Ikeda Masayuki, Shimazawa Rumiko
Department of Medical Informatics Kagawa University Hospital Kagawa Japan.
Department of Clinical Pharmacology Tokai University School of Medicine Kanagawa Japan.
J Gen Fam Med. 2019 Apr 4;20(4):129-138. doi: 10.1002/jgf2.244. eCollection 2019 Jul.
Glycated hemoglobin (HbA1c) is widely accepted as the most reliable measure of long-term glycemia. However, there is disagreement among professional medical societies on a proper glycemic target for long-term benefits in type 2 diabetes (T2D). The use of some glucose-lowering drugs was associated with heart failure despite substantial lowering of HbA1c. The failure of intensive glycemic control to reduce cardiovascular risk in some trials again brought into question the usefulness of HbA1c as a therapeutic target in T2D. In large cardiovascular outcome trials, some newer glucose-lowering drugs were associated with higher risks of heart failure or amputation despite comparable glycemic control between the test and placebo groups. Here, we provide evidence that variation in hemoglobin glycation between individuals is responsible for these inconsistencies. We suggest that further research be conducted in this area and that the findings be applied to clinical trials and practice.
糖化血红蛋白（HbA1c）被广泛认为是长期血糖水平最可靠的指标。然而，专业医学协会对于2型糖尿病（T2D）长期获益的合适血糖目标存在分歧。尽管HbA1c大幅降低，但使用某些降糖药物与心力衰竭有关。在一些试验中，强化血糖控制未能降低心血管风险，这再次让人质疑HbA1c作为T2D治疗靶点的有效性。在大型心血管结局试验中，尽管试验组和安慰剂组的血糖控制相当，但一些新型降糖药物与更高的心力衰竭或截肢风险有关。在此，我们提供证据表明个体间血红蛋白糖化的差异是这些不一致情况的原因。我们建议在该领域开展进一步研究，并将研究结果应用于临床试验和实践。
