血糖控制面临着前所未有的挑战——解读2008年美国糖尿病协会年会有关降糖药物的报道

It is more challenging today than it has ever been in the past for glucose control

第68届美国糖尿病协会（ADA）年会上报道了一些药物临床试验结果。ADVANCE研究发现，强化血糖控制可以减少糖尿病肾病，使平均糖化血红蛋白降至6．5％，可以减少微血管并发症风险，但心肌梗死和卒中风险并未减少。VADT提示强化血糖控制对心血管风险没有影响。新的二肽基肽酶（DDP）-4抑制剂对2型糖尿病是安全有效的。安全性研究没有发现甘精胰岛素增加视网膜病变。HEART2D研究没有发现针对餐后血糖的治疗使患者获得心血管方面的益处，餐后血糖和基础血糖控制策略产生的效果相似。吡格列酮可以减少75％以上的糖耐量减低者发生2型糖尿病。

A series of clinical trials was presented at the American Diabetes Association＇s 68th scientific sessions. ADVANCE study found that intensive glucose control reduces diabetic nephropathy. Mean HbAlc of 6.5% was associated with a decreased risk for microvascular complications, but risks for myocar- dial infarction and stroke were unaffected. VA Diabetes Trial showed that intensive glucose control had little effect on cardiovascular risk. New DDP-4 inhibitor shows safety, efficacy in type 2 diabetes. Safety study found that glargine is not associated with retinopathy. HEART2D study produced no cardiovascular benefit by targeting postprandial glucose levels. Prandial and basal glucose control strategies have similar effects. Pioglitazone reduces conversion from impaired glucose tolerance to type 2 diabetes by more than 75%.