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在2型糖尿病管理中针对餐后和空腹高血糖的临床意义。

Clinical significance of targeting postprandial and fasting hyperglycemia in managing type 2 diabetes mellitus.

作者信息

Fonseca Vivian

机构信息

Tulane University Health Sciences Center, 1430 Tulane Avenue--SL 53, New Orleans, LA 70112, USA.

出版信息

Curr Med Res Opin. 2003;19(7):635-41. doi: 10.1185/030079903125002351.

Abstract

Measurement of glycosylated hemoglobin (HbA1c) remains the gold standard for the assessment of glycemic control in patients with type 2 diabetes. Recent investigations have studied the correlations between HbA1c levels and other aspects of glucose metabolism, specifically, postprandial glucose (PPG) and fasting plasma glucose (FPG). The results suggest that PPG is also important to overall glycemic control and may be a better index of glucose regulation than FPG. Further, elevated PPG values have been associated with cardiovascular complications and cardiovascular mortality. Such evidence has led to recommendations that PPG levels be monitored as part of type 2 diabetes management, in addition to HbA1c and FPG. These glycemic parameters are differentially affected by the various classes of oral antidiabetic agents used in the treatment of type 2 diabetes--sulfonylureas, meglitinides, insulin sensitizers and alpha-glucosidase inhibitors. The sulfonylureas, for example, lower HbA1c, PPG and FPG, while the meglitinides have virtually no effect on FPG. The insulin sensitizer metformin, on the other hand, does not affect PPG levels, whereas the alpha-glucosidase inhibitors, in the presence of a high-carbohydrate diet, can effectively lower PPG. Many patients receive combination therapy, thereby benefiting from multiple mechanisms of glucose control, although in most cases insulin must later be added to the regimen in order to effectively suppress FPG. Thus, all aspects of glucose metabolism appear to be clinically relevant and should be monitored for effective diabetes management. Further study will more precisely define the clinical significance of PPG.

摘要

糖化血红蛋白(HbA1c)的测定仍然是评估2型糖尿病患者血糖控制的金标准。最近的研究探讨了HbA1c水平与葡萄糖代谢其他方面的相关性,特别是餐后血糖(PPG)和空腹血糖(FPG)。结果表明,PPG对总体血糖控制也很重要,并且可能是比FPG更好的血糖调节指标。此外,PPG值升高与心血管并发症和心血管死亡率相关。这些证据促使人们建议,除了监测HbA1c和FPG之外,还应将PPG水平作为2型糖尿病管理的一部分进行监测。这些血糖参数受到用于治疗2型糖尿病的各类口服抗糖尿病药物——磺脲类、格列奈类、胰岛素增敏剂和α-葡萄糖苷酶抑制剂的不同影响。例如,磺脲类药物可降低HbA1c、PPG和FPG,而格列奈类药物对FPG几乎没有影响。另一方面,胰岛素增敏剂二甲双胍不影响PPG水平,而α-葡萄糖苷酶抑制剂在高碳水化合物饮食的情况下可有效降低PPG。许多患者接受联合治疗,从而从多种血糖控制机制中获益,尽管在大多数情况下,为了有效抑制FPG,后期必须在治疗方案中添加胰岛素。因此,葡萄糖代谢的所有方面在临床上似乎都具有相关性,为了有效管理糖尿病,应对其进行监测。进一步的研究将更精确地界定PPG的临床意义。

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