Glycemic Variability and Diabetes Complications: Does It Matter? Simply Put, There Are Better Glycemic Markers!
Glycemic Variability and Diabetes Complications: Does It Matter? Simply Put, There Are Better Glycemic Markers!
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DOI：
10.2337/dc15-0099
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发表时间：
2015-08-01
期刊：
影响因子：
16.2
通讯作者：
Bergenstal, Richard M. t
中科院分区：
文献类型：
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作者：
Bergenstal, Richard M. t
没有证据表明改善糖化血红蛋白(HbA(1c))的平均血糖控制水平可以降低1型和2型糖尿病患者发生微血管并发症和心血管疾病事件的风险。然而，一些试验中的观察表明，将HBA(1c)定位于建议的靶点并不总是能改善长期存在的2型糖尿病患者的预后。在这些研究中主要使用HBA(1c)的血糖控制策略没有预测结果的原因尚不清楚。因此，对于是否有超越HBA(1c)的血糖指标可以被定义为除了HBA(1c)之外可以用来帮助评估个体发生糖尿病并发症的风险的有效措施，仍然存在争议。在这方面，“血糖变异性”(GV)这一概念引起了人们的广泛关注。GV可以简单地定义为患者的血糖水平在高(峰值)和低(低谷)水平之间波动的程度。评估GV的最好和最准确的方法也是一个仍然存在争议的方法。因此，虽然普遍认为糖化血红蛋白(1c)是目前主要临床靶点的黄金标准，但对于其他拟议的血糖指标是否有希望提供额外的临床数据，或者是否应该在HbA(1c)之外还有额外的靶点，还没有达成共识。因此，鉴于目前的争议，我们就这一问题进行点对点辩论。在前面的叙述中，Hirsch博士提出了他的论点，即GV指标评估的血糖波动是有害的，GV的控制应该是主要的治疗目标。在下面相反的叙述中，伯根斯塔尔博士认为，有比GV更好的标记物来评估糖尿病的风险，并提供了他对其他概念的考虑。
There is no argument that improvingmean levels of glycemic control as judged by assays for glycated hemoglobin (HbA(1c)) reduces the risks of microvascular complications and cardiovascular disease events in patients with type 1 and type 2 diabetes. However, observations in some trials have suggested that targeting HbA(1c) to suggested targets may not always result in improved outcomes for people with long-standing type 2 diabetes. The reasons why the glycemic control strategies that primarily use HbA(1c) in these studies did not have predicted outcomes are not clear. Thus, controversy remains as to whether there are glycemic metrics beyond HbA(1c) that can be defined as effective measures that can be used in addition to HbA(1c) to help in assessing the risk of an individual developing diabetes complications. In this regard, the concept of "glycemic variability" (GV) is onemetric that has attracted a lot of attention. GV can be simply defined as the degree to which a patient's blood glucose level fluctuates between high (peaks) and low (nadir) levels. The best and most precise way to assess GV is also one that is still debated. Thus, while there is universal agreement that HbA(1c) is the current gold standard for the primary clinical target, there is no consensus as to whether other proposed glycemic metrics hold promise to provide additional clinical data or whether there should be additional targets beyond HbA(1c). Therefore, given the current controversy, we provide a Point-Counterpoint debate on this issue. In the preceding point narrative, Dr. Hirsch provides his argument that fluctuations in blood glucose as assessed by GV metrics are deleterious and control of GV should be a primary treatment target. In the counterpoint narrative below, Dr. Bergenstal argues that there are better markers to assess the risk of diabetes than GV and provides his consideration of other concepts.