循環器ジャーナル67巻1号

2019年01月発行

特集 循環器の現場からの検証：そのエビデンスを日本で活用するには？ Ⅱ．予防医療

糖尿病患者管理—HbA1cでなければ何をターゲットにすればいいか？　最近の臨床試験の解釈を巡って

著者： 大杉満¹

所属機関： ¹国立国際医療研究センター糖尿病情報センター

ページ範囲：P.52 - P.58

Point
・血糖コントロール改善は糖尿病合併症を抑制する．
・HbA1cは血糖コントロールの一側面の指標である．
・低血糖・体重増加を避け，総合的に患者のイベント抑制を目指す治療を進めるべきである．

参考文献

1) Fullerton B, Jeitler K, Seitz M, et al:Intensive glucose control versus conventional glucose control for type 1 diabetes mellitus. Cochrane Database of Syst Rev 30:CD009122, 2014

2) Zoungas S, Arima H, Gerstein HC, et al:Effects of intensive glucose control on microvascular outcomes in patients with type 2 diabetes:a meta-analysis of individual participant data from randomised controlled trials. Lancet Diabetes Endocrinol 5:431-437, 2017

3) Action to Control Cardiovascular Risk in Diabetes Study Group, Gerstein HC, Miller ME, et al:Effects of intensive glucose lowering in type 2 diabetes. N Engl J Med 358:2545-2559, 2008

4) ADVANCE Collaborative Group, Patel A, MacMahon S, et al:Intensive blood glucose control and vascular outcomes in patients with type 2 diabetes. N Engl J Med 358:2560-2572, 2008

5) Duckworth W, Abraira C, Moritz T, et al:Glucose control and vascular complications in veterans with type 2 diabetes. N Engl J Med 360:129-139, 2009

6) Bonds DE, Miller ME, Bergenstal RM, et al:The association between symptomatic, severe hypoglycaemia and mortality in type 2 diabetes:retrospective epidemiological analysis of the ACCORD study. BMJ 340:b4909, 2010

7) Miller ME, Bonds DE, Gerstein HC, et al:The effects of baseline characteristics, glycaemia treatment approach, and glycated haemoglobin concentration on the risk of severe hypoglycaemia:post hoc epidemiological analysis of the ACCORD study. BMJ 340:b5444, 2010

8) Zoungas S, Patel A, Chalmers J, et al:Severe hypoglycemia and risks of vascular events and death. N Engl J Med 363:1410-1418, 2010

9) Ray KK, Seshasai SRK, Wijesuriya S, et al:Effect of intensive control of glucose on cardiovascular outcomes and death in patients with diabetes mellitus:a meta-analysis of randomised controlled trials. Lancet 373:1765-1772, 2009

10) Nathan DM, Cleary PA, Backlund J-YC, et al:Intensive diabetes treatment and cardiovascular disease in patients with type 1 diabetes. N Engl J Med 353:2643-2653, 2005

11) Holman RR, Paul SK, Bethel MA, et al:10-year follow-up of intensive glucose control in type 2 diabetes. N Engl J Med 359:1577-1589, 2008

12) Scirica BM, Bhatt DL, Braunwald E, et al:Saxagliptin and Cardiovascular Outcomes in Patients with Type 2 Diabetes Mellitus. N Engl J Med 369:1317-1326, 2013

13) White WB, Cannon CP, Heller SR, et al:Alogliptin after Acute Coronary Syndrome in Patients with Type 2 Diabetes. N Engl J Med 369:1327-1335, 2013

14) Pfeffer MA, Claggett B, Diaz R, et al:Lixisenatide in Patients with Type 2 Diabetes and Acute Coronary Syndrome. N Engl J Med 373:2247-2257, 2015

15) Green JB, Bethel MA, Armstrong PW, et al:Effect of Sitagliptin on Cardiovascular Outcomes in Type 2 Diabetes. N Engl J Med 373:233-242, 2015

16) Zinman B, Wanner C, Lachin JM, et al:Empagliflozin, Cardiovascular Outcomes, and Mortality in Type 2 Diabetes. N Engl J Med 373:2117-2128, 2015

17) Neal B, Perkovic V, Mahaffey KW, et al:Canagliflozin and Cardiovascular and Renal Events in Type 2 Diabetes. N Engl J Med 377:644-657, 2017

18) Marso SP, Daniels GH, Brown-Frandsen K, et al:Liraglutide and Cardiovascular Outcomes in Type 2 Diabetes. N Engl J Med 375:311-322, 2016

19) Marso SP, Bain SC, Consoli A, et al:Semaglutide and Cardiovascular Outcomes in Patients with Type 2 Diabetes. N Engl J Med 375:1834-1844, 2016

20) Ueki K, Sasako T, Okazaki Y, et al:Effect of an intensified multifactorial intervention on cardiovascular outcomes and mortality in type 2 diabetes（J-DOIT3）:an open-label, randomised controlled trial. Lancet Diabetes Endocrinol 5:951-964, 2017