Diabetes mellitus is a major health problem in the world. Several clinical trials have shown that some of the major complications of diabetes mellitus can be partially prevented or delayed by intensive glycaemic control. However, there are benefits and risks in aiming for near normal blood glucose levels. Intensive glycaemic control delays the onset and progression of retinopathy, nephropathy and neuropathy. Epidemiological and observational studies have shown that cardiovascular events may be correlated with the severity and duration of diabetes mellitus, but major randomised trials have only shown weak and nonsignificant benefits of intensive glycaemic management in decreasing event rates. A modest improvement in lipid profile results from blood glucose control although, in the majority of cases, not enough to reach current targets. Detrimental effects of intensive glycaemic control include bodyweight gain and hypoglycaemia. Controversial issues in the management of patients with diabetes mellitus include the unproven increase in cardiovascular morbidity from sulphonylureas and hyperinsulinaemia, and the still unknown long term effects of newer oral antihyperglycaemic agents alone or in combination with traditional therapies (such as sulphonylureas and metformin). It is important to individualise management in setting glycaemic goals. Control of cardiovascular risk factors through blood pressure and lipid control and treatment with aspirin (acetylsalicylic acid) and ACE inhibitors have consistently shown benefits in the prevention of both macro- and micro vascular complications in patients with diabetes mellitus; these measures deserve priority.
糖尿病是世界上一个主要的健康问题。一些临床试验表明,通过强化血糖控制,可以部分预防或延缓糖尿病的一些主要并发症。然而,以接近正常血糖
水平为目标有利有弊。强化血糖控制可延缓视网膜病变、肾病和神经病变的发生和发展。流行病学和观察性研究表明,心血管事件可能与糖尿病的严重程度和持续时间有关,但主要的随机试验仅显示强化血糖管理在降低事件发生率方面有微弱和不显著的益处。血糖控制可适度改善血脂状况,但在大多数情况下,还不足以达到目前的目标。强化血糖控制的不利影响包括体重增加和低血糖。糖尿病患者管理中的争议问题包括:磺
脲类药物和高
胰岛素血症会增加心血管疾病的发病率,这一点尚未得到证实;新型口服降糖药物单独使用或与传统疗法(如磺
脲类药物和
二甲双胍)联合使用的长期效果尚不清楚。在设定血糖目标时,个性化管理非常重要。通过控制血压和血脂以及使用
阿司匹林(乙酰
水杨酸)和
血管紧张素转换酶
抑制剂来控制心血管风险因素,在预防糖尿病患者的大血管和微血管并发症方面已不断显示出益处;这些措施值得优先考虑。