Scheen A J, Paquot N, Lefebvre P J
Université de Liège.
Rev Med Liege. 2008 Oct;63(10):624-9.
A 10-year post-trial monitoring of patients with newly diagnosed type 2 diabetes randomised in the "United Kingdom Prospective Diabetes Study" (UKPDS) demonstrated a continued reduction in microvascular risk (-24%, p = 0.001) and emergent risk reductions for myocardial infarction (-15%, p = 0.01) and death from any cause (-13%, p = 0.007), despite an early loss of glycaemic differences ("legacy effect"). A continued benefit after metformin therapy was evident during the ten-year post-trial follow-up among overweight patients (-33%, p = 0.005 for myocardial infarction and -27%, p = 0.002 for death from any cause). In contrast, the benefits of previously improved blood pressure control were not sustained when between-groups differences in blood pressure were lost during follow-up, except for a reduced risk for peripheral vascular disease. These observations are strong arguments in favour of an early optimisation of blood glucose control and of a sustained control of blood pressure in patients with type 2 diabetes.
在“英国前瞻性糖尿病研究”(UKPDS)中,对新诊断的2型糖尿病患者进行了为期10年的试验后监测,结果显示微血管风险持续降低(-24%,p = 0.001),心肌梗死的风险出现降低(-15%,p = 0.01),任何原因导致的死亡风险降低(-13%,p = 0.007),尽管血糖差异在早期就已消失(“遗留效应”)。在试验后的十年随访中,二甲双胍治疗后的持续获益在超重患者中很明显(心肌梗死风险降低-33%,p = 0.005;任何原因导致的死亡风险降低-27%,p = 0.002)。相比之下,当随访期间血压的组间差异消失时,先前改善的血压控制的益处并未持续,外周血管疾病风险降低除外。这些观察结果有力地支持了对2型糖尿病患者进行早期血糖控制优化和持续血压控制。