糖尿病的血糖管理:新旧方法
Glycaemic management in diabetes: old and new approaches.
作者信息
Ceriello Antonio, Prattichizzo Francesco, Phillip Moshe, Hirsch Irl B, Mathieu Chantal, Battelino Tadej
机构信息
IRCCS MultiMedica, Milan, Italy.
IRCCS MultiMedica, Milan, Italy.
出版信息
Lancet Diabetes Endocrinol. 2022 Jan;10(1):75-84. doi: 10.1016/S2213-8587(21)00245-X. Epub 2021 Nov 15.
HbA is the most used parameter to assess glycaemic control. However, evidence suggests that the concept of hyperglycaemia has profoundly changed and that different facets of hyperglycaemia must be considered. A modern approach to glycaemic control should focus not only on reaching and maintaining optimal HbA concentrations as early as possible, but to also do so by reducing postprandial hyperglycaemia, glycaemic variability, and to extend as much as possible the time in range in near-normoglycaemia. These goals should be achieved while avoiding hypoglycaemia, which, should it occur, should be reverted to normoglycaemia. Modern technology, such as intermittently scanned glucose monitoring and continuous glucose monitoring, together with new drug therapies (eg, ultra-fast insulins, SGLT2 inhibitors, and GLP-1 receptor agonists), could help to change the landscape of glycaemia management based on HbA in favour of a more holistic approach that considers all the different aspects of this commonly oversimplified pathophysiological feature of diabetes.
糖化血红蛋白(HbA)是评估血糖控制最常用的指标。然而,有证据表明,高血糖的概念已发生深刻变化,必须考虑高血糖的不同方面。现代血糖控制方法不仅应尽早关注达到并维持最佳糖化血红蛋白(HbA)浓度,还应通过降低餐后高血糖、血糖变异性,并尽可能延长血糖接近正常范围的时间来实现这一目标。这些目标应在避免低血糖的情况下实现,一旦发生低血糖,应恢复至正常血糖水平。现代技术,如间歇扫描式葡萄糖监测和持续葡萄糖监测,以及新的药物疗法(如超短效胰岛素、钠-葡萄糖协同转运蛋白2抑制剂和胰高糖素样肽-1受体激动剂),有助于改变基于糖化血红蛋白(HbA)的血糖管理模式,转向更全面的方法,该方法考虑了糖尿病这一通常被过度简化的病理生理特征的所有不同方面。