Berger W
Medizinische Universitätsklinik und -Poliklinik Basel.
Klin Monbl Augenheilkd. 1993 May;202(5):437-42. doi: 10.1055/s-2008-1045622.
In several studies a correlation between blood glucose levels and HbA1 (A1c) and the prevalence of retinopathy was documented. Minimal risk for the onset of retinopathy was observed when HbA1 was below 9% from the beginning of diabetes mellitus. This HbA1 (A1c) value corresponds with values above 7 mmol of blood glucose. In intervention trials with near normal values of blood glucose, initially i.e. during the first months of treatment, an increase of microaneurysm was observed. However, in the next 7 years (as was observed in the Oslo Study) the grade of retinopathy in patients was less severe than in patients with HbA1 > 10%. Only 20% of patients treated conventionally can reach the aim of optimal blood glucose regulation. Obviously, in patients with diabetes beginning before the age of 30, this is the reason why the prevalence for the diabetic retinopathy is 40-98% after 15 years of diabetes. Only the functional insulin therapy allows the achievement of optimal blood glucose control in about 40% of patients without increased risk of hypoglycemia. Therefore, this kind of therapy should be the therapy of choice in a great number of type 1 diabetes patients.
多项研究记录了血糖水平与糖化血红蛋白（HbA1，即A1c）之间的相关性以及视网膜病变的患病率。从糖尿病发病开始，当糖化血红蛋白低于9%时，观察到视网膜病变发病的风险最小。该糖化血红蛋白（A1c）值对应于血糖高于7 mmol的情况。在血糖接近正常水平的干预试验中，最初即在治疗的头几个月，观察到微动脉瘤有所增加。然而，在接下来的7年里（如奥斯陆研究中所观察到的），患者的视网膜病变程度比糖化血红蛋白>10%的患者要轻。接受传统治疗的患者中只有20%能够达到最佳血糖调节目标。显然，对于30岁之前发病的糖尿病患者，这就是糖尿病病程15年后糖尿病视网膜病变患病率为40 - 98%的原因。只有功能性胰岛素治疗能使约40%的患者实现最佳血糖控制，且低血糖风险不会增加。因此，这种治疗方法应成为大量1型糖尿病患者的首选治疗方法。
