強化血糖控制對2型糖尿病治療作用的系統評價_《中國循證醫學雜志》

作者：

王倩 ,  韓萍

中國醫科大學附屬盛京醫院內分泌科（沈陽?110004）;

關鍵詞：

2型糖尿病強化血糖控制系統評價

DOI：

10.7507/1672-2531.20090135

視頻：

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目的　系統評價強化血糖控制對2型糖尿病的療效及安全性。
方法　電子檢索數據庫MEDLINE、EMBASE、Cochrane圖書館、維普數據庫、中國期刊全文數據庫、中國生物醫學文獻數據庫、萬方數據庫等，文獻檢索起至時間均從建庫至2009年6月。檢索納入文獻的參考文獻，納入強化血糖控制研究2型糖尿病患者大血管或微血管并發癥的所有隨機對照試驗，評價納入研究方法學質量，并提取有效數據，用RevMan 5.0軟件進行Meta分析。
結果　共納入8個隨機對照試驗，37 004例2型糖尿病患者。Meta分析結果顯示：強化血糖控制可使心血管事件發生率降低9%［OR= 0.91，95%CI（0.85，0.98），P= 0.007］；使微血管事件發生率降低26%［OR= 0.74，95%CI（0.60，0.91），P= 0.005］；對周圍血管事件，兩組結果差異無統計學意義［OR= 0.94，95%CI（0.83，1.07），P= 0.35］。在所有原因導致的死亡［OR=1.00，95%CI（0.92，1.08），P= 0.98］及心血管事件導致的死亡［OR= 1.03，95%CI（0.83，1.28），P= 0.77］中，兩組結果差異均無統計學意義。強化血糖控制能使低血糖事件發生率增加超過1.1倍［OR= 2.12，95%CI（1.24，3.60），P= 0.006］。
結論　強化血糖控制較標準治療能顯著降低心血管，及微血管事件發生的危險性，但會增加低血糖事件發生的危險性。在死亡事件方面，兩者并無明顯差異。

引用本文： 王倩,韓萍. 強化血糖控制對2型糖尿病治療作用的系統評價. 中國循證醫學雜志, 2009, 09(7): 774-782. doi: 10.7507/1672-2531.20090135 復制

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16.	The Diabetes Control and Complications Trial Research Group. The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus. N Engl J Med, 1993, 329: 977-986.
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18.	Holman RR, Paul SK, Bethel MA, et al. 10-year follow-up of intensive glucose control in type 2 diabetes. N Engl J Med, 2008, 359(15): 1577-1589.
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1. American diabetes association. Standards of Medical Care in Diabetes-2009. Diabetes Care, 2009, 32(suppl1): s13-s61.
2. Alberti KG, Zimmet PZ. Definition, diagnosis and classification of diabetes mellitus and its complications. Part 1: diagnosis and classification of diabetes mellitus provisional report of a WHO consultation. Diabet Med, 1998, 15(7): 539-553.
3. American Diabetes Association. Standards of medical care in diabetes--2007. Diabetes Care, 2007, 30(Suppl 1): S4-S41.
4. Jadad AR, Moore RA, Carroll D, et al. Assessing the quality of reports of randomized clinical trials: is blinding necessary? Control Clin Trials, 1996, 17: 1-12.
5. Higgins JP, Thompson SG. Quantifying heterogeneity in a meta-analysis. Stat Med, 2002, 21: 1539-1558.
6. Higgins JP, Thompson SG, Deeks JJ, et al. Measuring inconsistency in meta-analyses. BMJ, 2003, 327: 557-560.
7. Egger M, Altman DG, Smith GD. Systematic reviews in health-care: meta-analysis in context. 2nd edn. BMJ Books, Wiley: London, 2001.
8. Duckworth W, Abraira C, Moritz T, et al. Glucose control and vascular complications in veterans with type 2 diabetes. N Engl J Med, 2009, 360(2): 129-139.
9. Action to Control Cardiovascular Risk in Diabetes Study Group. Effects of intensive glucose lowering in type 2 diabetes. N Engl J Med, 2008, 358(24):2545-2559.
10. ADVANCE Collaborative Group. Intensive blood glucose control and vascular outcomes in patients with type 2 diabetes. N Engl J Med, 2008, 358(24):2560-2572.
11. Home PD, Pocock SJ, Beck-Nielsen H, et al. Rosiglitazone evaluated for cardiovascular outcomes--an interim analysis. N Engl J Med, 2007, 357(1): 28-38.
12. Dormandy JA, Charbonnel B, Eckland DJ, et al. Secondary prevention of macrovascular events in patients with type 2 diabetes in the PROactive Study (PROspective pioglitAzone Clinical Trial In macroVascular Events): a randomised controlled trial. Lancet, 2005, 366(9493): 1279-1289.
13. Gaede P, Vedel P, Larsen N, et al. Multifactorial intervention and cardiovascular disease in patients with type 2 diabetes. N Engl J Med, 2003, 348(5): 383-393.
14. Shichiri M, Kishikawa H, Ohkubo Y, et al. Long-term results of the Kumamoto Study on optimal diabetes control in type 2 diabetic patients. Diabetes Care, 2000, 23 Suppl 2: B21-B29.
15. UK Prospective Diabetes Study (UKPDS) Group. Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33). Lancet, 1998, 352: 837-853.
16. The Diabetes Control and Complications Trial Research Group. The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus. N Engl J Med, 1993, 329: 977-986.
17. Stratton IM, Adler AI, Neil HA, et al. Association of glycaemia with macrovascular and microvascular complications of type 2 diabetes (UKPDS 35): prospective observational study. Br Med J, 2000, 321: 405-412.
18. Holman RR, Paul SK, Bethel MA, et al. 10-year follow-up of intensive glucose control in type 2 diabetes. N Engl J Med, 2008, 359(15): 1577-1589.
19. Nathan DM, Cleary PA, Backlund JY, et al. Intensive diabetes treatment and cardiovascular disease in patients with type 1 diabetes. N Engl J Med, 2005, 22:2643-53.
20. Skyler JS, Bergenstal R, Bonow RO, et al. Intensive glycemic control and the prevention of cardiovascular events: implications of the ACCORD, ADVANCE, and VA diabetes trials: a position statement of the American Diabetes Association and a scientific statement of the American College of Cardiology Foundation and the American Heart Association. Diabetes Care, 2009, 32(1): 187-192.

《中國循證醫學雜志》

強化血糖控制對2型糖尿病治療作用的系統評價

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《中國循證醫學雜志》

強化血糖控制對2型糖尿病治療作用的系統評價

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