Tackling hyperglycemia: a more comprehensive approach.
Tackling hyperglycemia: a more comprehensive approach.
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解决高血糖：更全面的方法。
DOI：
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发表时间：
2006
期刊：
影响因子：
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通讯作者：
S. Prato
中科院分区：
文献类型：
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作者：
S. Prato
目的回顾糖尿病患者血糖控制的构成要素，探讨糖尿病并发症的发生因素。方法总结了各种已发表的报告中的发现，特别是关于糖尿病的代谢改变、治疗和长期结局。结果：血红蛋白A1c是血糖暴露的综合标志物，是监测血糖控制的标准。英国前瞻性糖尿病研究的结果表明，血红蛋白A1c每降低1%，糖尿病相关死亡风险降低21%，心肌梗死风险降低14%。然而，空腹血糖和餐后血糖水平是明确的治疗目标。大量流行病学研究也支持这一观点，即摄入口服葡萄糖负荷后血糖过度波动与心血管疾病的独立风险相关，其风险大于空腹血糖水平。高血压显然激活不同的代谢途径，可能有助于微血管病和大血管病的发展。与常规治疗相比，强化治疗以维持严格的血糖控制已被证明可以更好地控制糖尿病相关并发症。结论糖尿病代谢改变的复杂性必须得到充分认识，并应考虑采取综合措施进行管理。
OBJECTIVE To review the components of glycemic control in patients with diabetes and discuss the factors contributing to development of complications. METHODS The findings in various published reports are summarized, particularly in reference to metabolic alterations, treatment, and long-term outcomes in diabetes. RESULTS Hemoglobin A1c, an integrated marker of overall glucose exposure, is the standard for monitoring glycemic control. The results in the United Kingdom Prospective Diabetes Study indicated that each 1% decrease in hemoglobin A1c reduced the risk for mortality associated with diabetes by 21% and the risk for myocardial infarction by 14%. Nevertheless, fasting plasma glucose and postprandial glucose levels are well-defined targets for therapy. Numerous epidemiologic studies also support the concept that excessive glucose excursion after ingestion of an oral glucose load is associated with an independent risk for cardiovascular disease that is greater than the one associated with the fasting plasma glucose level. Hyperglycemia apparently activates different metabolic pathways that may contribute to development of microangiopathy and macroangiopathy. Intensive treatment to maintain strict glycemic control has been shown to yield better control of diabetes-related complications in comparison with conventional therapy. CONCLUSION The complexity of the metabolic alterations in diabetes must be fully recognized, and a comprehensive approach to management should be considered.