Buse John B
Chapel Hill, North Carolina.
Trans Am Clin Climatol Assoc. 2015;126:62-76.
Through the 1990s convincing evidence emerged from studies involving relatively recent onset diabetes that glycemic control achieving glycated hemoglobin A1c levels of approximately 7% was associated with improved microvascular outcomes. Based on advocacy groups' statements encouraging lower targets and recognition of cardiovascular disease as the leading cause of death in diabetes, the Action to Control Cardiovascular Risk in Diabetes (ACCORD) study was funded in 1999 to explore more intensive targets and techniques in the treatment of type 2 diabetes. Most surprisingly, intensive management targeting normal levels of glycemia was associated with increased mortality and the ACCORD trial was terminated early in 2008. Post hoc analyses have allowed the emergence of some clarity around the role of glycemic management and targets in diabetes care and are the subject of this review.
在整个20世纪90年代，涉及相对近期发病糖尿病患者的研究出现了令人信服的证据，即糖化血红蛋白A1c水平达到约7%的血糖控制与改善微血管结局相关。基于倡导组织鼓励更低目标的声明以及认识到心血管疾病是糖尿病患者的主要死因，糖尿病控制心血管风险行动（ACCORD）研究于1999年获得资助，以探索2型糖尿病治疗中更强化的目标和技术。最令人惊讶的是，针对正常血糖水平的强化管理与死亡率增加相关，ACCORD试验于2008年早期提前终止。事后分析使得血糖管理和目标在糖尿病护理中的作用有了一定的明确性，这也是本综述的主题。
