Fraser D M, Smith A F, Gray R S, Borsey D Q, Sinclair M E, Clarke B F, Duncan L J
Br Med J. 1979 Apr 14;1(6169):979-81. doi: 10.1136/bmj.1.6169.979.
Concentrations of total glycosylated haemoglobins (Hb A1) were measured in 40 diabetics at diagnosis and at monthly intervals after treatment with chlorpropamide, insulin, or diet alone was begun. The mean Hb A1 concentration at presentation in 16 patients treated with chlorpropamide was significantly higher than that in 12 patients treated with insulin, and the duration of glycaemic symptoms was much longer in the chlorpropamide-treated group. In contrast, the mean plasma glucose concentration was similar in both groups. The mean concentrations of Hb A1 and plasma glucose at diagnosis in the 12 patients treated by diet alone were lower than those in the other two groups, and most of these patients were free of symptoms. Treatment quickly relieved symptoms and lowered plasma glucose in all patients. The Hb A1 concentration fell significantly with treatment such that after two months there was no significant difference between the three groups, although results remained above the normal range. These findings support the theory that the Hb A1 concentration reflects the blood glucose control over the previous one to two months and suggest that the duration of hyperglycaemia may be important in determining the Hb A1 concentration as well as the absolute blood glucose concentration.
对40名糖尿病患者在确诊时以及开始使用氯磺丙脲、胰岛素或仅采用饮食疗法治疗后的每月进行一次总糖化血红蛋白（Hb A1）浓度测定。16名接受氯磺丙脲治疗的患者在就诊时的平均Hb A1浓度显著高于12名接受胰岛素治疗的患者，且氯磺丙脲治疗组的血糖症状持续时间长得多。相比之下，两组的平均血浆葡萄糖浓度相似。12名仅接受饮食治疗的患者在确诊时的Hb A1和血浆葡萄糖平均浓度低于其他两组，且这些患者大多无症状。治疗迅速缓解了所有患者的症状并降低了血浆葡萄糖水平。治疗后Hb A1浓度显著下降，以至于两个月后三组之间无显著差异，尽管结果仍高于正常范围。这些发现支持了Hb A1浓度反映前一至两个月血糖控制情况的理论，并表明高血糖持续时间在决定Hb A1浓度以及绝对血糖浓度方面可能很重要。
