Shichiri M, Kishikawa H, Ohkubo Y, Wake N
Department of Metabolic Medicine, Kumamoto University School of Medicine, Japan.
Diabetes Care. 2000 Apr;23 Suppl 2:B21-9.
To examine whether intensive glycemic control could decrease the frequency or severity of diabetic microvascular complications, an 8-year prospective study of Japanese patients with type 2 diabetes was performed.
A total of 110 patients with type 2 diabetes (55 with no retinopathy [the primary prevention cohort] and 55 with simple retinopathy [the secondary intervention cohort]) were randomly assigned to multiple insulin injection therapy (MIT) groups and administered three or more daily insulin injections or assigned to conventional insulin injection therapy (CIT) groups and administered one or two daily intermediate-acting insulin injections. Worsening of microvascular complications was regularly assessed during 8 years. Two or more steps up in the 19 stages of the modified Early Treatment of Diabetic Retinopathy Study classification in retinopathy and one or more stages up among three stages in nephropathy (normoalbuminuria, microalbuminuria, and albuminuria) were defined as worsening of complications.
In both primary prevention and secondary intervention cohorts, the cumulative percentages of worsening in retinopathy and nephropathy were significantly lower (P < 0.05) in the MIT group than in the CIT group. In neurological tests after 8 years, the MIT group showed significant improvement (P < 0.05) in the median nerve conduction velocities (motor and sensory nerves), whereas the CIT group showed significant deterioration (P < 0.05) in the nerve conduction velocities and vibration threshold. From this study, the glycemic threshold to prevent the onset and progression of diabetic microvascular complications was as follows: HbA1c < 6.5%, fasting blood glucose concentration < 110 mg/dl, and 2-h postprandial blood glucose concentration < 180 mg/dl.
Intensive glycemic control can delay the onset and progression of the early stages of diabetic microvascular complications in Japanese patients with type 2 diabetes.
为了研究强化血糖控制是否能降低糖尿病微血管并发症的发生频率或严重程度，对日本2型糖尿病患者进行了一项为期8年的前瞻性研究。
总共110例2型糖尿病患者（55例无视网膜病变[一级预防队列]和55例有单纯视网膜病变[二级干预队列]）被随机分配至多次胰岛素注射治疗（MIT）组，每日注射三次或更多次胰岛素，或被分配至传统胰岛素注射治疗（CIT）组，每日注射一或两次中效胰岛素。在8年期间定期评估微血管并发症的恶化情况。视网膜病变改良早期糖尿病性视网膜病变研究分类的19个阶段中进展两个或更多阶段，以及肾病三个阶段（正常白蛋白尿、微量白蛋白尿和白蛋白尿）中进展一个或更多阶段被定义为并发症恶化。
在一级预防和二级干预队列中，MIT组视网膜病变和肾病恶化的累积百分比均显著低于CIT组（P<0.05）。8年后的神经学检查中，MIT组正中神经传导速度（运动和感觉神经）有显著改善（P<0.05），而CIT组神经传导速度和振动阈值有显著恶化（P<0.05）。从本研究来看，预防糖尿病微血管并发症发生和进展的血糖阈值如下：糖化血红蛋白<6.5%，空腹血糖浓度<110mg/dl，餐后2小时血糖浓度<180mg/dl。
强化血糖控制可延缓日本2型糖尿病患者糖尿病微血管并发症早期阶段的发生和进展。
