[EASD2008]血糖控制：多强合适？

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[EASD2008]血糖控制：多强合适？
自大学组糖尿病大纲(UGDP)1970年发布后，许多前瞻性临床试验、观察性研究以及数据库分析一直在探寻2型糖尿病中高血糖和并发症的复杂联系。证据表明多数微血管及大血管病变的减少是通过血糖长期良好的控制，直至血糖浓度接近正常范围来实现的。但是血糖控制的水平与正常血糖间应多接近才是理想的、可行的并且是操作安全的？从许多区别细微的研究中，我们应提炼出哪些信息从而能使血糖控制目标适当地“个体化”？

    我们将特别关注近期的一些临床试验结果，包括：ADVANCE、ACCORD以及VADT，特别是ACCORD试验中与强化血糖控制相关的死亡率增加。前述内容将包括避免低血糖事件和相关的致死性心肌梗塞，兼顾血糖控制与减少心血管风险综合措施的最佳方法以及调整治疗应对疾病病理生理学进展的时机。对上述临床试验的新解读将考虑到长期高血糖后对血糖“靶点”的适应性，治疗调整的速度和方式的效果以及在缺血事件中次正常的血糖对心肌代谢的影响。

    临床试验向我们传达了这样的治疗方针：以疾病为导向采取干预措施，以患者的实际情况予个体化治疗。

（北京协和医院  于淼译，黎明校）

Symposium: Oral antidiabetic agents – recent endpoint trial

Monday， 8 September 2008， 16.30-17.30， da Vinci Hall
Glycaemic control: how intensive?

C. J. Bailey
Aston University， Birmingham， UK

Since the University Group Diabetes Program (UGDP) reported in 1970， many prospective trials， observational studies and database interrogations have examined the complex association between hyperglycaemia and complications in type 2 diabetes.  The evidence attests that reductions in most measures of micro- and macro-vascular disease are achieved with long-term improvements in glycaemic control until blood glucose concentrations approach the normal range.  But how close to normoglycaemia is it desirable， practicable and safe to proceed?  What ***rmation can be distilled from the many subtly different studies that will enable glycaemic targets to be appropriately ‘individualised’?

Particular attention will focus on recent evidence from the Action in Diabetes and Vascular Disease: Preterax and Diamicron Modified Release Controlled Evaluation (ADVANCE) trial， the Action to Control Cardiovascular Risk in Diabetes (ACCORD) trial and the Veterans Affairs Diabetes Trial (VADT)， most notably the increased mortality associated with intensive glycaemic control in ACCORD.    Issues at the fore will include the avoidance of hypoglycaemic episodes and associated fatal myocardial infarctions， ways to optimally integrate glycaemic control within a comprehensive cardiovascular risk reduction strategy， and opportunities for adapting therapy to address the moving pathophysiology of disease progression.  New interpretations of trial outcomes might take account of adaptations to the blood glucose ‘set-point’ after protracted hyperglycaemia， the effect of the speed and the manner of therapeutic re-adjustment， and the impact of sub-normal glycaemia on myocardial metabolism during ischaemic episodes.

Clinical trials ***rm treatment policy: the disease dictates the intervention required， and patient circumstances determine what is individually appropriate.