Davidson Jaime A
Endocrine and Diabetes Associates of Texas, Dallas, TX 75230, USA.
Curr Med Res Opin. 2004 Dec;20(12):1919-27. doi: 10.1185/030079904X6291.
To review clinical trial evidence supporting treatment of patients to a near-normal HbA(1c) target level and outline therapeutic strategies that optimize glycemic control.
The current MEDLINE database and bibliographies were searched for literature relevant to diabetic complications, glycemic control, and the intensive management of diabetes mellitus.
Two randomized trials, the Diabetes Control and Complications Trial and the UK Prospective Diabetes Study (UKPDS), provided evidence that intensive glycemic control obtained with either intensive insulin or oral therapy effectively slowed the onset and progression of diabetic retinopathy, nephropathy, and neuropathy in patients with type 1 and type 2 diabetes. An epidemiologic analysis of the UKPDS results showed a significant correlation between glycemic control and microvascular and cardiovascular disease risk and mortality rates.
The results of clinical trials confirm that stringent levels of glycemic control can be attained through the use of intensive multiple-injection insulin regimens (administration of insulin 3 or more times daily by injection or an external pump with dosage adjustments as needed), oral monotherapy or combination therapy, or a combination of insulin and oral therapy. The expanded choices for oral agents and the availability of insulin analogs now provide physicians with the tools to tailor therapy to prevent or delay the devastating complications of diabetes. Indeed, newer insulin analogs, both short-acting (insulin lispro, insulin aspart) and long-acting (insulin glargine), are an important part of a treatment strategy to circumvent diabetes complications and overcome the shortcomings of conventional insulin preparations.
回顾支持将患者治疗至接近正常糖化血红蛋白（HbA1c）目标水平的临床试验证据，并概述优化血糖控制的治疗策略。
检索当前的MEDLINE数据库及参考文献，查找与糖尿病并发症、血糖控制和糖尿病强化管理相关的文献。
两项随机试验，即糖尿病控制与并发症试验（Diabetes Control and Complications Trial）和英国前瞻性糖尿病研究（UK Prospective Diabetes Study，UKPDS），提供了证据表明，通过强化胰岛素治疗或口服治疗实现的强化血糖控制有效地减缓了1型和2型糖尿病患者糖尿病视网膜病变、肾病和神经病变的发生和进展。对UKPDS结果的一项流行病学分析显示，血糖控制与微血管和心血管疾病风险及死亡率之间存在显著相关性。
临床试验结果证实，通过使用强化多次注射胰岛素方案（每日注射胰岛素3次或更多次，或使用外置泵并根据需要调整剂量）、口服单一疗法或联合疗法，或胰岛素与口服疗法的联合使用，可以实现严格的血糖控制水平。口服药物选择的增加以及胰岛素类似物的可得性，现在为医生提供了量身定制治疗方案的工具，以预防或延缓糖尿病的毁灭性并发症。事实上，新型胰岛素类似物，包括短效（赖脯胰岛素、门冬胰岛素）和长效（甘精胰岛素），是规避糖尿病并发症和克服传统胰岛素制剂缺点的治疗策略的重要组成部分。
