Clinical Characteristics Of Patients With Early-Onset Type 2 Diabetes And Patients With Nonalbuminuric Chronic Kidney Disease

Part I Features of metabolic profile and chronic complications in early onset type 2 diabetes inpatientsObjective To study the features of metabolic profile and chronic complications in early-onset type 2 diabetes patients and further investigate their prognosis.Methods Clinical data of the inpatients(n=3 628)in the Department of Endocrinology Nanjing Drum Tower Hospital from January 2015 to September 2018 were collected.The residents were divided into two groups: early-and late-onset groups which were defined as diagnosis at <40 and ≥40 years old.The independent sample t-test,chi-square test,and Mann-Whitney U test were used to analyze the clinical characteristics of the patients with early-onset type 2 diabetes.Additive models were used to analyze the interaction between early onset type 2 diabetes and diabetes duration on chronic complications.We further compared the change of their metabolic index between early and late-onset groups in newly-diagnosed patients(diabetes duration < 1 year).Results Compared with the late-onset type 2 diabetes group,the proportion of patients with a family history of diabetes was higher in the early-onset group,and BMI is higher.The early-onset group had higher glycated hemoglobin [(9.2±2.1)vs(8.7±2.2)%,t=-4.454,P<0.01] and more patients with microvascular complications(38.8% vs.29.4%,χ2=24.819,P<0.01).The early onset type 2 diabetes had interaction with factor of diabetes duration≥10 year on microvascular complications.Further adjustment of age,duration of diabetes,family history of diabetes,sex,traditional cardiovascular risk factors and treatment plan,the risk of diabetic kidney disease was still higher than that of the late-onset group(OR =1.66,95%CI:1.01-2.71,P<0.05).For newly diagnosed type 2 diabetic patients,after 373 days of median follow-up,the fasting blood glucose decreased more in the early-onset group(ΔFPG early-onset group-ΔFPG late-onset group=-0.62 mmol/L,95%CI:-1.18 mmol/L,-0.05 mmol/L).Conclusion The control of metabolic profiles of type 2 diabetes in early-onset group is worse,which is related to the higher prevalence of diabetic chronic complications.It is important to pay more attention to early treatment in early-onset type 2 diabetes.Part II Clinical features of nonalbuminuric chronic kidney disease in type 2 diabetes inpatientsObjective : Diabetes is the main cause of end-stage renal disease(ESRD),but the heterogeneity of the natural course of diabetic kidney disease is still lack of study,especially nonalbuminuric chronic kidney disease(NA-CKD).We investigates the clinical characteristics of type 2 diabetes patients with nonalbuminuric chronic kidney disease,and analyzed the relationship between nonalbuminuric chronic kidney disease and macrovascular complications.Methods: 5692 type 2 diabetes patients admitted to Nanjing Drum Tower Hospital were divided into groups based on albumin-to-creatinine ratio(ACR)and estimated glomerular filtration rate(e GFR)level.A total of 93 patients(1.6%)had nonalbuminuric chronic kidney disease.ANOVA and chi-square test were used to compare the clinical characteristics of patients in different categories,and the method of propensity score matching was used to compare the differences in clinical characteristics between NA-CKD group and A-CKD(albuminuric chronic kidney disease)group.Logistics regression was used to analyze the risk factors of macrovascular complications in patients with CKD 3-5 stages.Results: The NA-CKD group has the oldest age and the oldest onset age,mainly females.In terms of blood glucose,the fasting glucose and the 2h postprandial glucose in the NA-CKD group were the lowest.The NA-CKD group had the lowest prevalence of retinopathy,and the highest prevalence of coronary heart disease and cerebral infarction.After matching the propensity scores,compared with the A-CKD group,NA-CKD patients had lower fasting blood glucose,lower systolic and diastolic blood pressure,and a lower proportion of diabetic retinopathy(all of above P<0.05).In patients with CKD 3-5 stage,Logistics regression analysis suggested that patients with NA-CKD combined with higher risk of macrovascular disease.After adjusting the age,this factor was not significant.Conclusion: NA-CKD patients are mainly elderly women with well control of glucose,and their higher risk of macrovascular complications can be attributed to the higher age.