Marre Michel, Duval-Leclercq Maria, Travert Florence
Service d'endocrinologie-diabétologie-nutrition, groupe hospitalier Bichat-Claude-Bernard, Paris.
Rev Prat. 2007 Sep 15;57(13):1423-30.
Cardiovascular risk is related to increasing levels of blood glucose, even below those defining diabetes. However, this is a statistical association, but causality was not demonstrated by clinical trials. It is recommendable to adjust HbA1c <7 %, because this objective was proved to protect against microvascular disease. If microcirculation is intact, then post-CV event prognosis is similar to that seen in people without diabetes. Non-glycaemic strategies must be agressive in people with type 2 diabetes regarding classical risk factors: blood pressure, lipids, anti-platelet agents. A multiple intervention strategy was shown to be effective in type 2 diabetic subjects with microalbuminuria. Clinical trials aimed at normalizing blood glucose to reduce CV events will be available within 5 years.
心血管风险与血糖水平升高有关，即使血糖水平低于糖尿病的诊断标准。然而，这只是一种统计关联，临床试验并未证实因果关系。建议将糖化血红蛋白（HbA1c）调整至<7%，因为这一目标已被证明可预防微血管疾病。如果微循环完好无损，那么心血管事件后的预后与非糖尿病患者相似。对于2型糖尿病患者，在控制经典危险因素（血压、血脂、抗血小板药物）方面，非血糖管理策略必须积极。多项干预策略已被证明对患有微量白蛋白尿的2型糖尿病患者有效。旨在使血糖正常化以减少心血管事件的临床试验将在5年内开展。
