强化血糖控制对2型糖尿病治疗作用的系统评价_《中国循证医学杂志》

作者：

王倩 ,  韩萍

中国医科大学附属盛京医院内分泌科（沈阳 110004）;

关键词：

2型糖尿病强化血糖控制系统评价

DOI：

10.7507/1672-2531.20090135

视频：

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摘要 全文 图表 视频 参考文献 施引文献 补充材料

目的　系统评价强化血糖控制对2型糖尿病的疗效及安全性。
方法　电子检索数据库MEDLINE、EMBASE、Cochrane图书馆、维普数据库、中国期刊全文数据库、中国生物医学文献数据库、万方数据库等，文献检索起至时间均从建库至2009年6月。检索纳入文献的参考文献，纳入强化血糖控制研究2型糖尿病患者大血管或微血管并发症的所有随机对照试验，评价纳入研究方法学质量，并提取有效数据，用RevMan 5.0软件进行Meta分析。
结果　共纳入8个随机对照试验，37 004例2型糖尿病患者。Meta分析结果显示：强化血糖控制可使心血管事件发生率降低9%［OR= 0.91，95%CI（0.85，0.98），P= 0.007］；使微血管事件发生率降低26%［OR= 0.74，95%CI（0.60，0.91），P= 0.005］；对周围血管事件，两组结果差异无统计学意义［OR= 0.94，95%CI（0.83，1.07），P= 0.35］。在所有原因导致的死亡［OR=1.00，95%CI（0.92，1.08），P= 0.98］及心血管事件导致的死亡［OR= 1.03，95%CI（0.83，1.28），P= 0.77］中，两组结果差异均无统计学意义。强化血糖控制能使低血糖事件发生率增加超过1.1倍［OR= 2.12，95%CI（1.24，3.60），P= 0.006］。
结论　强化血糖控制较标准治疗能显著降低心血管，及微血管事件发生的危险性，但会增加低血糖事件发生的危险性。在死亡事件方面，两者并无明显差异。

引用本文： 王倩,韩萍. 强化血糖控制对2型糖尿病治疗作用的系统评价. 中国循证医学杂志, 2009, 09(7): 774-782. doi: 10.7507/1672-2531.20090135 复制

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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.
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.
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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.

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强化血糖控制对2型糖尿病治疗作用的系统评价

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《中国循证医学杂志》

强化血糖控制对2型糖尿病治疗作用的系统评价

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