Carlsen S M
Medisinsk avdeling, Regionsykehuset i Trondheim.
Tidsskr Nor Laegeforen. 1995 Aug 10;115(18):2271-5.
Cardiovascular disease is frequent and is the main cause of death in type 2-diabetic patients. Hyperinsulinaemia is a risk factor for cardiovascular disease, and insulin accelerates many of the processes leading to atherosclerosis. Studies in type 2-diabetic patients show that high insulin levels correlate with cardiovascular disease and overall mortality. A recent pilot study showed that intensive versus traditional insulin treatment increased the incidence of cardiovascular disease. Therefore treatment regimens that reduce insulin levels should be preferred, at least when equal glucose levels are achieved. In this perspective metformin is the drug of choice. Insulin treatment should be considered only when combined treatment with metformin and sulfonylurea is contraindicated or leads to insufficient blood glucose control. Special caution should be shown with insulin treatment in patients with cardiovascular disease.
心血管疾病在2型糖尿病患者中很常见，且是其主要死因。高胰岛素血症是心血管疾病的一个危险因素，胰岛素会加速许多导致动脉粥样硬化的过程。对2型糖尿病患者的研究表明，高胰岛素水平与心血管疾病及总体死亡率相关。最近一项试点研究显示，强化胰岛素治疗与传统胰岛素治疗相比，会增加心血管疾病的发病率。因此，至少在达到同等血糖水平时，应优先选择降低胰岛素水平的治疗方案。从这个角度来看，二甲双胍是首选药物。只有在二甲双胍和磺脲类药物联合治疗禁忌或导致血糖控制不充分时，才应考虑胰岛素治疗。对于心血管疾病患者，胰岛素治疗应格外谨慎。
