由于糖尿病可增加患心血管病之风险，故有主张对２型糖尿病患者实施强化降糖疗法（Intensive glucose-lowering treatment for people with type 2 diabetes）。所谓的强化降糖疗法是指采取综合措施将2型糖尿病患者的糖化血红蛋白水平降低至6.0%以下；相反，标准疗法仅将患者的糖化血经蛋白水平降低至7.0%～7.9%（intensive therapy (targeting a glycated hemoglobin level below 6.0%) or standard therapy (targeting a level from 7.0 to 7.9%)。近年来，尽管该项疗法之安全性与有效性尚未被充分证实，但在临床上似已广泛应用。最近，法国学者基于他们的研究结果指出“强化降糖疗法不仅不能够降低２型糖尿病患者因心血管疾病导致死亡之风险，并且更易诱发严重的低血糖反应（dangerously low blood glucose levels or severe hypoglycemia）”。据此，法国学者建议临床医生们慎用“强化降糖疗法”。更多资讯，请阅读原文和新英格兰医学杂志曾经发表的文章（见：http://www.nejm.org/doi/full/10.1056/NEJMoa0802743 ）。

Caution Urged in Intensive Treatment of Type 2 Diabetes

Such therapy may double the risk of dangerously low blood glucose levels, study finds

WEDNESDAY, July 27 (HealthDay News) -- Intensive glucose-lowering treatment for people with type 2 diabetes doesn't reduce the risk of cardiovascular-related death and doctors need to be cautious about prescribing this type of treatment, a new study suggests.

Patients with type 2 diabetes are at increased risk for cardiovascular disease. Intensive glucose-lowering treatment is widely used for these patients even though previous research hasn't shown any clear benefits, the researchers pointed out in a report published in the July 27 online edition of the BMJ.

In the new study, Catherine Cornu, a research physician at the Clinical Investigation Centre, Louis Pradel Hospital in Bron, France, and colleagues reviewed 13 studies that included a total of 34,533 diabetes patients -- 18,315 who underwent intensive glucose-lowering treatment and 16,218 who received standard treatment.

Intensive treatment did not significantly reduce cardiovascular death or all-cause death, but it was associated with a 15 percent reduced risk of non-fatal heart attacks and a 10 percent reduced risk of microalbuminuria, an indicator of kidney problems and heart disease, the researchers found.

But, intensive treatment was also linked with a more than twofold increase in the risk of dangerously low blood glucose levels (severe hypoglycemia), the investigators noted in a journal news release.

Over a five-year treatment period, 117 to 150 patients would need to undergo intensive glucose-lowering treatment to prevent one heart attack, 32 to 142 patients would have to be treated to prevent one case of microalbuminuria, and 15 to 52 would need to be treated to avoid one severe hypoglycemic event, the researchers calculated.

"Intensive glucose-lowering treatment of type 2 diabetes should be considered with caution and therapeutic escalation should be limited," the authors concluded.

SOURCE: BMJ, news release, July 26, 2011