Department of Internal Medicine: Endocrinology and Metabolism, Marmara University, Istanbul, Turkey.
Int J Clin Pract. 2009 Oct;63(10):1421-5. doi: 10.1111/j.1742-1241.2009.02165.x.
There is compelling evidence showing that achieving good glycaemic control reduces the risk of microvascular complications in people with type 1 and type 2 diabetes. Likewise, there is clear evidence to show that achieving good glycaemic control reduces the risk of macrovascular complications in type 1 diabetes. The UKPDS 10-year follow up suggests that good glycaemic control also reduces the risk of macrovascular complications in type 2 diabetes. Despite this, recent results from ACCORD, ADVANCE and VADT present conflicting results and data from the ACCORD trial appear to suggest that very low HbA(1c) targets (<6.0%) may, in fact, be dangerous in certain patient populations.
To review recent results from ACCORD, ADVANCE and VADT and provide clear guidance on the clinical significance of the new data and their implications for the practising physician treating patients with type 2 diabetes.
A Pubmed search was used to identify major randomised clinical trials examining the association between glycaemic control and diabetes-associated complications. The data was reviewed and discussed by the GTF through a consensus meeting. The recommendations for clinical practice in this statement are the conclusions of these analyses and discussions.
Evidence from ACCORD, ADVANCE, VADT and UKPDS suggests that certain patient populations, such as those with moderate diabetes duration and/or no pre-existing CVD, may benefit from intensive blood glucose control. These trials highlight the benefit of a multifactorial treatment approach to diabetes. However, ACCORD results indicate that aggressive HbA(1c) targets (<6.0%) may not be beneficial in patients with existing CVD and a longer duration of diabetes.
Glycaemic control remains a very important component of treatment for type 2 diabetes and contrasting results from the ACCORD, ADVANCE and VADT should not discourage physicians from controlling blood glucose levels.
有确凿的证据表明，良好的血糖控制可降低 1 型和 2 型糖尿病患者发生微血管并发症的风险。同样，也有明确的证据表明，良好的血糖控制可降低 1 型糖尿病患者发生大血管并发症的风险。UKPDS10 年随访表明，良好的血糖控制也可降低 2 型糖尿病患者发生大血管并发症的风险。尽管如此，最近的 ACCORD、ADVANCE 和 VADT 研究结果却存在相互矛盾之处，而且 ACCORD 试验的数据似乎表明，极低的糖化血红蛋白（HbA1c）目标值（<6.0%）实际上可能对某些患者群体有害。
回顾 ACCORD、ADVANCE 和 VADT 的最新研究结果，就新数据的临床意义及其对治疗 2 型糖尿病患者的临床医生的影响提供明确的指导。
使用 Pubmed 搜索确定了检查血糖控制与糖尿病相关并发症之间关联的主要随机临床试验。通过共识会议，由 GTF 对数据进行了审查和讨论。本声明中的临床实践建议是对这些分析和讨论的结论。
来自 ACCORD、ADVANCE、VADT 和 UKPDS 的证据表明，某些患者群体，如糖尿病病程中等且/或无预先存在的心血管疾病的患者，可能从强化血糖控制中获益。这些试验强调了糖尿病多因素治疗方法的益处。然而，ACCORD 结果表明，对于已经存在心血管疾病和较长糖尿病病程的患者，积极的 HbA1c 目标值（<6.0%）可能无益。
血糖控制仍然是 2 型糖尿病治疗的一个非常重要的组成部分，来自 ACCORD、ADVANCE 和 VADT 的相互矛盾的结果不应阻止医生控制血糖水平。
