Fioretto Paola, Bruseghin Marino, Berto Ilaria, Gallina Pietro, Manzato Enzo, Mussap Michele
Department of Medical and Surgical Sciences, University of Padova, Via Giustiniani 2, 35128 Padova, Italy.
J Am Soc Nephrol. 2006 Apr;17(4 Suppl 2):S86-9. doi: 10.1681/ASN.2005121343.
Diabetes is the most common cause of ESRD in Western countries. This article describes the impact of glycemic control in the various stages of the disease and considers the impact of tight glycemic control on the development and progression of diabetic nephropathy (DN). The Diabetes Control and Complications Trial and the United Kingdom Prospective Diabetic Study have demonstrated in type 1 and type 2 diabetes that intensive glycemic control significantly reduces the risk for development of microalbuminuria. Although observational studies suggest an impact of glycemia also on the progression of DN, fewer data are available on the impact of improved metabolic control in secondary prevention. The long-term follow-up of the patients who participated in the Diabetes Control and Complications Trial (Epidemiology of Diabetes Interventions and Complications Study) demonstrated a sustained effect of previous tight glycemic control on both development and progression of DN. Finally, long-term normoglycemia, achieved by pancreas transplantation, is able not only to prevent the development of early diabetic glomerulopathy in kidney transplant recipients but also to halt progression and induce regression of the established diabetic renal lesions in nonuremic patients. Taken together, these studies strongly demonstrate that improvement in glucose control is the most important therapeutic approach in primary prevention. Tight glycemic control also is important in slowing progression of DN, and if blood glucose is normalized, then regression of DN can be achieved. Therefore, a target of glycated hemoglobin levels <7% should be recommended in all patients with diabetes.
在西方国家，糖尿病是终末期肾病（ESRD）最常见的病因。本文描述了血糖控制在该疾病各个阶段的影响，并探讨了严格血糖控制对糖尿病肾病（DN）发生和进展的影响。糖尿病控制与并发症试验（DCCT）和英国前瞻性糖尿病研究（UKPDS）已在1型和2型糖尿病患者中证实，强化血糖控制可显著降低微量白蛋白尿的发生风险。尽管观察性研究表明血糖水平对DN的进展也有影响，但关于二级预防中改善代谢控制的影响的数据较少。参与糖尿病控制与并发症试验的患者的长期随访（糖尿病干预与并发症流行病学研究）表明，既往严格的血糖控制对DN的发生和进展均有持续影响。最后，通过胰腺移植实现的长期血糖正常不仅能够预防肾移植受者早期糖尿病肾小球病变的发生，还能阻止非尿毒症患者已有的糖尿病肾脏病变进展并使其逆转。综上所述，这些研究有力地证明，改善血糖控制是一级预防中最重要的治疗方法。严格的血糖控制对于减缓DN的进展也很重要，并且如果血糖恢复正常，则可以实现DN的逆转。因此，应建议所有糖尿病患者将糖化血红蛋白水平目标设定为<7%。
