Glycemic Control in Type 2 Diabetes: Time for an Evidence-Based About-Face?
Glycemic Control in Type 2 Diabetes: Time for an Evidence-Based About-Face?
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DOI：
10.7326/0003-4819-150-11-200906020-00008
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发表时间：
2009-06-02
影响因子：
39.2
通讯作者：
Fernandez-Balsells, Merce
中科院分区：
文献类型：
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作者：
Montori, Victor M.;Fernandez-Balsells, Merce
一些糖尿病指南为2型糖尿病患者设定了较低的血糖控制目标(如血红蛋白A(1c)水平低至6.5%至7.0%)，以避免或推迟并发症。我们对最近在2型糖尿病患者中进行的大型随机试验的回顾和评论表明，严格的血糖控制使患者负担复杂的治疗方案、低血糖、体重增加和成本，并提供不确定的回报。我们认为，临床医生应该优先支持这些患者的福祉和健康的生活方式、预防性护理和降低心血管风险。血糖控制工作应使血红蛋白A1c目标个体化，以使这些目标和实现这些目标所需的行动反映患者的个人和临床情况以及他们知情的价值观和偏好。
Some diabetes guidelines set low glycemic control goals for patients with type 2 diabetes mellitus (such as a hemoglobin A(1c) level as low as 6.5% to 7.0%) to avoid or delay complications. Our review and critique of recent large randomized trials in patients with type 2 diabetes suggest that tight glycemic control burdens patients with complex treatment programs, hypoglycemia, weight gain, and costs and offers uncertain benefits in return. We believe clinicians should prioritize supporting well-being and healthy lifestyles, preventive care, and cardiovascular risk reduction in these patients. Glycemic control efforts should individualize hemoglobin A1c targets so that those targets and the actions necessary to achieve them reflect patients' personal and clinical context and their informed values and preferences.