Ishibashi Clinic, Hiroshima, Japan.
University of Exeter Medical School, Exeter, U.K.
Diabetes Care. 2019 Jan;42(1):110-118. doi: 10.2337/dc18-1560. Epub 2018 Nov 19.
To investigate the impact of normalizing HbA by extensive HbA control (EHC) on neuropathy outcome measures (NOMs), nephropathy, and retinopathy in type 2 diabetes.
Detailed clinical and neurological examinations were performed in two cohorts of 38 patients with uncontrolled type 2 diabetes (HbA 9.6% [81.4 mmol/mol]) at baseline and after glycemic control (GC) with or without EHC by diet restriction and hypoglycemic agents over 4 years along with 48 control subjects with normal glucose tolerance (NGT) and 34 subjects with impaired glucose tolerance (IGT) only at baseline. EHC patients, control subjects, and subjects with IGT underwent oral glucose tolerance tests. Glycemic variability (GV) was evaluated by SD and coefficient of variation of monthly measured HbA levels and casual plasma glucose.
In the EHC cohort, HbA levels over 4.3 years and the last 2 years improved to 6.1% (43.2 mmol/mol) and 5.8% (39.9 mmol/mol) with 7.3 kg body wt reduction, and 50% and 28.9% of patients returned to IGT and NGT, respectively, at end point. Baseline neurophysiological and corneal nerve fiber (CNF) measures were impaired in patients. Normalized HbA with EHC improved neurophysiological and CNF measures to be similar for those for IGT, while GC without EHC (mean HbA level 7.0% [53.5 mmol/mol]) improved only vibration perception. The mean normalized HbA levels by EHC determined NOM improvements. The high GV and baseline HbA levels compromised NOMs. Albumin excretion rate significantly decreased, while retinopathy severity and frequency insignificantly worsened on EHC.
Normalizing HbA in type 2 diabetes of short duration improves microvascular complications including neuropathy and nephropathy more effectively than standard GC but not retinopathy.
研究通过广泛糖化血红蛋白控制（EHC）使糖化血红蛋白正常化对 2 型糖尿病神经病变结局指标（NOM）、肾病和视网膜病变的影响。
在两个队列中，对未经控制的 2 型糖尿病（HbA 9.6%[81.4 mmol/mol]）的 38 例患者进行了详细的临床和神经检查，基线时进行了检查，然后在 4 年内通过饮食限制和降糖药物进行了血糖控制（GC），其中包括 EHC，以及 48 例正常糖耐量（NGT）对照者和仅基线时 34 例糖耐量受损（IGT）者。EHC 患者、对照者和 IGT 患者接受了口服葡萄糖耐量试验。通过每月测量的 HbA 水平和随机血糖的标准差和变异系数评估血糖变异性（GV）。
在 EHC 队列中，经过 4.3 年和最后 2 年的治疗，HbA 水平改善至 6.1%（43.2 mmol/mol）和 5.8%（39.9 mmol/mol），体重减轻 7.3kg，分别有 73%和 28.9%的患者恢复到 IGT 和 NGT。基线时神经生理学和角膜神经纤维（CNF）测量结果受损。EHC 使 HbA 正常化改善了神经生理学和 CNF 测量结果，使其与 IGT 相似，而无 EHC 的 GC（平均 HbA 水平为 7.0%[53.5 mmol/mol]）仅改善了振动感觉。EHC 确定的平均正常化 HbA 水平决定了 NOM 的改善。高 GV 和基线 HbA 水平使 NOM 恶化。白蛋白排泄率显著降低，而视网膜病变严重程度和频率在 EHC 上无显著恶化。
在短期 2 型糖尿病中使 HbA 正常化比标准 GC 更有效地改善微血管并发症，包括神经病变和肾病，但对视网膜病变无效。
