Shanghai Institute of Cardiovascular Disease, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai 200032, China.
Ann Med. 2010 May 6;42(4):305-15. doi: 10.3109/07853891003796752.
The effects of intensive glucose control over conventional glucose control on cardiovascular outcomes of patients with type 2 diabetes remain uncertain.
We searched MEDLINE, EMBASE, and the Cochrane database to identify randomized controlled trials that compared the effects of intensive glucose control and conventional glucose control, on cardiovascular events in patients with type 2 diabetes.
Seven trials involving 34,144 participants with type 2 diabetes were included. Intensive glucose control significantly reduced major cardiovascular events by 10% (relative risk (RR) 0.90, 95% CI 0.85-0.96; P = 0.0006), and non-fatal myocardial infarction by 16% (0.84, 95% CI 0.76-0.93; P = 0.0006) at the expense of increased incidence of severe hypoglycemia (2.30, 95% CI 1.74-3.03; P < 0.00001), while all-cause mortality, cardiovascular death, non-fatal stroke, and heart failure were similar between the two groups. Subgroup analyses showed that patients with longer follow-up duration, shorter diabetic duration, less glycosylated hemoglobin (HbA1c) reduction, higher HbA1c concentration at follow-up, and lower base-line HbA1c benefited more from intensive glucose control.
An intensive glucose control strategy can effectively reduce the risk of major cardiovascular events but at the expense of a significantly increased risk of severe hypoglycemia in patients with type 2 diabetes.
强化血糖控制对比常规血糖控制对 2 型糖尿病患者心血管结局的影响仍不确定。
我们检索了 MEDLINE、EMBASE 和 Cochrane 数据库，以确定比较强化血糖控制与常规血糖控制对 2 型糖尿病患者心血管事件影响的随机对照试验。
纳入了 7 项涉及 34144 例 2 型糖尿病患者的试验。强化血糖控制显著降低了 10%的主要心血管事件（相对风险（RR）0.90，95%置信区间（CI）0.85-0.96；P=0.0006）和 16%的非致死性心肌梗死（0.84，95%CI 0.76-0.93；P=0.0006），但其代价是严重低血糖发生率增加（2.30，95%CI 1.74-3.03；P<0.00001），而两组间全因死亡率、心血管死亡率、非致死性卒中和心力衰竭无差异。亚组分析显示，随访时间更长、糖尿病病程更短、糖化血红蛋白（HbA1c）降幅更小、随访时 HbA1c 浓度更高、基线 HbA1c 更低的患者从强化血糖控制中获益更多。
强化血糖控制策略可有效降低 2 型糖尿病患者主要心血管事件的风险，但会显著增加严重低血糖的风险。
