Evaluation of a program designed to prevent diabetic nephropathy aggravation: A retrospective cohort study using health checkups and claims data in Japanese municipalities

IF 6.1 3区医学 Q1 ENDOCRINOLOGY & METABOLISM

Diabetes research and clinical practice Pub Date : 2024-07-30 DOI:10.1016/j.diabres.2024.111804

{"title":"Evaluation of a program designed to prevent diabetic nephropathy aggravation: A retrospective cohort study using health checkups and claims data in Japanese municipalities","authors":"","doi":"10.1016/j.diabres.2024.111804","DOIUrl":null,"url":null,"abstract":"<div><h3>Aims</h3><p>Japan started the Diabetic Nephropathy Aggravation Prevention Program. Its early impact was assessed in this study.</p></div><div><h3>Methods</h3><p>This study used the Kokuho Database of patients with type 2 diabetes from program-implementing and non-implementing municipalities (fiscal years [FYs] 2015–2021). Implementing municipalities facilitated clinic visits and provided education to eligible patients. Average treatment effects on the treated in FYs 2016 and 2018 were evaluated using the inverse probability of treatment weighting. Comparison included intervened vs. non-intervened patients in program-implementing municipalities (Comparison A), intervened patients in program-implementing vs. eligible patients in non-implementing municipalities (Comparison B), and eligible patients in implementing and non-implementing municipalities (Comparison C).</p></div><div><h3>Results</h3><p>Overall, 89,611/89,685 patients from FY 2016/2018 were eligible. Among 68,125/68,170 patients in program-implementing municipalities, 1,470/1,819 were intervened. In Comparison A, the estimated effect of the program on ΔeGFR at 3 years were −0.4 (95 % confidence interval; −1.0, 0.2)/−0.4 (−0.9, 0.1) mL/min/1.73 m<sup>2</sup> in FY 2016/2018. Comparisons B and C demonstrated similar tendency; distribution of %change in eGFR varied between municipalities.</p></div><div><h3>Conclusions</h3><p>Early in the program, renal function did not improve in the intervened patients or program-implementing municipalities. Diverse eGFR changes across municipalities highlighted diverse intervention outcomes, emphasizing the need of program refinement.</p></div>","PeriodicalId":11249,"journal":{"name":"Diabetes research and clinical practice","volume":null,"pages":null},"PeriodicalIF":6.1000,"publicationDate":"2024-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S0168822724007149/pdfft?md5=e47f8b632efa866bc61e0c30556c496c&pid=1-s2.0-S0168822724007149-main.pdf","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Diabetes research and clinical practice","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S0168822724007149","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"ENDOCRINOLOGY & METABOLISM","Score":null,"Total":0}

引用次数: 0

Abstract

Aims

Japan started the Diabetic Nephropathy Aggravation Prevention Program. Its early impact was assessed in this study.

Methods

This study used the Kokuho Database of patients with type 2 diabetes from program-implementing and non-implementing municipalities (fiscal years [FYs] 2015–2021). Implementing municipalities facilitated clinic visits and provided education to eligible patients. Average treatment effects on the treated in FYs 2016 and 2018 were evaluated using the inverse probability of treatment weighting. Comparison included intervened vs. non-intervened patients in program-implementing municipalities (Comparison A), intervened patients in program-implementing vs. eligible patients in non-implementing municipalities (Comparison B), and eligible patients in implementing and non-implementing municipalities (Comparison C).

Results

Overall, 89,611/89,685 patients from FY 2016/2018 were eligible. Among 68,125/68,170 patients in program-implementing municipalities, 1,470/1,819 were intervened. In Comparison A, the estimated effect of the program on ΔeGFR at 3 years were −0.4 (95 % confidence interval; −1.0, 0.2)/−0.4 (−0.9, 0.1) mL/min/1.73 m² in FY 2016/2018. Comparisons B and C demonstrated similar tendency; distribution of %change in eGFR varied between municipalities.

Conclusions

Early in the program, renal function did not improve in the intervened patients or program-implementing municipalities. Diverse eGFR changes across municipalities highlighted diverse intervention outcomes, emphasizing the need of program refinement.

查看原文本刊更多论文

一项旨在预防糖尿病肾病恶化的计划的评估：利用日本城市的健康检查和索赔数据进行的回顾性队列研究。

目的：日本启动了糖尿病肾病加重预防计划，本研究对该计划的早期影响进行了评估：本研究使用了 Kokuho 数据库，其中包括实施和未实施计划的市镇（2015-2021 财年）的 2 型糖尿病患者。实施计划的市镇为符合条件的患者提供就诊便利和教育。采用治疗的逆概率加权法评估了 2016 财年和 2018 财年接受治疗者的平均治疗效果。比较对象包括计划实施城市的干预患者与非干预患者（比较 A）、计划实施城市的干预患者与非实施城市的合格患者（比较 B）以及计划实施城市与非实施城市的合格患者（比较 C）：总体而言，2016/2018 财政年度有 89,611/89,685 名患者符合条件。在计划实施城市的 68 125/68 170 名患者中，1 470/1 819 人接受了干预。在比较 A 中，2016/2018 财政年度该计划对 3 年后ΔeGFR 的估计效果为-0.4（95 % 置信区间；-1.0，0.2）/-0.4（-0.9，0.1）毫升/分钟/1.73 平方米。比较 B 和 C 显示了相同的趋势；各市之间的 eGFR 变化百分比分布有所不同：结论：在计划实施初期，受干预患者或计划实施城市的肾功能并未得到改善。各市的 eGFR 变化各不相同，突显了干预结果的多样性，强调了完善计划的必要性。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文求助全文

来源期刊

Diabetes research and clinical practice 医学-内分泌学与代谢

CiteScore

10.30

自引率

3.90%

发文量

862

审稿时长

32 days

期刊介绍： Diabetes Research and Clinical Practice is an international journal for health-care providers and clinically oriented researchers that publishes high-quality original research articles and expert reviews in diabetes and related areas. The role of the journal is to provide a venue for dissemination of knowledge and discussion of topics related to diabetes clinical research and patient care. Topics of focus include translational science, genetics, immunology, nutrition, psychosocial research, epidemiology, prevention, socio-economic research, complications, new treatments, technologies and therapy.