Azad Nasrin, Agrawal Lily, Bahn Gideon, Emanuele Nicholas V, Reaven Peter D, Hayward Rodney, Reda Domenic
Endocrinology Section, Edward Hines, Jr. VA Hospital, Hines, IL
Cooperative Studies Program Coordinating Center, Hines, IL.
Diabetes Care. 2021 Jun 29;44(10):2397-402. doi: 10.2337/dc20-2882.
The objective of this study was to assess the long-term role of intensive glycemic control (INT) compared with standard glycemic control in accumulated eye procedures in patients with advanced diabetes.
We compared the effect of treatment assignment on the accumulated number of eye procedures during the intervention period of the Veteran Affairs Diabetes Trial (VADT) (2000-2008) (median follow-up 5.6 years), the interim VADT follow-up study (2000-2013), and the full 17 years of VADT follow-up (2000-2017). We further analyzed data using various cardiovascular markers in two models. Model I included total cholesterol, HDL cholesterol, LDL cholesterol, triglycerides, systolic and diastolic blood pressure, and BMI. Model II included these covariates plus age and diabetic retinopathy (DR) severity score at baseline of the original trial.
The final analysis of the data showed a mild but nonsignificant increase in number of procedures and in retinal or retinal plus cataract surgery during the three periods of the study.
We found no significant benefit of INT during the original trial period in eye-related procedures, such as various procedures for DR, or during the 17 years of follow-up in cataract surgery. However, after adjusting data for some known vascular markers, the increase in the number of eye procedures with INT becomes more prevalent. This finding indicates that INT might not have a protective role in events requiring surgery in individuals with advanced diabetes.
本研究的目的是评估强化血糖控制（INT）与标准血糖控制相比，在晚期糖尿病患者累积眼部手术中的长期作用。
我们比较了治疗分配对退伍军人事务部糖尿病试验（VADT）（2000 - 2008年）（中位随访5.6年）、VADT中期随访研究（2000 - 2013年）以及VADT完整17年随访（2000 - 2017年）期间累积眼部手术数量的影响。我们在两个模型中使用各种心血管标志物进一步分析数据。模型I包括总胆固醇、高密度脂蛋白胆固醇、低密度脂蛋白胆固醇、甘油三酯、收缩压和舒张压以及体重指数。模型II包括这些协变量加上原始试验基线时的年龄和糖尿病视网膜病变（DR）严重程度评分。
数据的最终分析显示，在研究的三个阶段，手术数量以及视网膜或视网膜加白内障手术数量有轻微但不显著的增加。
我们发现在原始试验期间，强化血糖控制在与眼睛相关的手术（如各种糖尿病视网膜病变手术）中没有显著益处，在白内障手术的17年随访中也没有。然而，在对一些已知血管标志物的数据进行调整后，强化血糖控制组眼部手术数量的增加变得更为普遍。这一发现表明，强化血糖控制可能对晚期糖尿病患者需要手术的情况没有保护作用。
