comparing with the two groups after interventions, Hb AIc was decreased more significantly in strengthen group than standard group, the difference was statistically significance(P=0.027); In both groups, the levels of LDL-C was both decreased significantly, the levels of LDLC was decreased more significantly in strengthen group than standard group(P=0.034); While TC level was decreased in strengthen group, TC level did not change much in standard group.TC level was controlled more effectively in strengthen group than standard group after interventions(P=0.013); Systolic Blood Pressure(SBP) and Diastolic Blood pressure(DBP) both decreased in strengthen group and standard group. Comparing with the two groups after interventions, SBP(P=0.018) and DBP(P=0.019) was controlled more effectively in strengthen group than standard group; ACR were decreased in the two groups comparing with the two groups after interventions.ACR(albumin creatinine ratio) was controlled more effectively in strengthen group than standard group(P=0.024); After interventions, While serum creatinine level was decreased in strengthen group, increasied in standard group. Serum creatinine level was controlled more effectively in strengthen group than standard group(P=0.008); After interventions, e GFR increased in strengthen group while decreased in standard group. Comparing with the two groups, e GFR was controlled more effectively in strengthen group than standard group(P<0.001). The levels of TG, HDL-C, Potassium, TP, Albumin did not change much, Above levels of metabolites have no statistical significance in two groups(P>0.05).2.Therapeutic effect of neuroblastoma:Compared with the standard group,the cure rate(11.7% vs 2.6%, P=0.021), the effective rate(30.2% vs 16.2%, P=0.022), the total effective rate(41.9% vs 18.8%, P=0.007) in strengthen group were higher; the noneffective rate in strengthen group were lower(51.9% vs 71.1%, P=0.005). The evolutional rate have no statistical significanc in two groups(6.2% vs 10.5%, P=0.236).3. The rate of severe hypoglycemia occurs were 13.6% in strengthen group and 10.5% in standard group. The difference was not statistical significant about the rate of severe hypoglycemia occurs by χ2 test(χ2=5.422, P=0.020).4. The rate of the cardiovascular end point events were 5.6% in strenghten group and 15.8% in standard group. The difference was not statistical significant about the rate of the cardiovascular end point events by χ2 test(χ2=6.567, P=0.010).5. The rate of deaths were 2.5% in strengthen group and 10.5% in standard group. The difference was not statistical significant about the rate of deaths by χ2 test(χ2=5.432, P=0.021).Conclusion: Multifactorial intervention strengthening treatment can not only delay the progress of the newly diagnosed diabetic kidney disease stage IV, but does not increase the risk of severe hypoglycemia occurs. The multifactorial intervention strengthening treatment can effectively reduce the risk of the cardiovascular end point events and the incidence of deaths events.