Woolf S H, Davidson M B, Greenfield S, Bell H S, Ganiats T G, Hagen M D, Palda V A, Rizza R A, Spann S J
Department of Family Medicine, Medical College of Virginia-Virginia Commonwealth University, Richmond, USA.
J Fam Pract. 2000 May;49(5):453-60.
To review evidence about the benefit of intensive glycemic control for patients with type 2 diabetes and to develop practice recommendations.
A 9-member panel composed of family physicians, general internists, endocrinologists, and a practice guidelines methodologist was assembled by the American Academy of Family Physicians, the American Diabetes Association, and the American College of Physicians.
Admissible evidence included published randomized controlled trials and observational studies regarding the effects of glycemic control on microvascular and macrovascular complications and on adverse effects. We followed systematic search and data abstraction procedures. Greater weight was given to clinical trials and to evidence about health outcomes.
Interpretations of evidence and approval of documents were finalized by unanimous vote, with recommendations linked to evidence and not expert opinion. The full report was prepared by the chair and 2 panel members, representing each of the 3 organizations. The initial draft underwent external review by 14 diabetologists and family physicians and changes consistent with the evidence were incorporated.
The evidence demonstrates that the risk of microvascular and neuropathic complications is reduced by lowering glucose concentrations. Whether glycemic control affects macrovascular outcomes is less clear. The potential benefits of glycemic control must be balanced against factors that either preempt benefits (eg, limited life expectancy, comorbid disease) or increase risk (eg, severe hypoglycemia). The magnitude of benefit is a function of individual clinical variables (eg, baseline glycated hemoglobin level, presence of preexisting microvascular disease). Appropriate targets for treatment should be determined by considering these factors, patients' risk profiles, and personal preferences.
回顾关于强化血糖控制对2型糖尿病患者益处的证据，并制定实践建议。
由美国家庭医师学会、美国糖尿病协会和美国医师学会组建了一个由家庭医生、普通内科医生、内分泌学家和一名实践指南方法学家组成的9人小组。
可接受的证据包括已发表的关于血糖控制对微血管和大血管并发症以及不良反应影响的随机对照试验和观察性研究。我们遵循了系统的检索和数据提取程序。更重视临床试验和关于健康结局的证据。
证据的解释和文件的批准通过一致投票最终确定，建议与证据而非专家意见相关联。完整报告由主席和2名小组成员编写，他们分别代表3个组织。初稿由14名糖尿病专家和家庭医生进行外部评审，并纳入了与证据一致的修改。
证据表明，降低血糖浓度可降低微血管和神经病变并发症的风险。血糖控制是否影响大血管结局尚不清楚。血糖控制的潜在益处必须与那些要么抢先获得益处（如预期寿命有限、合并疾病）要么增加风险（如严重低血糖）的因素相平衡。益处的大小是个体临床变量（如基线糖化血红蛋白水平、既往微血管疾病的存在）的函数。应通过考虑这些因素、患者的风险概况和个人偏好来确定适当的治疗目标。
