Young C W
Am J Med. 1985 Sep 20;79(3B):8-11. doi: 10.1016/s0002-9343(85)80002-4.
Whether long-term glycemic control will prevent the chronic vascular complications of diabetes mellitus remains unknown. Microangiopathy and accelerated macroangiopathy are prevalent in both type I, or insulin-dependent diabetes mellitus, and type II, or non-insulin-dependent diabetes mellitus. Microangiopathy is predominantly responsible for the excessive morbidity and mortality in type I diabetic patients, whereas accelerated macroangiopathy directly relates to the excessive morbidity and mortality in type II diabetic patients. Institution of euglycemia for short periods will reverse preclinical, functional, renal, and retinal abnormalities, but will not reverse clinical nephropathy and retinopathy. Intensive insulin therapy, although it increases the risk of hypoglycemic encephalopathy, seems rational for type I diabetic patients without vascular complications who can recognize and respond normally to hypoglycemia. In patients with type II diabetes, sulfonylurea therapy, which is associated with fewer adverse reactions than intensive insulin therapy, may lower the risk of atherosclerosis development by correcting hyperglycemia and associated lipid abnormalities.
长期血糖控制是否能预防糖尿病的慢性血管并发症仍不清楚。微血管病变和加速的大血管病变在I型（胰岛素依赖型糖尿病）和II型（非胰岛素依赖型糖尿病）糖尿病中都很常见。微血管病变是I型糖尿病患者过高发病率和死亡率的主要原因，而加速的大血管病变则直接关系到II型糖尿病患者过高的发病率和死亡率。短期内实现血糖正常可逆转临床前期、功能性、肾脏和视网膜异常，但不能逆转临床肾病和视网膜病变。强化胰岛素治疗虽然会增加低血糖性脑病的风险，但对于没有血管并发症且能正常识别和应对低血糖的I型糖尿病患者来说似乎是合理的。在II型糖尿病患者中，与强化胰岛素治疗相比不良反应较少的磺脲类药物治疗，可能通过纠正高血糖和相关的脂质异常来降低动脉粥样硬化发展的风险。
