Diabetes Care:糖尿病标准治疗时,低血糖可影响动脉粥样硬化进展

2016-02-22 fsy 译 MedSci原创

该研究的目的是在一项退伍军人糖尿病试验(VADT)中确定严重低血糖和动脉粥样硬化进展之间是否存在联系,并检查VADT期间血糖控制是否可以改善严重的低血糖和冠状动脉钙化(CAC)的进展之间的关联。严重低血糖被定义为意识丧失或需要帮助或记录的血糖<50 mg/dL的严重发作。CAC的进展是在197例参与者中开展的,基线和随访时通过计算机断层扫描进行确定的。在扫描之间平均4.5年的随访过程中,97

该研究的目的是在一项退伍军人糖尿病试验(VADT)中确定严重低血糖和动脉粥样硬化进展之间是否存在联系,并检查VADT期间血糖控制是否可以改善严重的低血糖和冠状动脉钙化(CAC)的进展之间的关联。

严重低血糖被定义为意识丧失或需要帮助或记录的血糖<50 mg/dL的严重发作。CAC的进展是在197例参与者中开展的,基线和随访时通过计算机断层扫描进行确定的。

在扫描之间平均4.5年的随访过程中,97名参与者报告有严重的低血糖(n=23)或葡萄糖<50mg/dL(n=74)。严重低血糖在强化治疗组中比标准治疗组更频繁地发生(74% vs 21%,P<0.01);在整个队列中严重的低血糖与CAC的进展无关,但严重的低血糖和治疗之间的相互作用是显著的(P <0.01)。标准治疗组中严重低血糖的参与者,但不包括强化治疗组中的参与者,约50%参与者的CAC比没有严重的低血糖的患者进展更大(平均11.15 vs 5.4 mm3,P=0.02)。调整所有基线差异,包括CAC,或在试验过程中不同的风险因素的时间变化后,并没有改变结果。通过试验过程中糖化血红蛋白水平检查的严重低血糖的影响(截止7.5%),也得到了类似的结果。此外,剂量反应关系只有在标准治疗组中的严重低血糖和CAC进展之间才观察到。

尽管在强化治疗组中严重低血糖的频率较高,但只有在标准治疗组中严重低血糖才和CAC的进展相关。

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