Division of Endocrinology and Metabolism, The EVMS Strelitz Center for Diabetes and Endocrine Disorders, Department of Internal Medicine, Eastern Virginia Medical School Norfolk, VA, USA.
Front Endocrinol (Lausanne). 2012 Aug 29;3:110. doi: 10.3389/fendo.2012.00110. eCollection 2012.
Cardiovascular disease accounts for nearly 70% of morbidity and mortality in patients with diabetes mellitus. Strides made in diabetes care have indeed helped prevent or reduce the burden of microvascular complications in both type 1 and type 2 diabetes. However, the same cannot be said about macrovascular disease in diabetes. Several prospective trials so far have failed to provide conclusive evidence of the superiority of glycemic control in reducing macrovascular complications or death rates in people with advanced disease or those with long duration of diabetes. There are trends that suggest that benefits are restricted to those with lesser burden and shorter duration of disease. Furthermore, it is also suggested that benefits might accrue but it would take a longer time to manifest. Clinicians are faced with the challenge to decide how to triage patients for intensified care vs less intense care. This review focuses on evidence and attempts to provide a balanced view of the literature that has radically affected how physicians treat patients with macrovascular disease. It also takes cognizance of the fact that the natural course of the disease may be changing as well, possibly related to better overall awareness and possibly improved access to information about better individual healthcare. The review further takes note of some hard held notions about the pathobiology of the disease that must be interpreted with caution in light of new and emerging data. In light of recent developments ADA and EASD have taken step to provide some guidance to clinicians through a joint position statement. A lot more research would be required to figure out how best to manage macrovascular disease in diabetes mellitus. Glucocentric stance would need to be reconsidered, and attention paid to concurrent multifactorial interventions that seem to be effective in reducing vascular outcomes.
心血管疾病在糖尿病患者的发病率和死亡率中占近 70%。在糖尿病治疗方面取得的进展确实有助于预防或减轻 1 型和 2 型糖尿病的微血管并发症负担。然而，对于糖尿病的大血管疾病来说并非如此。到目前为止，几项前瞻性试验未能提供确凿证据证明血糖控制可降低晚期疾病或糖尿病病程较长患者的大血管并发症或死亡率。有一些趋势表明，获益仅限于疾病负担较小和病程较短的患者。此外，还表明可能会有获益，但需要更长的时间才能显现。临床医生面临着决定如何对患者进行强化护理与非强化护理分类的挑战。本综述重点关注证据，并尝试提供对文献的平衡观点，这些文献彻底改变了医生治疗大血管疾病患者的方式。它还认识到，随着整体意识的提高和更好地获得有关更好的个体医疗保健的信息，疾病的自然病程也可能发生变化。该综述进一步注意到一些关于疾病病理生物学的顽固观念，鉴于新出现的数据，这些观念必须谨慎解释。鉴于最近的发展，ADA 和 EASD 通过联合立场声明为临床医生提供了一些指导。需要进行更多的研究以确定如何最好地管理糖尿病中的大血管疾病。需要重新考虑以葡萄糖为中心的立场，并关注似乎可有效降低血管结局的同时进行的多因素干预。
