Soeters Maarten R, Hoekstra Joost B, de Vries J H Hans
Academisch Medisch Centrum, afd. Inwendige Geneeskunde, Amsterdam, the Netherlands.
Ned Tijdschr Geneeskd. 2010;154:A2113.
The treatment of diabetes mellitus is focused on the prevention of micro- and macrovascular complications. The target HbA(1c) should therefore be 7% or lower. However, a recent study advised a HbA(1c) of 7.5%, since it was found that mortality increased with an HbA(1c) below 7.5%. This was probably caused by hypoglycaemia. A higher mortality in patients with a low HbA(1c) has been described before, but the causes were never understood. It is true that a lower HbA(1c) leads to more hypoglycaemia, but there are no indications that this is the cause of the increased mortality. Changing the target HbA(1c) based on one epidemiological retrospective study is unwise. Taking into account historic prospective studies such as the United Kingdom Prospective Diabetes Study, we think the target HbA(1c) should remain 7% or lower in the treatment of diabetes mellitus.
糖尿病的治疗重点在于预防微血管和大血管并发症。因此,糖化血红蛋白(HbA1c)的目标应在7%或更低。然而,最近一项研究建议将HbA1c目标设定为7.5%,因为研究发现,HbA1c低于7.5%时死亡率会增加。这可能是由低血糖引起的。之前已有低HbA1c患者死亡率较高的描述,但原因一直不明。的确,较低的HbA1c会导致更多低血糖情况,但并无迹象表明这就是死亡率增加的原因。基于一项流行病学回顾性研究来改变HbA1c目标是不明智的。考虑到像英国前瞻性糖尿病研究这样的历史前瞻性研究,我们认为在糖尿病治疗中,HbA1c目标应保持在7%或更低。