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  3. A 17-year U. S. study has finally answered one of the most pressing questions about diabetes: Can tight control of blood sugar p

A 17-year U. S. study has finally answered one of the most pressing questions about diabetes: Can tight control of blood sugar p

admin2012-07-13  30
问题     A 17-year U. S. study has finally answered one of the most pressing questions about diabetes: Can tight control of blood sugar prevent heart attacks and strokes?
    The answer, reported Thursday in The New England Journal of Medicine, is yes. Intense control can reduce the risk by nearly half.
    And, the study found, the effect occurred even though the patients had only had a relatively brief period of intense blood sugar control when they were young adults. None the less, more than a decade later, when they reached middle age, when heart disease and strokes normally start to appear, they were protected. The study involved those with Type 1 diabetes, which usually arises early in life and involves the death of insulin-secreting cells.
    The question of whether rigid blood sugar control protects against heart disease and strokes has divided the field for decades, diabetes researchers said.
    "It’s really a major question that has been around for a long time," said Dr. Judith Fradkin, who directs diabetes research at the National Institute of Diabetes and Digestive and Kidney Diseases.
    Researchers knew that diabetes was linked to heart disease — at least two-thirds of diabetics die of heart disease. But although studies showed that controlling blood sugar protects against damage to the eyes, kidneys and nerves, there was no conclusive evidence that it would have the same effect on heart disease and strokes.
    "In that sense, this is a landmark study," said Fradkin.
    But the result also gives rise to questions: Does the same effect occur in people with Type 2 diabetes, which usually occurs later in life and involves an inability to respond to insulin? And why would tight control of blood sugar for one brief period have such a pronounced effect later?
    Fradkin said she expected the results would hold for Type 2 diabetes. Another large U. S. federal study is addressing that question, she notes, but it is already known that tight control of blood sugar in Type 2 diabetes protects against nerve, kidney and eye damage, just as it does with Type 1 diabetes. In addition, a study in Britain hinted — although it did not demonstrate — that Type 2 diabetics who keep their blood sugar low have less heart disease and strokes.
    Fradkin said she hoped the emerging evidence and improving therapies would make a difference.
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答案 美国一项进行了17年的研究为糖尿病亟需解决的问题之一找到了答案。这个问题就是：严格控制血糖能不能预防心脏病发作和中风? 据周四《新英格兰医学杂志》报道，答案是肯定的。严格控制血糖几乎可以使发病的危险减半。 研究发现，即或病人年轻时只对血糖严密控制过一段较短的时间，也会有效果的。十多年后，他们人到中年，心脏病和中风通常开始出现，这时他们就会受到保护。这项研究的相关病人患有1型糖尿病，这种病往往在年纪不大时就会发生，是分泌胰岛素的细胞死亡造成的。 糖尿病研究人员指出，严格控制血糖是否能防止心脏病发作和中风的问题，在糖尿病研究领域一直存在着互相对立的看法，已有数十年之久。 “这的确是一个重大问题，困扰我们已经很久了。”朱迪思?福莱德金博士说道。她在全国糖尿病、消化及肾脏疾病研究所主持糖尿病方面的研究。 研究人员早就知道，糖尿病与心脏病有联系——糖尿病患者至少有三分之二死于心脏病。然而，尽管早有研究结果表明控制血糖可以防止眼睛、肾脏和神经受损，却一直没有充分的证据证明控制血糖对防止心脏病和中风也能起同样的作用。 “就这一方面而言，这是一项具有里程碑意义的研究，”福莱德金说道。 但这项研究成果也引起了一些问题：2型糖尿病患者通常在年纪较大时发病，而且不能对胰岛素作出反映，对于这样的病人，也能产生同样的疗效吗?为什么在一段不长的时间里严格控制血糖，会在日后产生深远影响? 福莱德金说，她预期这项研究结果将同样适用于2型糖尿病。她说，美国另外一项大规模的国家级研究项目正在解决这一问题。现已查明，严格控制血糖对2型糖尿病的作用和对l型糖尿病的作用相同，能防止神经、肾脏和眼睛受到损伤。此外，英国进行的一项研究已经露出迹象——虽然没有公开表示——表明2型糖尿病患者，凡是保持血糖低的，患心脏病和中风的可能性就小。 福莱德金说，她希望随着新证据的出现和医疗方法的改进，情况将有所变化。
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