Monami Matteo, Aleffi Sara
SODc Diabetologia, AOU Careggi.
Monaldi Arch Chest Dis. 2016 Jun 22;84(1-2):726. doi: 10.4081/monaldi.2015.726.
Diabetes mellitus is one of the most important causes of cardiovascular morbidity and mortality; the incidence of chronic complications of diabetes appears to be closely related to the degree of hyperglycaemia. However, results of clinical trials showed that intensive treatment of hyperglycaemia prevents microvascular complications, but has little or no effect on the incidence of cardiovascular events. Different hypoglycaemic drugs show different effects on cardiovascular risk. However, those trials have shown a neutral effect on cardiovascular mortality. This paradoxical result could be explained with the frequent use, in the past, of glucose-lowering agents capable of increasing the risk of hypoglicemia, glycemic variability and weight gain. In conclusion, an adequate glycemic control, in particular in elderly patients, should be achieved, whenever possible, using agents not inducing hypogycemia, glucose fluctuations, and weight gain. In fact, hypoglycaemia and glucose variability should be considered as independent cardiovascular risk factors to a similar extent to hyperglycemia. In this article, the author will review literature supporting the hypothesis that hyperglycemia, hypoglycaemia and glycemic variability are a fatal triad capable of increasing morbidity and mortality in patients with diabetes mellitus.
糖尿病是心血管疾病发病和死亡的最重要原因之一；糖尿病慢性并发症的发生率似乎与高血糖程度密切相关。然而，临床试验结果表明，强化血糖治疗可预防微血管并发症，但对心血管事件的发生率几乎没有影响。不同的降糖药物对心血管风险有不同的影响。然而，这些试验对心血管死亡率显示出中性作用。过去频繁使用能够增加低血糖风险、血糖变异性和体重增加的降糖药物，可以解释这一矛盾的结果。总之，只要有可能，应使用不引起低血糖、血糖波动和体重增加的药物，实现充分的血糖控制，特别是在老年患者中。事实上，低血糖和血糖变异性应被视为与高血糖类似程度的独立心血管危险因素。在本文中，作者将回顾支持以下假设的文献：高血糖、低血糖和血糖变异性是一个致命三联征，能够增加糖尿病患者的发病率和死亡率。
