Investigation On The Status Of Diabetes Among Inpatients In The Department Of Nephrology Of Tertiary General Hospital

ObjectiveAnalysis the clinical characteristics of nephrology department kidney disease patients with diabetes mellitus.Comparison control of glycemic,blood pressure and blood lipid and other comprehensive management level before and after admitted to hospital.In order to explore the non-endocrinologist department of better diabetes management modes.Methods1.Use case retrieval system,collected 270 patients with diabetes from Peking union medical college hospital between January 1,2016 and December 31,2016.We retrospectively analyzed the age,sex,course,body mass index,blood pressure,biochemical test results,kidney biopsy and pathology results,complications,drug usage,and so on.2.Analysis and comparison the clinical characteristics with diabetic kidney disease or without.Comparison control of glycemic,blood pressure and blood lipid,medication and other comprehensive management level before and after admitted to hospital.Analysis of nephrology department diabetes management status include glycemic control before and after the consultation.3.Use mean,percentage,the median and quartiles,t-test,rank sum test,Chi-square test for countiong and analysis.Results1.A total number of 270 patients with diabetes mellitus were selected.The main is type 2 diabetes(66.67%).Followed by steroid diabetes(87,32.2%).Male more than femal(58.52%vs 41.48%).The overall mean age is 54.5±13.7 years old,mainly middle-aged(45-59),the second is the younger old(60-74).The main was primary kidney disease(103,38%),followed by diabetes kidney disease(94,34.8%).2.Male were 2 times more than femal(65 VS 29,X2=6.71,P=0.01)with DKD.Diabetes mellitus course in DKD was 3.7 times than those without(12.7±9.1 vs 3.5±6.2,P<0.01),especially in these with diabetes duration of 5 years and above(77.1%).Mean systolic BP was higher in those with DKD(144.3±24.1 vs 137.1±20.4,P=0.O11).The control rate of HbA1c was 16.3%(HbAlc<7%)for those with DKD,33.7%for those without(X2=7.0,P<0.05).With DKD had higher rate of end-stage renal disease(ESRD)than those without(27.7%vs 14.79%,X2=18,P<0.01).It was more difficult to control blood pressure in DKD,they need three or more kind of anti-hypertensive drugs than those without DKD(21.3%VS 9%X2=13.20,P=0.01).3.2h postprandial glycemic after three meals respectively 33%,47.4%,52.2%for above 10mmol/L,and 7.4%,10.7%,7.4%respectively higher than 13.9mmol/L.50%of the patients achieved the target of HbAlc<7%.Less than 30%of lipid was under controled.Systolic BP controlled in 62.2%of these patient after admission.4.The prevalence of chronic diabetic complications and comorbidities were respectively:63%for hypertension,37.4%for atherosclerosis,34.8%for diabetic kidney disease,30.4%for diabetic retinopathy,33%for ischemic heart disease,10%for cerebral infarction and 77%for lipid disorders.The rate of diabetic retinopathy and diabetic peripheral neuropathy,ischemic heart disease,cerebral infarction,hypertension were higher in patients with DKD than those without,and the difference was statistically significant(P<0.05).5.Glycemic screening rate were 93%?98%before admission,and 88.9%?93.3%before out of the hospital.HbAlc screening rate were 740%.Only 64.9%that did at least one peripheral artery ultrasound and fundus examination were 69%,three lipid check 81.9%,echocardiography were 67%in those with DKD.Lack of inspection of peripheral neuropathy.6.Lack of the real meaning of education in diet and exercise treatments.Lipid-lowering drugs utilization for 54.8%of the patiens,for 51.5%use with insulin.24.1%had consultation.2h postprandial glycemic after dinner achieved rate higher than before consultation(31.1%VS 46.9%,P<0.05).However,they oraled biguanides and glycosidase inhibitor,respectively 1.9%,8.5%overmedication in CKD3-5,including a small number of cases after consultation.Conclusions1.Men more than women in nephrology department kidney disease with diabetes mellitus in Peking Union Medical College Hospital.The main was primary kidney disease,followed by diabetes kidney disease.DKD had higher blood pressure,glycemic,complications and a higher proportion of CKD5 period compared those without.Blood pressure control was more difficult with DKD,and required three or more antihypertensives.2.Nephrology department diabetes consultation rate was low,and blood pressure,blood glucose,blood fats of standardized rates were not high.Lipid-lowering medicine,insulin utilization rate is low.In addition,there were over use of antidiabetes drug in CKD3-5.We need better diabetes management modes in non-endocrinologist department.