Molyneaux L M, Constantino M I, McGill M, Zilkens R, Yue D K
Diabetes Center of Royal Prince Alfred Hospital and Department of Medicine of The University of Sydney, Camperdown, NSW, Australia.
Diabetes Res Clin Pract. 1998 Nov;42(2):77-83. doi: 10.1016/s0168-8227(98)00095-3.
To construct dose response curves relating the development of diabetic complications (retinopathy and microalbuminuria) to mean glycaemic exposure in a cohort of Type 2 patients followed over a period of several years. This allows a comparison with similar data on Type 1 subjects reported by the Diabetes Control and Complications Trial (DCCT) and provides a rational basis for deciding what levels of glycaemic control should be aimed for in advising individual patients and in setting guidelines for conducting health services.
This was an analysis of data prospectively collected in our computerized data base for Type 2 patients who attended and were followed up at the Complications Assessment Service of our Diabetes Center. The initial development of retinopathy and microalbuminuria was analyzed with respect to the mean HbA1c during the follow up period. Statistical procedures identical to those employed in the DCCT were used to construct the dose response curve.
A smooth relationship between the development of retinopathy with increasing hyperglycaemia was found. For every 10% decrease in HbA1c, there was a 24%) (confidence interval (CI): 16-32) reduction in relative risk, about 2/3 of that reported for insulin-dependent diabetes mellitus (IDDM) patients. The relationship between microalbuminuria and HbAc was more linear and less steep with a relative risk reduction of 9% (CI: -2-19%) for any 10% fall in HbA1c, about 1/3 of that reported for IDDM subjects. No threshold of HbA1c can be found for the relative risk of developing complications. However, more cases of complications are prevented by the same degree of improvement in glycaemic control at higher levels of HbA1c.
The development of diabetic retinopathy in Type 2 subjects is also related to the magnitude of hyperglycaemia although the degree of dependence is less than that in Type 1. Glycaemic control has less influence on microalbuminuria in Type 2. In terms of relative risk, no threshold of 'safe HbA1c' can be found but in absolute terms more cases of diabetic complications can be prevented by improving the glycaemic control of the very hyperglycaemic patients.
构建糖尿病并发症（视网膜病变和微量白蛋白尿）的发生与2型患者队列中数年期间平均血糖暴露之间的剂量反应曲线。这使得能够与糖尿病控制与并发症试验（DCCT）报告的1型受试者的类似数据进行比较，并为在为个体患者提供建议以及制定卫生服务指南时确定应追求的血糖控制水平提供合理依据。
这是对前瞻性收集于我们糖尿病中心并发症评估服务部计算机数据库中的2型患者数据的分析。针对随访期间的平均糖化血红蛋白（HbA1c）分析视网膜病变和微量白蛋白尿的初始发生情况。使用与DCCT中所采用的相同统计程序构建剂量反应曲线。
发现视网膜病变的发生与血糖升高之间存在平滑的关系。糖化血红蛋白每降低10%，相对风险降低24%（置信区间（CI）：16 - 32），约为胰岛素依赖型糖尿病（IDDM）患者报告值的2/3。微量白蛋白尿与糖化血红蛋白之间的关系更呈线性且斜率较小，糖化血红蛋白每降低10%，相对风险降低9%（CI： - 2 - 19%），约为IDDM受试者报告值的1/3。未发现并发症发生相对风险的糖化血红蛋白阈值。然而，在较高糖化血红蛋白水平时，相同程度的血糖控制改善可预防更多并发症病例。
2型受试者糖尿病视网膜病变的发生也与高血糖程度相关，尽管依赖程度低于1型。血糖控制对2型患者微量白蛋白尿的影响较小。就相对风险而言，未发现“安全糖化血红蛋白”阈值，但从绝对数量来看，通过改善高血糖患者的血糖控制可预防更多糖尿病并发症病例。
