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| DC 欄位 | 值 | 語言 |
|---|---|---|
| dc.contributor.advisor | 黃崇興 | |
| dc.contributor.author | Ming-Chia Hsieh | en |
| dc.contributor.author | 謝明家 | zh_TW |
| dc.date.accessioned | 2021-06-16T17:54:32Z | - |
| dc.date.available | 2015-08-28 | |
| dc.date.copyright | 2012-08-28 | |
| dc.date.issued | 2012 | |
| dc.date.submitted | 2012-08-13 | |
| dc.identifier.citation | 英文文獻
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Impact of late-stage CKD and aging on medical utilization in the elderly population: a closed-cohort study in Taiwan. Nephrol Dial Transplant. 2010;25(10):3230-5. 25.Lin T, Chou P, Tsai ST, et al. Predicting factors associated with costs of diabetic patients in Taiwan. Diabetes Res Clin Pract. 2004 ;63(2):119-25. 26.MacIsaac RJ, Tsalamandris C, Panagiotopoulos S, et al. Nonalbuminuric renal insufficiency in type 2 diabetes. Nonalbuminuric renal insufficiency in type 2 diabetes. Diabetes Care. 2004 ;27(1):195-200. 27.Molitch ME, DeFronzo RA, Franz MJ, et al ; American Diabetes Association. Nephropathy in diabetes. Diabetes Care. 2004 ;27 Suppl 1:S79-83. 28.Parving HH, Lewis JB, Ravid M, et al ; DEMAND investigators. Prevalence and risk factors for microalbuminuria in a referred cohort of type II diabetic patients: a global perspective. Kidney Int. 2006 Jun;69(11):2057-63. 29.Patel A, MacMahon S, Chalmers J, et al. Intensive blood glucose control and vascular outcomes in patients with type 2 diabetes.N Engl J Med. 2008 ;358(24):2560-72. 30.Pettitt DJ, Saad MF, Bennett PH, et al. Familial predisposition to renal disease in two generations of Pima Indians with type 2 (non-insulin-dependent) diabetes mellitus. Diabetologia. 1990 ;33(7):438-43. 31.Quinn M, Angelico MC, Warram JH, et al . Familial factors determine the development of diabetic nephropathy in patients with IDDM. Diabetologia. 1996 ;39(8):940-5. 32.Reiner Z, Catapano AL, De Backer G, et al. ESC/EAS Guidelines for the management of dyslipidaemias: the Task Force for the management of dyslipidaemias of the European Society of Cardiology (ESC) and the European Atherosclerosis Society (EAS). Eur Heart J. 2011 ;32(14):1769-818. 33.Ritz E. Limitations and future treatment options in type 2 diabetes with renal impairment. Diabetes Care. 2011 May;34 Suppl 2:S330-4. 34.Roglic G, Unwin N. Mortality attributable to diabetes: estimates for the year 2010. Diabetes Res Clin Pract. 2010 ;87(1):15-9. 35.Schmitz R. Ueber die prognostische Bedeutung und die Aetiologie der Albuminurie bei Diabetes. Berliner Klinische Wochenschrift 1891; 28: 373 – 377 36.Shichiri M, Kishikawa H, Ohkubo Y, et al. Long-term results of the Kumamoto Study on optimal diabetes control in type 2 diabetic patients. Diabetes Care. 2000 ;23 Suppl 2:B21-9. 37.Skyler JS, Bergenstal R, Bonow RO, et al. Intensive glycemic control and the prevention of cardiovascular events: implications of the ACCORD, ADVANCE, and VA diabetes trials: a position statement of the American Diabetes Association and a scientific statement of the American College of Cardiology Foundation and the American Heart Association. Diabetes Care. 2009 ;32(1):187-92. 38.So WY, Kong AP, Ma RC, et al. Glomerular filtration rate, cardiorenal end points, and all-cause mortality in type 2 diabetic patients. Diabetes Care. 2006 ;29(9):2046-52. 39.Stephenson JM, Kenny S, Stevens LK, et al. Proteinuria and mortality in diabetes: the WHO Multinational Study of Vascular Disease in Diabetes. Diabet Med. 1995 ;12(2):149-55. 40.The IDF Diabetes Atlas.Fourth Edition.Brussels:International Diabetes Federation;2009 41.Tu ST, Chang SJ, Chen JF, et al. Prevention of diabetic nephropathy by tight target control in an asian population with type 2 diabetes mellitus: a 4-year prospective analysis. Arch Intern Med. 2010 ;170(2):155-61. 42.WHO,2008 http://www.who.int/whosis/whostat/2008/en/index.html 43.Wong TY, Shankar A, Klein R, et al. Retinal vessel diameters and the incidence of gross proteinuria and renal insufficiency in people with type 1 diabetes. Diabetes. 2004 ;53(1):179-84. 44.Yang WC, Hwang SJ, Chiang SS, et al. The impact of diabetes on economic costs in dialysis patients: experiences in Taiwan. Diabetes Res Clin Pract. 2001;54 Suppl 1:S47-54. 45.Zhang L, Zuo L, Wang F, et al. Cardiovascular disease in early stages of chronic kidney disease in a Chinese population. J Am Soc Nephrol. 2006 ;17(9):2617-21. 中文文獻 1.台灣糖尿病學會，2011年 2.衛生署，2010年 3.衛生署，2009年 4.健保局，2008年 5.台灣腎臟醫會，2011年 6.台灣糖尿病衛教學會，2012年 | |
| dc.identifier.uri | http://tdr.lib.ntu.edu.tw/jspui/handle/123456789/64559 | - |
| dc.description.abstract | 糖尿病腎病變是造成末期腎病的主因，台灣的末期腎病(透析)的盛行率高居世界第一且發生率為世界第二。糖尿病腎病變是造成台灣末期腎病變的首要原因。之前的研究顯示，良好的血糖管控可以預防及延緩糖尿病腎病變，但良好的血糖管控對末期腎病及死亡率的成效並不清楚，我們欲研究良好血糖管控對台灣糖尿病腎病變、末期腎病及死亡率在第二型糖尿病患之成效。
本研究採用馬可夫鏈來評估良好血糖管控之成效，轉移機率由作者先前的世代研究分析取得，2107位台灣第二型糖尿病患平均追蹤4年來，病患依研究期間的平均糖化血色素(HbA1C)分成兩組─良好血糖控制組(HbA1C<7%)及不良血糖控制組(HbA1C 7%)，馬可夫鏈的假設如下：1. 每年轉移機率是穩定的，但年齡是轉移機率主要因子，隨年齡做調整，2. 糖尿病腎病變的發生從正常白蛋白期進入微量白蛋白期，而後進入明顯白蛋白期，最後進入末期腎病，3. 血壓及其他因子被假設是相同。 我們的研究顯示，一位60歲無腎病變之糖尿病患，若接受良好血糖管控，20年後，末期腎病的發生率為1.02%，死亡率為21.74%，若血糖控制不良，末期腎病的發生率為1.88%，死亡率為23.69%。40歲明顯蛋白尿的第二型糖尿病患，接受良好的血糖管控，則進入末期腎病或死亡為22年，若血糖控制不良，則12年即進入末期腎病或死亡。另外經馬可夫鏈算出，若一位60歲正常白蛋白期病患接受良好血糖管控，20年的醫療費用為65058.54美元，若血糖控制不足，醫療費用則為71016.25美元。 結論，良好的血糖管控可以預防及延緩糖尿病腎病變，在台灣，良好的血糖管控可能可以減少末期腎病及死亡率的發生。 | zh_TW |
| dc.description.abstract | Diabetic nephropathy (DN) is the leading cause of end-stage renal disease (ESRD) worldwide. Taiwan was found to have had the highest incidence of ESRD and the second highest prevalence in the world. DN is the main cause of the increases in prevalence and incidence of ESRD in Taiwan. Intensive glycemic control could reduce the incidence and progression of diabetic nephropathy. However, the effect of intensive glycemic control on ESRD and mortality was unclear. We evaluate the effect of glycemic control on diabetic nephropathy, ESRD and mortality in Taiwanese with type 2 diabetes.
The Markov model was used to evaluate the effect of intensive glycemic control on diabetic nephropathy. The transition probabilities were calculated from the cohort which included 2107 Taiwanese with type 2 diabetes followed op for 4.5 years. All patients were divided into intensive glycemic control (mean HbA1c <7% during the study period) and poor glycemic control (mean HbA1c >= 7% during the study period). The assumption was made as following: 1. annual transition probabilities were stable and age-dependent; 2. diabetic nephropathy progressed without skipping any stages, and 3. blood pressure and other confounding factors were the same. The 20- year incidence of ESRD and mortality rate was 1.02% and 21.74% in a 60 y/o normoalbuminuric patients with intensive glycemic control. The incidence of ESRD and mortality rate was 1.88% and 23.69% in normoalbuminuric patients with poor glycemic control. The average time before ESRD or death was longer in a 40 y/o patients with overt proteinuria under intensive glycemic control as compared to patients under poor glycemic control (22 years vs. 12 years). The 20-year medical cost was estimated to be lower in a 60 y/o normoalbuminuric patients under intensive glycemic control as compared to patients with poor glycemic control (68058.54 vs. 71016.25 US dollar). The diabetic nephropathy can be prevented and delayed by intensive glycemic control in Taiwan. The intensive glycemic control seems to reduce the incidence of ESRD and mortality in Taiwanese with type 2 diabetes. | en |
| dc.description.provenance | Made available in DSpace on 2021-06-16T17:54:32Z (GMT). No. of bitstreams: 1 ntu-101-P98748035-1.pdf: 1427620 bytes, checksum: 0570e5141a5a4eb84a3c560ed15e9ebf (MD5) Previous issue date: 2012 | en |
| dc.description.tableofcontents | 口試委員會審定書 i
誌謝 ii 中文摘要 iii THESIS ABSTRACT iv 圖目錄 viii 表目錄 ix 第一章 緒論 1 第二章 文獻探討 2 第三章 糖尿病 7 第一節 流行病學 7 第二節 慢性併發症 7 第三節 全球人類死因 7 第四節 醫療費用 8 第五節 西太平洋區 8 第四章 糖尿病腎病變 9 第一節 診斷分期及盛行率 9 一、 測定方式 9 二、 分期 10 三、 盛行率 11 第二節 糖尿病腎病變和末期腎病 12 第三節 糖尿病腎病變與心血管疾病及死亡率 12 一、 糖尿病與心血管風險 12 二、 糖尿病腎病變和心血管風險 12 三、 糖尿病腎病變和死亡率 13 第四節 血糖管控對糖尿病腎病變的影響 13 一、 初級預防 14 二、 次級預防 14 二、 治療準則 15 第五章 台灣糖尿病糖尿病腎病變及透析之現況 16 第一節 糖尿病 16 一、 盛行率 16 二、 十大死因 16 三、 健保支出 16 第二節 末期腎病和糖尿病腎病變 17 一、 透析盛行率 17 二、 透析原因分析 20 三、 透析健保費用 20 第三節 糖尿病腎病變與心血管疾病風險及死亡率 20 第四節 血糖控制對糖尿病腎病變的影響 23 一、 初級預防 23 二、 次級預防 25 二、 全因死亡率 28 第五節 目前面臨的困境或問題 28 第六章 研究方法 30 一、 轉移機率之建立 31 二、 轉移機率矩陣定義 32 三、 醫療費用之定義 36 第七章 結果 38 第八章 討論與結論 42 參考文獻 45 附錄 50 | |
| dc.language.iso | zh-TW | |
| dc.subject | 糖尿病腎病變 | zh_TW |
| dc.subject | 血糖管控 | zh_TW |
| dc.subject | 末期腎病 | zh_TW |
| dc.subject | 馬可夫鏈 | zh_TW |
| dc.subject | diabetic nephropathy | en |
| dc.subject | ESRD | en |
| dc.subject | glycemic control | en |
| dc.subject | Markov chain | en |
| dc.title | 以馬可夫鏈模型評估良好的血糖管控對台灣糖尿病腎病變之成效 | zh_TW |
| dc.title | An Application of Marcov Process to Evaluate the Effect of Intensive Glycemic Control on Diabetic Nephropathy in Taiwan | en |
| dc.type | Thesis | |
| dc.date.schoolyear | 100-2 | |
| dc.description.degree | 碩士 | |
| dc.contributor.oralexamcommittee | 余峻瑜,葉明義 | |
| dc.subject.keyword | 糖尿病腎病變,末期腎病,血糖管控,馬可夫鏈, | zh_TW |
| dc.subject.keyword | diabetic nephropathy,ESRD,glycemic control,Markov chain, | en |
| dc.relation.page | 69 | |
| dc.rights.note | 有償授權 | |
| dc.date.accepted | 2012-08-13 | |
| dc.contributor.author-college | 管理學院 | zh_TW |
| dc.contributor.author-dept | 商學組 | zh_TW |
| 顯示於系所單位： | 商學組 | |
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