Effects of intensive glucose lowering in type 2 diabetes
Effects of intensive glucose lowering in type 2 diabetes
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DOI：
10.1056/nejmoa0802743
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发表时间：
2008-06-12
影响因子：
158.5
通讯作者：
Friedewald, William T.
中科院分区：
文献类型：
--
作者：
Gerstein, Hertzel C.;Miller, Michael E.;Friedewald, William T.
背景资料：流行病学研究表明，2型糖尿病患者糖化血红蛋白水平与心血管事件之间存在相关性。我们研究了以正常糖化血红蛋白水平为目标的强化治疗是否会减少患有心血管疾病或其他心血管危险因素的2型糖尿病患者的心血管事件。在这项随机研究中，10,251名患者（平均年龄，62.2岁），中位糖化血红蛋白水平为8.1%，（目标糖化血红蛋白水平低于6.0%）或标准治疗（目标水平为7.0至7.9%）。在这些患者中，38%是女性，35%以前有过心血管事件。主要结局为非致死性心肌梗死、非致死性卒中或心血管原因死亡的复合终点。在强化治疗组的死亡率较高的发现，导致中断强化治疗后，平均3.5年的following.Results：在1年，稳定的中位糖化血红蛋白水平为6.4%和7.5%，分别达到强化治疗组和标准治疗组。在随访期间，强化治疗组有352例患者发生主要结局，而标准治疗组有371例患者发生主要结局（风险比，0.90; 95%置信区间[CI]，0.78 - 1.04; P=0.16）。同时，强化治疗组有257例患者死亡，而标准治疗组有203例患者死亡（风险比，1.22; 95%CI，1.01 - 1.46; P=0.04）。需要辅助的低血糖和体重增加超过10 kg在强化治疗组更常见（P
Background: Epidemiologic studies have shown a relationship between glycated hemoglobin levels and cardiovascular events in patients with type 2 diabetes. We investigated whether intensive therapy to target normal glycated hemoglobin levels would reduce cardiovascular events in patients with type 2 diabetes who had either established cardiovascular disease or additional cardiovascular risk factors.Methods: In this randomized study, 10,251 patients (mean age, 62.2 years) with a median glycated hemoglobin level of 8.1% were assigned to receive intensive therapy (targeting a glycated hemoglobin level below 6.0%) or standard therapy (targeting a level from 7.0 to 7.9%). Of these patients, 38% were women, and 35% had had a previous cardiovascular event. The primary outcome was a composite of nonfatal myocardial infarction, nonfatal stroke, or death from cardiovascular causes. The finding of higher mortality in the intensive-therapy group led to a discontinuation of intensive therapy after a mean of 3.5 years of follow-up.Results: At 1 year, stable median glycated hemoglobin levels of 6.4% and 7.5% were achieved in the intensive-therapy group and the standard-therapy group, respectively. During follow-up, the primary outcome occurred in 352 patients in the intensive-therapy group, as compared with 371 in the standard-therapy group (hazard ratio, 0.90; 95% confidence interval [CI], 0.78 to 1.04; P=0.16). At the same time, 257 patients in the intensive-therapy group died, as compared with 203 patients in the standard-therapy group (hazard ratio, 1.22; 95% CI, 1.01 to 1.46; P=0.04). Hypoglycemia requiring assistance and weight gain of more than 10 kg were more frequent in the intensive-therapy group (P