Effects of medical therapies on retinopathy progression in type 2 diabetes.
Effects of medical therapies on retinopathy progression in type 2 diabetes.
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DOI：
10.1056/nejmoa1001288
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发表时间：
2010-07-15
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影响因子：
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通讯作者：
Fine LJ
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作者：
ACCORD Study Group;ACCORD Eye Study Group;Chew EY;Ambrosius WT;Davis MD;Danis RP;Gangaputra S;Greven CM;Hubbard L;Esser BA;Lovato JF;Perdue LH;Goff DC Jr;Cushman WC;Ginsberg HN;Elam MB;Genuth S;Gerstein HC;Schubart U;Fine LJ
我们研究了强化血糖控制、血脂异常联合治疗和强化血压控制是否会限制2型糖尿病患者糖尿病视网膜病变的进展。以前的数据表明，这些全身因素可能在糖尿病视网膜病变的发展和进展中很重要。在一项随机试验中，我们招募了10，251名患有2型糖尿病的参与者，他们具有心血管疾病的高风险，接受强化或标准治疗。（目标糖化血红蛋白水平，<6.0%或7.0至7.9%，也用于血脂异常（非诺贝特加辛伐他汀或安慰剂加辛伐他汀每日160 mg）或用于收缩压控制（目标，<120或<140 mm Hg）。一个2856名参与者的亚组在4年时通过早期治疗糖尿病视网膜病变研究严重程度量表上的3个或更多步骤来评估这些干预措施对糖尿病视网膜病变进展的影响（如从七视野立体眼底照片评估的，有17个可能的步骤，步骤数越多表示严重性越大）或糖尿病视网膜病变的发展需要激光光凝或玻璃体切除术。4年时，强化治疗组的糖尿病视网膜病变进展率为7.3%，而标准治疗组为10.4（校正比值比，0.67; 95%置信区间[CI]，0.51至0.87; P = 0.003）;非诺贝特强化血脂异常治疗组6.5%，安慰剂组10.2%（校正比值比，0.60; 95%CI，0.42 - 0.87; P = 0.006）;强化血压治疗组为10.4%，标准治疗组为8.8%（校正比值比，1.23; 95%CI，0.84 - 1.79; P=0.29）。强化血糖控制和血脂异常强化联合治疗，但不是强化血压控制，降低糖尿病视网膜病变的进展速度。（由国家心肺血液研究所和其他机构资助; ClinicalTrials.gov编号，雅阁研究的NCT 00000620和雅阁眼研究的NCT 00542178。
We investigated whether intensive glycemic control, combination therapy for dyslipidemia, and intensive blood-pressure control would limit the progression of diabetic retinopathy in persons with type 2 diabetes. Previous data suggest that these systemic factors may be important in the development and progression of diabetic retinopathy. In a randomized trial, we enrolled 10,251 participants with type 2 diabetes who were at high risk for cardiovascular disease to receive either intensive or standard treatment for glycemia (target glycated hemoglobin level, <6.0% or 7.0 to 7.9%, respectively) and also for dyslipidemia (160 mg daily of fenofibrate plus simvastatin or placebo plus simvastatin) or for systolic blood-pressure control (target, <120 or <140 mm Hg). A subgroup of 2856 participants was evaluated for the effects of these interventions at 4 years on the progression of diabetic retinopathy by 3 or more steps on the Early Treatment Diabetic Retinopathy Study Severity Scale (as assessed from seven-field stereoscopic fundus photographs, with 17 possible steps and a higher number of steps indicating greater severity) or the development of diabetic retinopathy necessitating laser photocoagulation or vitrectomy. At 4 years, the rates of progression of diabetic retinopathy were 7.3% with intensive glycemia treatment, versus 10.4% with standard therapy (adjusted odds ratio, 0.67; 95% confidence interval [CI], 0.51 to 0.87; P = 0.003); 6.5% with fenofibrate for intensive dyslipidemia therapy, versus 10.2% with placebo (adjusted odds ratio, 0.60; 95% CI, 0.42 to 0.87; P = 0.006); and 10.4% with intensive blood-pressure therapy, versus 8.8% with standard therapy (adjusted odds ratio, 1.23; 95% CI, 0.84 to 1.79; P=0.29). Intensive glycemic control and intensive combination treatment of dyslipidemia, but not intensive blood-pressure control, reduced the rate of progression of diabetic retinopathy. (Funded by the National Heart, Lung, and Blood Institute and others; ClinicalTrials.gov numbers, NCT00000620 for the ACCORD study and NCT00542178 for the ACCORD Eye study.)