Division of Endocrinology, Phoenix VA Health Care System, 650 East Indian School Road, Phoenix, AZ 85012, USA.
Curr Cardiol Rep. 2012 Feb;14(1):79-88. doi: 10.1007/s11886-011-0238-6.
Diabetes is increasing rapidly worldwide and frequently results in severe vascular complications. A target glycated hemoglobin of less than 7% has commonly been recommended in hopes of preventing both macrovascular and microvascular complications. Although results from trials of intensive glycemic control have generally supported the notion that lower glycated hemoglobin values reduce microvascular disease, the evidence for similar benefits for macrovascular disease has been less clear. As macrovascular disease is the major cause of morbidity and mortality in type 2 diabetes, this remains one of the more important unresolved clinical questions. Recent results from the ACCORD, ADVANCE, and VADT studies have challenged the conventional believe that lower glycated hemoglobin values should be pursued in all diabetic patients. Factors that may influence whether intensive glucose management is advisable include duration of diabetes, pre-existing macrovascular disease, hypoglycemic unawareness, and significant comorbidities. Glycated hemoglobin goals should account for these factors and be individualized for each patient.
糖尿病在全球范围内迅速增加，经常导致严重的血管并发症。通常建议将糖化血红蛋白控制在 7%以下，以预防大血管和微血管并发症。尽管强化血糖控制试验的结果普遍支持较低的糖化血红蛋白值可降低微血管疾病的观点，但对于大血管疾病类似获益的证据尚不明确。由于大血管疾病是 2 型糖尿病发病率和死亡率的主要原因，这仍然是一个更为重要的未解决的临床问题之一。最近来自 ACCORD、ADVANCE 和 VADT 研究的结果对传统观点提出了挑战，即所有糖尿病患者都应追求较低的糖化血红蛋白值。可能影响强化血糖管理是否合理的因素包括糖尿病病程、已存在的大血管疾病、无症状性低血糖和严重的合并症。糖化血红蛋白目标应考虑这些因素，并针对每个患者进行个体化。
