Renal protection in diabetes: Role of glycemic control
Renal protection in diabetes: Role of glycemic control
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DOI：
10.1681/asn.2005121343
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发表时间：
2006-04-01
影响因子：
13.6
通讯作者：
Mussap, Michele
中科院分区：
文献类型：
--
作者：
Fioretto, Paola;Bruseghin, Marino;Mussap, Michele
糖尿病是西方国家ESRD最常见的原因。本文描述了血糖控制在疾病的各个阶段的影响，并考虑了严格的血糖控制对糖尿病肾病（DN）的发展和进展的影响。糖尿病控制和并发症试验和英国前瞻性糖尿病研究表明，在1型和2型糖尿病中，强化血糖控制可显著降低发生微量白蛋白尿的风险。虽然观察性研究表明，糖尿病肾病的进展也有影响，但关于二级预防中改善代谢控制的影响的数据较少。参与糖尿病控制和并发症试验（糖尿病干预和并发症流行病学研究）的患者的长期随访表明，既往严格血糖控制对DN的发生和进展具有持续影响。最后，通过胰腺移植实现的长期正常血糖不仅能够预防肾移植受者早期糖尿病肾小球病的发展，而且还能够阻止非尿毒症患者中已建立的糖尿病肾脏病变的进展并诱导其消退。总之，这些研究有力地证明，改善血糖控制是一级预防中最重要的治疗方法。严格的血糖控制在减缓DN的进展中也是重要的，并且如果血糖正常化，则可以实现DN的消退。因此，应推荐所有糖尿病患者的糖化血红蛋白水平< 7%的目标。
Diabetes is the most common cause of ESRD in Western countries. This article describes the impact of glycemic control in the various stages of the disease and considers the impact of tight glycemic control on the development and progression of diabetic nephropathy (DN). The Diabetes Control and Complications Trial and the United Kingdom Prospective Diabetic Study have demonstrated in type 1 and type 2 diabetes that intensive glycemic control significantly reduces the risk for development of microalbuminuria. Although observational studies suggest an impact of glycemia also on the progression of DN, fewer data are available on the impact of improved metabolic control in secondary prevention. The long-term follow-up of the patients who participated in the Diabetes Control and Complications Trial (Epidemiology of Diabetes Interventions and Complications Study) demonstrated a sustained effect of previous tight glycemic control on both development and progression of DN. Finally, long-term normoglycemia, achieved by pancreas transplantation, is able not only to prevent the development of early diabetic glomerulopathy in kidney transplant recipients but also to halt progression and induce regression of the established diabetic renal lesions in nonuremic patients. Taken together, these studies strongly demonstrate that improvement in glucose control is the most important therapeutic approach in primary prevention. Tight glycemic control also is important in slowing progression of DN, and if blood glucose is normalized, then regression of DN can be achieved. Therefore, a target of glycated hemoglobin levels < 7% should be recommended in all patients with diabetes.