Department of Internal Medicine 4, Safárik University, Faculty of Medicine, L. Pasteur Faculty Hospital, Kosice, Slovakia.
Diabetes Res Clin Pract. 2009 Dec;86 Suppl 1:S57-62. doi: 10.1016/S0168-8227(09)70011-7.
More intensive diabetes control prevents microangiopathy in patients with both type 1 diabetes and type 2 diabetes. The data related to prevention of macrovascular disease in patients with type 2 diabetes are controversial. The data confirming benefit of the HbA(1c) levels below 6.5% came almost exclusively from epidemiological studies. The following article reviews the data from five large clinical randomized trials which compared the more intensive glucose lowering strategy with the standard antidiabetic treatment i.e. UKPDS, PROactive, ACCORD, ADVANCE and VADT. Metaanalysis of five trials showed a highly significant reduction of the incidence of non fatal myocardial infarction [OR 0.84 (95% CI 0.75-0.93), p = 0.001] in patients with intensive glycemic control. No significant differences were observed by combined analysis for the non-fatal stroke, cardiovascular mortality and all-cause mortality between the compared groups. The reason for the discordance of the results of the epidemiological and interventional studies is not clear. The possible explanations could include short duration of the trials to show effect of glucose lowering, as well as attenuating of the beneficial effect of better glycemic control by increased hypoglycemia-related mortality in patients with preexisting cardiovascular disease.
更严格的糖尿病控制可以预防 1 型和 2 型糖尿病患者的微血管并发症。关于预防 2 型糖尿病患者大血管疾病的数据存在争议。确认 HbA1c 水平低于 6.5%有益的数据几乎完全来自于流行病学研究。本文综述了来自 UKPDS、PROactive、ACCORD、ADVANCE 和 VADT 这五项大型临床随机试验的数据，这些试验比较了强化降糖策略与标准降糖治疗。五项试验的荟萃分析显示，强化血糖控制可显著降低非致命性心肌梗死的发生率[OR 0.84（95% CI 0.75-0.93），p=0.001]。对非致命性卒中、心血管死亡率和全因死亡率进行联合分析，两组间无显著差异。流行病学和干预研究结果不一致的原因尚不清楚。可能的解释包括试验持续时间短，无法显示降糖效果，以及在有心血管疾病的患者中，低血糖相关死亡率增加，减弱了更好的血糖控制的有益效果。
