Vinik A I, Richardson D W
Department of Internal Medicine, Eastern Virginia Medical School, Norfolk 23510, USA.
South Med J. 1997 Mar;90(3):268-82. doi: 10.1097/00007611-199703000-00001.
The Diabetes Control and Complications Trial has conclusively established that intensive control of insulin-dependent diabetes mellitus in persons aged 19 to 26 years (almost exclusively white, normotensive, nondyslipidemic, of normal weight, and insulin sensitive) reduces by +/- 50% the likelihood of retinopathy, nephropathy, and neuropathy. In contrast, persons with non-insulin-dependent diabetes mellitus (NIDDM) are older, overweight, hypertensive, dyslipidemic, and insulin resistant. Glycemia is only one of their risk factors, and they die of macrovascular disease. Review of studies supporting glycemic control versus risk factor reduction as management of NIDDM suggests a clear need to address risk factors besides glycemic control for successful prevention of complications of NIDDM. A new schematic proposal for intervention based upon risk factor reduction is presented.
糖尿病控制与并发症试验已确凿地证实，对19至26岁的胰岛素依赖型糖尿病患者（几乎全为白人，血压正常、血脂正常、体重正常且胰岛素敏感）进行强化控制，可使视网膜病变、肾病和神经病变的发生几率降低约50%。相比之下，非胰岛素依赖型糖尿病（NIDDM）患者年龄较大、超重、高血压、血脂异常且胰岛素抵抗。血糖只是他们的风险因素之一，他们死于大血管疾病。对支持将血糖控制与降低风险因素作为NIDDM管理方法的研究进行综述表明，除血糖控制外，明确需要解决其他风险因素，以成功预防NIDDM的并发症。本文提出了一项基于降低风险因素的新干预方案示意图。
