将糖化血红蛋白控制在7.0%以下是否更安全  

Is It Safer to Increase the Target of A1C from 6.5% to 7.0% in Glycemic Control in Patient with Type 2 Diabetes?

作　　者：王顺钰[1] 苏本利[1] 

机构地区：[1]大连医科大学附属第二医院内分泌科,辽宁大连116027

出　　处：《医学与哲学（B）》2011年第5期10-12,16,共4页Medicine & Philosophy(B)

摘　　要：2008年一项针对2型糖尿病强化血糖控制对心血管病变研究(ACCORD)发现,对于病程在10年左右,30%存在心血管疾病的2型糖尿病人群,利用现有手段努力实现血糖"正常化",即糖化血红蛋白(A1C)<6.0%并没有减少糖尿病全因死亡。人们开始重新思考对2型糖尿病是否还需要强调强化血糖控制、血糖控制的目标多少为宜。中华医学会糖尿病学分会也在今年重新修订了其《中国2型糖尿病防治指南》的A1C控制目标,A1C目标由原来的6.5%提高到7.0%。那么这一改变对2型糖尿病患者来讲到底有多大意义呢?ACCORD强化降糖治疗终止后的随访研究发现强化组患者在血糖控制目标与标准治疗组相似的情况下,全因死亡率并没有随之减少。因此,需要重新检视2型糖尿病防治策略。Two large clinical trials aiming to achieve A1C level of 6.0% failed in decreasing all--cause mortality, while in ACCORD trial showed increased total mortality with intensive glycemic control. One trial with target level of 6.5 % did not decrease all--mortality. Therefore, Chinese Diabetes Society increases its A1C target to 7.0% in its new guideline. In the follow--up observation of the ACCORD trial which transited their patients in intensive glycemie control group to standard control, the researcher did not observe a reverse the previously observed increase in mortality. The results remind us to re- think the already accepted causes and pathogenesis of Type 2 diabetes and its chronic complications. Revolutionary view and methods of combating type 2 diabetes are highly needed.

关 键 词：2型糖尿病 强化治疗 冠心病 死亡率 

分 类 号：R587.1[医药卫生—内分泌]