Deedwania Prakash C, Fonseca Vivian A
Division of Cardiology, Department of Medicine, Veterans Affairs Central California Health Care System, University of California San Francisco Medical Education Program, Fresno, 93703, USA.
Am J Med. 2005 Sep;118(9):939-47. doi: 10.1016/j.amjmed.2005.05.018.
As the prevalence of diabetes continues to increase worldwide, diabetes-related macrovascular morbidity and mortality are becoming major health care problems. Epidemiologic evidence suggests this relationship begins early in the progression from normal glucose tolerance to frank diabetes. This report reviews this epidemiologic evidence linking early stages of glucose dysregulation with cardiovascular disease and discusses the results of major clinical trials demonstrating that lifestyle or pharmacologic intervention can reduce the incidence of diabetes in high-risk individuals. These observations indicate that early identification and aggressive treatment of subjects with impaired fasting glucose or impaired glucose tolerance have the potential to reduce both the incidence of diabetes and its related cardiovascular disease. Three clinical trials are being conducted to test whether early pharmacotherapy can reduce or delay the incidence of diabetes, and their results may well begin to shift the treatment paradigm toward earlier intervention.
随着全球糖尿病患病率持续上升，糖尿病相关的大血管发病率和死亡率正成为主要的医疗保健问题。流行病学证据表明，这种关系在从正常糖耐受到显性糖尿病的进展过程中很早就开始了。本报告回顾了将血糖调节异常早期阶段与心血管疾病联系起来的流行病学证据，并讨论了主要临床试验的结果，这些试验表明生活方式或药物干预可降低高危个体患糖尿病的发生率。这些观察结果表明，对空腹血糖受损或糖耐量受损的受试者进行早期识别和积极治疗，有可能降低糖尿病及其相关心血管疾病的发生率。目前正在进行三项临床试验，以测试早期药物治疗是否可以降低或延迟糖尿病的发生率，其结果很可能会使治疗模式朝着更早干预的方向转变。
