Bouhanick Béatrice, Barigou Mohamed, Kantambadouno Jean-Baptiste, Chamontin Bernard
CHU de Rangueil, service d'HTA et médecine interne TSA 50 032, 31059 Toulouse cedex 9, France.
Presse Med. 2013 May;42(5):849-54. doi: 10.1016/j.lpm.2013.02.315. Epub 2013 Mar 27.
In France, 2.8 millions of patients have type 2 diabetes, which is a well-established risk factor for cardiovascular disease. In about 15 years, several large clinical trials tried to study the relationship between a tight glycaemic control and the occurrence of micro- and macroangiopathy. Meta-analyses of targeting intensive versus conventional glycaemic control focused on divergent results. In type 1 diabetes, a tight glycaemic control reduced the occurrence of microangiopathy whereas more time, at least 5 years is needed to reduce macroangiopathy. Conclusions drawn from studies are less clear for type 2 diabetes and depend on the caracteristics of the population studied, particularly for retinopathy. When microalbuminuria is the judgement criteria, its progression is lower in the intensive group than in the conventional one and it takes more than about 5 years to emerge; the impact on glomerular filtration rate is less clear. Worries about the excess of mortality observed in the ACCORD study in the intensive treatment group were not described in other studies. The decrease of mortality was not associated with an intensive glyceamic control. Intensified multifactorial intervention is finally needed to improve microangiopathy.
在法国，280万患者患有2型糖尿病，这是心血管疾病公认的危险因素。在大约15年的时间里，几项大型临床试验试图研究严格血糖控制与微血管和大血管病变发生之间的关系。针对强化血糖控制与传统血糖控制的荟萃分析关注了不同的结果。在1型糖尿病中，严格血糖控制可减少微血管病变的发生，而减少大血管病变则至少需要5年时间。对于2型糖尿病，研究得出的结论不太明确，且取决于所研究人群的特征，尤其是视网膜病变方面。当以微量白蛋白尿作为判断标准时，强化组中其进展低于传统组，且需要约5年以上才会出现；对肾小球滤过率的影响则不太明确。在强化治疗组的ACCORD研究中观察到的死亡率过高问题，在其他研究中并未提及。死亡率的降低与强化血糖控制无关。最终需要强化多因素干预来改善微血管病变。
