Preventing Diabetes Complications: Are we too Glucocentric?

http://www.medscape.com/viewarticle/726443?src=mp&spon=2&uac=62514FX

https://docs.google.com/fileview?id=0B278nGJMQBk7NzdiOTEzNzItOWY3Ny00OTQxLTg1MGItMjA3Y2U2MTVkNDEw&hl=zh_TW
Abstract

The prevention of macrovascular complications is a major goal of diabetes management. Control of hypertension and hyperlipidemia is a well supported means for preventing macrovascular events in people with and without diabetes. Data from large trials have questioned the macrovascular benefits of aggressive glucose control. Nevertheless, diabetes management has become increasingly focused on achieving tight glycemic control. New research highlights the growing concern that this 'glucocentric' approach may be coming at the expense of controlling other cardiovascular risk factors such as hypertension and hyperlipidemia. Clinicians may need to reprioritise their efforts in diabetes management to better reflect the current evidence base.

UKPDS讓大家在15年前開始，追逐控制血糖的目標，但嚴格控制血糖，只對microvascular complication有幫忙，對macrovascular complication沒有大幫忙。最近幾個大研究 ACCORD, ADVANCE均不贊成tight control of sugar, esp. > 65 y/o,

美國資料，血糖，血壓，血脂三種東西，只有 58%，29%，43%的控制率，而控制血壓血脂所獲得的cost/beneift ratio可能比血糖更高

所以，放血糖一馬，好好控制血壓血脂可能比較合算
(最近也認為，血壓壓到130/80以下沒幫忙?)

https://docs.google.com/fileview?id=0B278nGJMQBk7MDI0ZjUyOTctZDVjZi00YTdmLWFhMjEtMmRkYzE5Y2M5OTU4&hl=zh_TW

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