University of California Irvine, Irvine, California, USA.
Ann Intern Med. 2009 Dec 15;151(12):854-60. doi: 10.7326/0003-4819-151-12-200912150-00005.
Recent studies have shown mixed results regarding the effectiveness of intensive glucose-lowering therapy in reducing risk for cardiovascular events.
To determine whether attaining hemoglobin A(1c) (HbA(1c)) targets of 6.5% or less or 7.0% or less for glycemic control at baseline provides differential benefits for patients with high versus low-to-moderate levels of comorbidity.
5-year longitudinal observational study of patients with type 2 diabetes. Patients were categorized into high and low-to-moderate comorbidity subgroups by using the Total Illness Burden Index (TIBI), a validated patient-reported measure of comorbidity.
101 diabetes outpatient clinics and 103 general practitioners' clinics in Italy.
2613 (83%) of 3074 patients with type 2 diabetes, sampled randomly from diabetes outpatient clinic rosters and recruited consecutively from general practitioners' clinics, who completed the baseline questionnaire.
TIBI score, total mortality, and incident cardiovascular events. Hazard ratios (HRs) were adjusted for age and sex.
Attaining an HbA(1c) level of 6.5% or less at baseline was associated with lower 5-year incidence of cardiovascular events in the low-to-moderate comorbidity subgroup (adjusted HR, 0.60 [95% CI, 0.42 to 0.85]; P = 0.005) but not in the high comorbidity subgroup (adjusted HR, 0.92 [CI, 0.68 to 1.25]; P = 0.61; P for subgroup by HbA(1c) interaction = 0.048). Similarly, attaining a baseline HbA(1c) level of 7.0% predicted fewer cardiovascular events in the low-to-moderate comorbidity subgroup (adjusted HR, 0.61 (CI, 0.44 to 0.83; P = 0.001) but not in the high comorbidity subgroup (adjusted HR, 0.88 [CI, 0.66 to 1.17]; P = 0.38; P for subgroup by HbA(1c) interaction = 0.093).
The observational nature of the study does not allow causal inference. The length of the data collection period was limited. Information on clinical management was not available.
Patients with the high levels of comorbidity common in type 2 diabetes may receive diminished cardiovascular benefit from intensive blood glucose control. Comorbidity should be considered when tailoring glucose-lowering therapy in patients with type 2 diabetes.
Pfizer of Italy.
最近的研究表明，强化降糖治疗在降低心血管事件风险方面的效果存在差异。
确定在基线时将糖化血红蛋白（HbA（1c））目标控制在 6.5%或更低或 7.0%或更低，对于合并症高低程度不同的患者是否具有不同的益处。
对患有 2 型糖尿病的患者进行了为期 5 年的纵向观察性研究。使用总疾病负担指数（TIBI）将患者分为高合并症和低中度合并症亚组，这是一种经过验证的患者报告的合并症测量方法。
意大利的 101 个糖尿病门诊诊所和 103 个全科医生诊所。
2613 名（83%）接受随机抽样的来自糖尿病门诊患者名单的 2 型糖尿病患者，以及连续从全科医生诊所招募的患者，他们完成了基线问卷。
TIBI 评分、总死亡率和心血管事件发生率。风险比（HRs）经年龄和性别调整。
在低中度合并症亚组中，基线时 HbA（1c）水平达到 6.5%或更低与较低的 5 年心血管事件发生率相关（调整后的 HR，0.60 [95%CI，0.42 至 0.85]；P=0.005），但在高合并症亚组中没有（调整后的 HR，0.92 [CI，0.68 至 1.25]；P=0.61；HbA（1c）交互作用的亚组间 P 值=0.048）。同样，基线时 HbA（1c）水平达到 7.0%预测低中度合并症亚组的心血管事件较少（调整后的 HR，0.61（CI，0.44 至 0.83；P=0.001），但在高合并症亚组中没有（调整后的 HR，0.88 [CI，0.66 至 1.17]；P=0.38；HbA（1c）交互作用的亚组间 P 值=0.093）。
研究的观察性质不允许进行因果推断。数据收集时间有限。临床管理信息不可用。
在 2 型糖尿病中常见的高合并症患者可能从强化血糖控制中获得较少的心血管益处。在为 2 型糖尿病患者定制降糖治疗时，应考虑合并症。
意大利辉瑞公司。
