Bonora E, Muggeo M
Division of Endocrinology and Metabolic Disease, University of Verona Medical School, Ospedale Maggiore, Piazzale Stefani 1, Verona, Italy.
Diabetologia. 2001 Dec;44(12):2107-14. doi: 10.1007/s001250100020.
That cardiovascular disease occurs more frequently in patients with Type II (non-insulin-dependent) diabetes mellitus has been recognized for a long time. However, the extent to which hyperglycaemia contributes to atherosclerosis and cardiovascular disease is still not clear. Epidemiological studies published in recent years suggest that postprandial blood glucose might be an independent risk factor of cardiovascular disease. The main results of these studies, which are reviewed in this article, are that subjects from the general population with mild to moderate hyperglycaemia, following oral glucose load, but not in the fasting state, showed an increased cardiovascular risk. Furthermore, the post-challenge as well as postprandial glucose concentrations of subjects with Type II diabetes were found to be directly associated to incident cardiovascular disease independently of fasting glucose. Also, the correction of fasting hyperglycaemia or HbA1 c or both, disregarding the specific correction of postprandial hyperglycaemia was not found to significantly reduce the incidence of cardiovascular disease in patients with Type II diabetes. Finally, the strict control of both preprandial and postprandial hyperglycaemia yielded a substantial reduction of cardiovascular disease in Type II diabetes. Trials specifically designed to address this issue are needed to determine whether postprandial hyperglycaemia plays an independent and causative role in cardiovascular disease in patients with Type II diabetes.
心血管疾病在II型（非胰岛素依赖型）糖尿病患者中更为常见，这一点早已为人所知。然而，高血糖在动脉粥样硬化和心血管疾病中所起作用的程度仍不明确。近年来发表的流行病学研究表明，餐后血糖可能是心血管疾病的独立危险因素。本文综述了这些研究的主要结果，即一般人群中轻度至中度高血糖的受试者，在口服葡萄糖负荷后而非空腹状态下，心血管风险增加。此外，发现II型糖尿病患者的餐后血糖浓度以及口服葡萄糖耐量试验后血糖浓度与心血管疾病的发生直接相关，且独立于空腹血糖。而且，在不考虑餐后高血糖的具体纠正措施的情况下，单纯纠正空腹高血糖或糖化血红蛋白（HbA1c）或两者，并未发现能显著降低II型糖尿病患者心血管疾病的发病率。最后，严格控制餐前和餐后高血糖可使II型糖尿病患者的心血管疾病大幅减少。需要专门设计针对这一问题的试验，以确定餐后高血糖在II型糖尿病患者的心血管疾病中是否起独立的致病作用。
