Savage S, Estacio R O, Jeffers B, Schrier R W
Division of Renal Diseases and Hypertension, Denver Health Medical Center, University of Colorado Health Sciences Center, USA.
Proc Assoc Am Physicians. 1997 Mar;109(2):181-9.
A cross-sectional population study was performed in a cohort of 890 non-insulin-dependent diabetes mellitus (NIDDM) patients residing in the greater Denver metropolitan region. Its purpose was to evaluate the relationship between insulin and oral hypoglycemic agents (OHAs) with regard to metabolic control and diabetic complications. The mean glycosylated hemoglobin for patients treated with insulin was 12.0 +/- 0.15% versus 11.4 +/- 0.14% (p < .03) for OHA. The difference in fasting blood sugar for the insulin-treated group (195.0 +/- 3.5 mg/dl) versus the OHA-treated group (194.0 +/- 2.9 mg/dl) was not statistically significant. Categorical increases in urinary albumin excretion were associated positively within insulin versus OHA therapy (p < .0001). Patients treated with insulin therapy had a higher frequency of peripheral vascular disease (insulin therapy, 14%; OHA therapy, 10%; p < .05); neuropathy (insulin therapy, 55%; OHA therapy, 37%; p < .0001); and retinopathy (insulin therapy, 71%; OHA therapy, 45%; p < .0001). The frequency of cardiovascular disease was equivalent in the two groups (17% versus 13%). In protocols correcting for diabetes duration, glycosylated hemoglobin, and gender in a multivariate model, the use of insulin still was related significantly to increases in urinary albumin excretion (p < .01), retinopathy (p < .0001), and neuropathy (p < .0008). In a subgroup of individuals with diabetes duration > 10 years (n = 211 for insulin treatment, n = 118 for OHA treatment), the frequency of neuropathy still was significantly higher in the insulin group (63% vs 49%; p < .016) as was retinopathy (85% vs 58%; p < .0001). Overt albuminuria also was more significant in the insulin-treated patients (p < .04). In summary, the NIDDM patients treated with insulin had more nephropathy, retinopathy, and neuropathy than did NIDDM patients treated with OHA, independent of duration of diabetes, fasting blood glucose, glycosylated hemoglobin, age, and blood pressure level. These results in NIDDM patients may be due to contributions from worse blood glucose control at an earlier stage in the patients' diabetes and/or the mitogenic, atherogenic, thrombogenic, and vascular permeability effects of insulin.
对居住在丹佛大都会区的890名非胰岛素依赖型糖尿病（NIDDM）患者进行了一项横断面人群研究。其目的是评估胰岛素和口服降糖药（OHA）在代谢控制和糖尿病并发症方面的关系。接受胰岛素治疗的患者糖化血红蛋白平均为12.0±0.15%，而接受OHA治疗的患者为11.4±0.14%（p<0.03）。胰岛素治疗组（195.0±3.5mg/dl）与OHA治疗组（194.0±2.9mg/dl）的空腹血糖差异无统计学意义。胰岛素治疗与OHA治疗相比，尿白蛋白排泄的分类增加呈正相关（p<0.0001）。接受胰岛素治疗的患者外周血管疾病发生率更高（胰岛素治疗组为14%；OHA治疗组为10%；p<0.05）；神经病变发生率更高（胰岛素治疗组为55%；OHA治疗组为37%；p<0.0001）；视网膜病变发生率更高（胰岛素治疗组为71%；OHA治疗组为45%；p<0.0001）。两组心血管疾病发生率相当（分别为17%和13%）。在多变量模型中对糖尿病病程、糖化血红蛋白和性别进行校正的方案中，胰岛素的使用仍与尿白蛋白排泄增加（p<0.01）、视网膜病变（p<0.0001）和神经病变（p<0.0008）显著相关。在糖尿病病程>10年的亚组中（胰岛素治疗组n=211，OHA治疗组n=118），胰岛素组神经病变发生率（63%对49%；p<0.016）和视网膜病变发生率（85%对58%；p<0.0001）仍显著更高。胰岛素治疗的患者显性蛋白尿也更显著（p<0.04）。总之，与接受OHA治疗的NIDDM患者相比，接受胰岛素治疗的NIDDM患者有更多的肾病、视网膜病变和神经病变，这与糖尿病病程、空腹血糖、糖化血红蛋白、年龄和血压水平无关。NIDDM患者的这些结果可能是由于患者糖尿病早期血糖控制较差和/或胰岛素的促有丝分裂、致动脉粥样硬化、致血栓形成及血管通透性作用所致。
