Klein R, Klein B E, Moss S E
University of Wisconsin Medical School, Madison, USA.
Ann Intern Med. 1996 Jan 1;124(1 Pt 2):90-6. doi: 10.7326/0003-4819-124-1_part_2-199601011-00003.
To describe the relation between glycated hemoglobin and the incidence or progression, or both, of diabetic microvascular complications in persons with insulin-dependent (IDDM) and non-insulin-dependent diabetes mellitus (NIDDM).
Population-based on cohort study.
An 11-county area in southern Wisconsin.
All persons with IDDM diagnosed before age 30 and taking insulin (n = 996) and a probability sample (based on duration of disease) of persons diagnosed with diabetes at age 30 or older who were either taking insulin (n = 674) or not taking insulin (n = 696) and who participated in a baseline examination from 1980 to 1982. Survivors of the cohort were re-examined again in 1984 to 1986 and 1990 to 1992.
The incidence and progression of diabetic retinopathy was determined by masked grading of stereoscopic color fundus photographs using the modified Early Treatment Diabetic Retinopathy Study severity scale. Gross proteinuria was determined using a dipstick. Ten-year incidence of renal dialysis or transplantation or loss of tactile sensation or of temperature sensitivity was based on self-reported history.
The glycated hemoglobin level at baseline was strongly related to the incidence or progression, or both, of diabetic retinopathy, the incidence of gross proteinuria, and the incidence of loss of tactile sensation or temperature sensitivity in persons with either IDDM or NIDDM.
These prospective epidemiologic data suggest that glycemic control is similarly related to the incidence and progression of diabetic microvascular complications in both IDDM and NIDDM. However, further evidence from clinical trials in persons with NIDDM is necessary to assess the risks and benefits of such treatment in preventing these complications.
描述糖化血红蛋白与胰岛素依赖型糖尿病（IDDM）和非胰岛素依赖型糖尿病（NIDDM）患者糖尿病微血管并发症的发生、进展或两者之间的关系。
基于人群的队列研究。
威斯康星州南部的一个11县地区。
所有30岁前诊断为IDDM且正在接受胰岛素治疗的患者（n = 996），以及一个按疾病持续时间抽样的样本，这些患者年龄在30岁及以上，诊断为糖尿病，要么正在接受胰岛素治疗（n = 674），要么未接受胰岛素治疗（n = 696），并于1980年至1982年参加了基线检查。该队列的幸存者在1984年至1986年以及1990年至1992年再次接受检查。
糖尿病视网膜病变的发生和进展通过使用改良的早期糖尿病视网膜病变研究严重程度量表对立体彩色眼底照片进行盲法分级来确定。使用试纸条测定大量蛋白尿。肾透析或移植、触觉丧失或温度敏感性丧失的10年发生率基于自我报告的病史。
IDDM或NIDDM患者基线时的糖化血红蛋白水平与糖尿病视网膜病变的发生、进展或两者均密切相关，与大量蛋白尿的发生率以及触觉丧失或温度敏感性丧失的发生率密切相关。
这些前瞻性流行病学数据表明，血糖控制与IDDM和NIDDM患者糖尿病微血管并发症的发生和进展同样相关。然而，需要来自NIDDM患者临床试验的进一步证据来评估这种治疗在预防这些并发症方面的风险和益处。
