Fava Stephen
Diabetes & Endocrine Centre, Mater Dei Hospital, Msida MSD2090, Malta.
Curr Diabetes Rev. 2014 Mar;10(2):124-30. doi: 10.2174/1573399810666140421124051.
The prevalence of diabetes is increasing world-wide. Tight glycaemic control has been shown to reduce diabetes complications in a number of landmark trials. Apart from increasing the risk of microvascular and macrovascular disease, poor glycaemic control is also associated with cognitive and memory impairment as well as with mood disturbance. However, tighter glycaemic control with conventional anti-hyperglycaemic medication is also associated with increased risk of hypoglycaemia. There is increasing evidence that hypoglycaemia is much more than a troublesome inconvenience. Indeed it is associated with acute cognitive impairment, dementia, increased risk of falls, rebound hyperglycaemia with consequent loss of glycaemic control, acute coronary syndrome and increased mortality. Hence, a very difficult balance needs to be achieved so as to achieve the best glycaemic control possible, whilst avoiding hypoglycaemia. This paper will briefly discuss the potential benefits of tight glycemic control and reviews the risks associated with hypoglycaemia. A paradigm shift in diabetes care may be needed; use of newer anti-hyperglycemic agents with low hypoglycaemia risk may allow us to achieve good control in most patients whilst avoiding the serious consequences of hypoglycaemia. This may be especially important in those at significant risk of hypoglycaemia (e.g. those with brittle diabetes) or of its consequences such as elderly patients, those in certain occupations or those with cardiovascular disease or epilepsy.
糖尿病在全球的患病率正在上升。在一些具有里程碑意义的试验中，严格的血糖控制已被证明可减少糖尿病并发症。除了增加微血管和大血管疾病的风险外，血糖控制不佳还与认知和记忆障碍以及情绪紊乱有关。然而，使用传统降糖药物进行更严格的血糖控制也会增加低血糖风险。越来越多的证据表明，低血糖远不止是一个令人烦恼的不便之处。事实上，它与急性认知障碍、痴呆、跌倒风险增加、导致血糖控制丧失的血糖反跳性升高、急性冠状动脉综合征及死亡率增加有关。因此，需要在实现尽可能最佳的血糖控制与避免低血糖之间达成非常困难的平衡。本文将简要讨论严格血糖控制的潜在益处，并回顾与低血糖相关的风险。糖尿病护理可能需要范式转变；使用低血糖风险低的新型降糖药物可能使我们在大多数患者中实现良好控制，同时避免低血糖的严重后果。这对于那些有显著低血糖风险（如脆性糖尿病患者）或有低血糖后果风险的人群（如老年患者、某些职业人群或患有心血管疾病或癫痫的患者）可能尤为重要。
