[WCIR2009]D.McGuire教授访谈:2型糖尿病,低血糖与心血管风险
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专家访谈 心脑血管 综合领域 作者未知 来源:未知 2009/12/1 18:06:00    加入收藏
内容概要:那是来自瑞典的一项小研究,但是已经有许多研究认为不是那么高的患病率。但是有一个类似的数字,急性冠状动脉综合症的患者有达到50%的患者将会合并有糖尿病,那些患者有一半以上是以前未做糖尿病诊断的。因此他们糖尿病的并发症实际上是急性心肌梗死,而他们的糖尿病是后诊断的......

   International Diabetes :  Since hypoglyecmia is much more dangerous in patients with CBD.  Do you have any advice for clinical practitioners for alternate treatment strategies to control blood glucose in those patients?

《国际糖尿病》:由于低血糖在CBD患者中是非常危险的,那么你对临床医生在选择控制那些患者血糖的方法上有哪些建议呢?

    Dr McGuire:  Yeah it is a very complicated question and a very timely question.  Certainly hypoglycemia is at best a nuisance to the patient and at worst can precipitate cardiovascular events or even in patients with cardiovascular events worsen prognosis in that setting so avoidance of hypoglycemia, especially in patients with cardiovascular events it appears to be increasingly important.  There are a number of therapies available. In the old days when we just had insulin and sulfonylureas it was a little bit of a dangerous game but we have a lot of hypoglycemic agents and glucose lowering agents now that do not have associated hyperglycemia and probably those drugs individually and in combination may be preferable in this case.  And second thing I want to say is probably reasonable based on the accumulated data to set glucose targets slightly less aggressively in those patients with cardiovascular disease or at an increased cardiovascular risk.  So the young people with diabetes without cardiovascular disease the data seems to support a more intensive glycemia control but once cardiovascular disease has manifest I think those in the field are tending towards slightly less aggressive targets in part to prevent the hypoglycemia.  

McGuire教授:这是一个非常复杂而有很及时的问题。低血糖对患者来说最好的情况就是它比较麻烦,但最坏的是能够导致心血管疾病的突然发生,或者是对已有心血管疾病的患者会加重疾病进展。因此避免低血糖,尤其是对已患有心血管疾病的患者越来越重要。有很多方法可以利用。在我们只有胰岛素和磺脲类药物的时候这是有点危险。现在我们有很多的降糖药和口服降糖药,不会有高血糖出现,或许这些药物单独或者联合应用是较好的。第二件我要说的事情是,根据积累的数据对有心血管疾病的患者或者有逐渐增高的心血管疾病发生危险的患者,要合理的轻微的降糖而不要过强的降糖。因此说,对于年轻的未患有心血管疾病的糖尿病,这项数据似乎支持强烈的控制血糖。但是一旦出现心血管疾病,我认为降糖就要轻微以防止低血糖的发生。
 



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网站用户: 王仁友 时间:2010/3/1 15:31:16
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