Kendall D M, Bergenstal R M
International Diabetes Center, 3800 Park Nicollet Blvd, Minneapolis, MN 55416, USA.
Am J Manag Care. 2001 Aug;7(10 Suppl):S327-43; quiz S344-8.
Type 2 diabetes is a complex metabolic disorder characterized by elevated blood glucose levels and a marked increase in the risk of cardiovascular disease (CVD). The increased CVD risk is caused by a unique cluster of metabolic abnormalities, including dyslipidemia, hypertension, insulin resistance, and hyperglycemia. To reduce the risk of cardiovascular complications in patients with type 2 diabetes, comprehensive management of risk factors is essential. Aggressive treatment of dyslipidemia and hypertension is known to benefit patients with type 2 diabetes. In addition, intensive glycemic control and targeted treatment of insulin resistance can further reduce the enormous burden of CVD in this high-risk population. Increasing evidence suggests that insulin resistance is one of the earliest markers of risk for both CVD and diabetes, and it is known that insulin resistance alone can significantly increase the risk of CVD. Type 2 diabetes and insulin resistance are both associated with disordered lipid metabolism, manifest in elevated triglyceride levels, low levels of high-density lipoprotein cholesterol, and small, dense low-density lipoprotein cholesterol particles. Patients with type 2 diabetes and insulin resistance have an increased risk of hypertension, which further contributes to their CVD risk. Each of these factors can also contribute to the risk of microvascular disease. To ensure that patients with type 2 diabetes receive comprehensive, high-quality care, specific standards have been developed. These standards can help providers establish clear treatment targets, identify specific priorities of care, and use therapies of known efficacy to reduce the risk of complications. This review summarizes the current standards of care for patients with type 2 diabetes, with an emphasis on treatments that reduce the cardiovascular risk factors. Using a case study approach, it reviews the essential components of diabetes care and proposes a rational approach to these complex cases--an approach that should result in consistent, high-quality care.
2型糖尿病是一种复杂的代谢紊乱疾病，其特征为血糖水平升高以及心血管疾病（CVD）风险显著增加。CVD风险增加是由一系列独特的代谢异常所致，包括血脂异常、高血压、胰岛素抵抗和高血糖。为降低2型糖尿病患者发生心血管并发症的风险，对危险因素进行综合管理至关重要。积极治疗血脂异常和高血压已知对2型糖尿病患者有益。此外，强化血糖控制和针对胰岛素抵抗的靶向治疗可进一步减轻这一高危人群中CVD的巨大负担。越来越多的证据表明，胰岛素抵抗是CVD和糖尿病风险的最早标志物之一，且已知仅胰岛素抵抗就能显著增加CVD风险。2型糖尿病和胰岛素抵抗均与脂质代谢紊乱相关，表现为甘油三酯水平升高、高密度脂蛋白胆固醇水平降低以及小而密的低密度脂蛋白胆固醇颗粒。2型糖尿病和胰岛素抵抗患者患高血压的风险增加，这进一步加剧了他们的CVD风险。这些因素中的每一个也都可能导致微血管疾病风险增加。为确保2型糖尿病患者获得全面、高质量的护理，已制定了特定标准。这些标准可帮助医疗服务提供者确立明确的治疗目标，确定具体的护理重点，并使用已知有效的疗法降低并发症风险。本综述总结了2型糖尿病患者当前的护理标准，重点关注降低心血管危险因素的治疗方法。通过案例研究方法，它回顾了糖尿病护理的基本组成部分，并针对这些复杂病例提出了一种合理的方法——一种应能带来一致、高质量护理的方法。
