Cugnet-Anceau C, Bauduceau B
Fédération d'endocrinologie, diabète et nutrition, hôpital cardiovasculaire et pneumologique Louis-Pradel, 69677 Bron cedex, France.
Ann Endocrinol (Paris). 2009 Mar;70(1):48-54. doi: 10.1016/j.ando.2008.12.008. Epub 2009 Feb 3.
The year 2008 was rich in teachings and suspense in diabetology. Past studies, i.e. United Kingdom Prospective Diabetes Study (UKPDS) in type 2 diabetic patients and Diabetes Control and Complications Trial (DCCT) in type 1 diabetic patients, have shown that in the short term, intensive treatment reduces the incidence of microvascular complications linked to diabetes and in the long term that of both microvascular and macrovascular ones. The in-the-raw conclusions of the recent Action to Control Cardiovascular risk in Diabetes (ACCORD) study note an increase in mortality in type 2 diabetic patients treated intensively, while the Action in Diabetes and Vascular disease, Perindopril and Indapamide Controlled Evaluation (ADVANCE) study evidences a reduction in microvascular complications and the Veterans Affairs Diabetes Trial (VADT) study shows that intensive treatment has no significant effect. A well thought-out analysis of the studies published in 2008 (ACCORD, STENO 2 post-trial, ADVANCE, VADT, UKPDS post-trial, Epidemiology of Diabetes Interventions and Complications [EDIC]) is particularly instructive and highlights the existence of glycaemic memory, the non-existence of blood pressure memory, the need to control all cardiovascular risk factors and to treat diabetes early while avoiding hypoglycaemic incidents. The glycaemic target based on HbA1c must take into account the patient's age and the duration of his diabetes, as well as his cardiovascular risk factors and previous glycaemic control. All in all, the intensive treatment of type 2 diabetes must begin early; it must not be too rapid and must avoid hypoglycaemic incidents and be combined with a strict control of other cardiovascular risk factors.
2008年在糖尿病学领域充满了经验教训和悬念。过去的研究，即针对2型糖尿病患者的英国前瞻性糖尿病研究（UKPDS）和针对1型糖尿病患者的糖尿病控制与并发症试验（DCCT）表明，短期内强化治疗可降低与糖尿病相关的微血管并发症的发生率，长期来看可降低微血管和大血管并发症的发生率。近期糖尿病心血管风险控制行动（ACCORD）研究的初步结论指出，强化治疗的2型糖尿病患者死亡率增加，而糖尿病与血管疾病、培哚普利吲达帕胺控制评估行动（ADVANCE）研究证明微血管并发症有所减少，退伍军人事务部糖尿病试验（VADT）研究表明强化治疗没有显著效果。对2008年发表的研究（ACCORD、STENO 2试验后研究、ADVANCE、VADT、UKPDS试验后研究、糖尿病干预与并发症流行病学[EDIC]）进行深思熟虑的分析特别具有启发性，突出了血糖记忆的存在、血压记忆的不存在、控制所有心血管危险因素以及早期治疗糖尿病同时避免低血糖事件的必要性。基于糖化血红蛋白（HbA1c）的血糖目标必须考虑患者的年龄、糖尿病病程、心血管危险因素以及既往血糖控制情况。总而言之，2型糖尿病的强化治疗必须尽早开始；不能过于迅速，必须避免低血糖事件，并与严格控制其他心血管危险因素相结合。
