Scripps Clinic Torrey Pines, La Jolla, California 92037, USA.
Diabetes Technol Ther. 2011 Jun;13 Suppl 1:S65-74. doi: 10.1089/dia.2011.0019.
Life expectancy for a patient with type 2 diabetes remains substantially shorter than an equivalent individual without diabetes, largely because of a greater risk of cardiovascular disease. Diabetes is also associated with an increased incidence of many types of cancer, suggesting that malignancy may also contribute to higher rates of mortality. Hyperglycemia is one of the key risk factors for diabetes-associated macro- and microvascular disease, and as such, intensive glycemic control is associated with improved outcomes for patients, including a reduction in this risk of death from any cause, when initiated early in the disease course. Recent trials in patients with more advanced disease have failed to demonstrate a mortality benefit with intensive glycemic control, although this may reflect their short observation period. Intensive multifactorial therapy, including lifestyle intervention and control of hyperglycemia, hypertension, lipids, thrombosis, and microalbuminuria, is likely to be the best strategy against diabetes-associated macrovascular mortality. However, analysis of the Action to Control Cardiovascular Risk in Diabetes (ACCORD) trial indicates that there may be a subpopulation of patients who are unable to achieve glycemic targets with intensive therapy and that aggressive intensification of treatment in this group may increase mortality risk. It remains to be determined whether the relationship between diabetes and malignancy is causal or whether they share common risk factors. Current recommendations for a healthy lifestyle based on good diet, physical exercise, and weight management in order to control diabetes-related complications are likely to apply in reducing the risk of many forms of cancer and should be advocated for all patients.
预期寿命为 2 型糖尿病患者仍然大大短于一个没有糖尿病的个体，主要是因为心血管疾病的风险较大。糖尿病也与许多类型的癌症发病率增加有关，这表明恶性肿瘤也可能导致更高的死亡率。高血糖是糖尿病相关的大血管和微血管疾病的关键危险因素之一，因此，早期开始强化血糖控制与改善患者预后相关，包括降低任何原因导致的死亡风险。最近在疾病进展更为严重的患者中进行的试验未能证明强化血糖控制可带来死亡率获益，尽管这可能反映了其观察期较短。强化多因素治疗，包括生活方式干预和控制高血糖、高血压、血脂、血栓形成和微量白蛋白尿，可能是对抗糖尿病相关大血管死亡率的最佳策略。然而，对心血管风险控制行动（ACCORD）试验的分析表明，可能存在一部分患者无法通过强化治疗实现血糖目标，而在该组中积极强化治疗可能会增加死亡风险。糖尿病和恶性肿瘤之间的关系是因果关系还是存在共同的危险因素仍有待确定。目前基于良好饮食、体育锻炼和体重管理的健康生活方式建议，以控制糖尿病相关并发症，可能适用于降低多种癌症的风险，应该向所有患者提倡。
