An Insight into the Recent Diabetes Trials: What is the Best Approach to Prevent Macrovascular and Microvascular Complications?
An Insight into the Recent Diabetes Trials: What is the Best Approach to Prevent Macrovascular and Microvascular Complications?
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DOI：
10.2174/15733998113099990077
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发表时间：
2013-01-01
影响因子：
3.3
通讯作者：
Davis, Stephen N.
中科院分区：
文献类型：
--
作者：
Konig, Manige;Lamos, Elizabeth Mary;Davis, Stephen N.
2型糖尿病（T2 DM）占所有糖尿病病例的90%-95%。护理T2 DM患者的首要目标是通过血糖控制预防微血管和大血管并发症。已经进行了几项研究，如UKPDS、DCCT和EDIC，以评价血糖控制对糖尿病患者组织并发症的影响。在最近的糖尿病试验（包括雅阁、ADVANCE、VADT、巴里2D和ORIGIN）中，强化血糖控制不能预防伴有心血管疾病或心血管疾病风险因素的长期糖尿病老年患者的大血管并发症。事实上，雅阁试验中强化治疗与死亡率增加相关。虽然在这些试验中没有观察到明显的大血管获益，但对早期1型和2型糖尿病年轻患者的研究分析表明，强化血糖控制对糖尿病病程较短和血管病变较少的患者有显著获益。在UKPDS中，通过强化血糖控制，微血管疾病（尤其是视网膜病变）的发生率显著降低，但在最近的试验（雅阁、ADVANCE、VADT、ORIGIN）中，获益相对温和，仅限于蛋白尿减少。也许上述试验最重要的信息是优化心血管风险因素的控制。尽管根据美国糖尿病协会的规定，预防微血管和大血管并发症的目标HbA 1c低于7%，但应避免低血糖，因为它会增加严重心血管事件的风险。
Type 2 diabetes mellitus (T2DM) accounts for 90%-95% of all diabetes cases. The overarching goal in caring for patients with T2DM is to prevent microvascular and macrovascular complications with glycemic control. Several studies such as UKPDS, DCCT, and EDIC have been performed to evaluate the effects of glucose control on tissue complications in patients with diabetes. In recent diabetes trials including ACCORD, ADVANCE, VADT, BARI 2D, and ORIGIN, intensive glucose control did not prevent macrovascular complications in older patients with long-standing diabetes with either cardiovascular disease or risk factors for cardiovascular disease. In fact, intensive therapy was associated with increased mortality in the ACCORD trial. Although no clear macrovascular benefit was seen in these trials, analyses of earlier studies in younger patients with type 1 and type 2 diabetes have suggested a significant benefit of intensive glycemic control in patients with a shorter duration of diabetes and less vasculopathy. In the UKPDS, the incidence of microvascular disease, particularly retinopathy, was reduced significantly with intensive glucose control, but in the more recent trials (ACCORD, ADVANCE, VADT, ORIGIN) the benefit was relatively modest and limited to reduced proteinuria. Perhaps the most important message from the above trials is to optimize control of cardiovascular risk factors. Although the goal HbA1c to prevent microvascular and macrovascular complications, per the American Diabetes Association, is less than 7%, hypoglycemia should be avoided as it can increase the risk for severe cardiovascular events.