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Diabetologia:强化血糖控制可降低糖尿病足溃疡风险

2014-05-12 佚名 丁香园

既往的研究结果提示,通过胰岛素强化治疗改善血糖控制,可降低1型糖尿病患者微血管和大血管并发症发生风险。然而,强化血糖控制对1型糖尿病患者皮肤微循环及缺血性足溃疡发生率的影响尚不清楚。 为此,来自瑞典卡罗琳斯卡医学院的Nyström教授及其团队进行了一项研究,探讨胰岛素强化治疗对1型糖尿病患者微循环的影响,以及其对1型糖尿病患者HbA1c和缺血性足溃疡发生率的影响。该研究结果在线发表在2014年0

既往的研究结果提示,通过胰岛素强化治疗改善血糖控制,可降低1型糖尿病患者微血管和大血管并发症发生风险。然而,强化血糖控制对1型糖尿病患者皮肤微循环及缺血性足溃疡发生率的影响尚不清楚。

为此,来自瑞典卡罗琳斯卡医学院的Nyström教授及其团队进行了一项研究,探讨胰岛素强化治疗对1型糖尿病患者微循环的影响,以及其对1型糖尿病患者HbA1c和缺血性足溃疡发生率的影响。该研究结果在线发表在2014年05月01日的Diabetologia杂志上。

斯德哥尔摩糖尿病干预研究中,1型糖尿病患者被随机分到胰岛素强化常规治疗(ICT)或标准治疗(ST),平均随访周期为7.5年。Nyström教授等对来自斯德哥尔摩糖尿病干预研究的72例1型糖尿病患者中,使用离子电渗透法将以下血管活性刺激物导入局部皮肤:乙酰胆碱(ACh)、硝普钠(SNP)和辣椒素,重新确定72例患者(ICT组35例;ST组37例)的皮肤微循环。前瞻性的收集这72例患者1990年至1995年期间HbA1c水平,并检测其与皮肤微循环的关系。对这些患者进行随访,直到患者首次因缺血性足溃疡住院治疗,或者直到2011年。的后继研究。

该研究发现,平均28年随访期间,ICT组有2例患者发生缺血性足溃疡,而ST组患者有10例发生缺血性足溃疡。在进行离子电渗透治疗时,ICT组患者的平均HbA1c水平低于ST组,分别为57mmol/l和68mmol/l。ICT组经ACh、SNP和辣椒素刺激后,血流灌注量显著增加,且高于ST组,分别为8.1PU vs 5.3PU、8.1PU vs 5.6PU和5.0PU vs 3.4PU。HbA1c水平与ACh和辣椒素诱导的血管舒张功能独立相关。

该研究提示,改善1型糖尿病患者的血糖控制,可使患者皮肤微循环得到改善,并可降低缺血性足溃疡发生率和截肢风.

原始出处

Rathsman B1, Jensen-Urstad K, Nyström T.Intensified insulin treatment is associated with improvement in skin microcirculation and ischaemic foot ulcer in patients with type 1 diabetes mellitus: a long-term follow-up study.Diabetologia. 2014 May 7.

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    2014-06-13 智智灵药
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