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[ADA2010]糖尿病前期患者的CV风险干预——Ira J. Goldberg教授专访
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专家访谈  来源:国际糖尿病 2010/6/24 16:56:00    加入收藏
内容概要:本届ADA大会Edwin Bierman 奖的获得者来自哥伦比亚大学医学院预防医学和营养系的 Ira J. Goldberg教授,他将就糖尿病前期患者心血管疾病风险干预话题接收我们的专访,敬请期待!

      International Diabetes:  I am at ADA 2010 with Dr Ira Goldberg.  Glucose and lipids metabolism plays an important role in the progress of both diabetes and cardiovascular disease. Therefore the both the patient and the doctor need to be acutely aware of what the patient is eating.  How should the diet of the diabetic diet differ from different stages of the disease?
     《国际糖尿病》:我现在与Ira Goldberg博士在一起。葡萄糖和脂质代谢在糖尿病和心血管疾病的进展中具有重要作用。因此患者和医生都需要高度关注患者的饮食。不同阶段的糖尿病饮食应当有哪些不同?
      Dr. Goldberg:  Well, there are two issues that are really need to be looked at in people with diabetes. So just like anybody who has cardiovascular risk, low cholesterol and low saturated fat should be a major part of the diet.  Partly because of the glucose excursion, partly because of the large incidence of hypertriglyceridemia, the intake of free sugars and by that I mean sugars itself or simple carbohydrates that are in rice, bread, and pasta, are also a problem and should only be eaten in moderation.
      Dr. Goldberg:事实上糖尿病患者需要关注两个问题。如心血管高危患者一样,食物应当低胆固醇和低饱和脂肪酸。因为葡萄糖释放以及高甘油三酯血症的高发生率,游离糖以及糖本身或者米、面包、面食中的单一碳水化合物的进食也是一个问题,这些食物仅应当适量食用。
      International Diabetes:  And would that include complex carbohydrates?
     《国际糖尿病》:包括复合碳水化合物吗?
      Dr. Goldberg:  Complex carbohydrates are good.
      Dr. Goldberg:复合碳水化合物没有问题。
      International Diabetes:  More and more evidence seems to indicate that postprandial hyperglycemia is an independent risk factor for cardiovascular disease. With that said, what do you think about aggressive intervention of pre diabetes for the cardiovascular disease patients?
     《国际糖尿病》:愈来愈多的证据显示餐后血糖是心血管事件的独立危险因素。你认为对合并心血管疾病的糖尿病前期患者是否应当进行积极干预?
      Dr. Goldberg:  Well, aggressive intervention to me is blood pressure intervention and cholesterol reduction, and so that is what I view as aggressive intervention.  The other aggressive intervention that we know of in people with pre diabetes is lifestyle changes.  In fact lifestyle changes is the most effective way to modify risk favors to prevent diabetes and by risk factor modification I mean often weight loss and certainly increased exercise. 
      Dr. Goldberg:我认为的积极干预包括血压的干预和降低胆固醇,这是我对积极干预的观点。至于其他的积极干预,我们知道对糖尿病前期的积极干预是指改变生活方式。事实上生活方式的改变是影响危险因素预防糖尿病的最有效的方法,我认为危险因素的改变是指减轻体重和适当的增加运动。
      International Diabetes:  At your talk today you mentioned that the ACCORD trial which was stopped because of the death of many of the patients, was stopped perhaps prematurely for another point that you brought out that could have been noticed.  What was that point?
     《国际糖尿病》:在今天的演讲中你提到ACCORD研究已经由于许多患者的死亡而停止,但你指出对另一个已经注意到的问题来说研究停止的过早了。你指的另一个问题是什么?
      Dr. Goldberg:  Yes, so when they stopped the ACCORD and they analyzed the data, the one really positive light in that trial was that there was a marked reduction in non fatal myocardial infarctions in the group of patients who had more intensive therapy.  I wonder and other people have wondered whether this suggests that glucose lowering is really good in a way to prevent early atherosclerosis progression.  Maybe if the trial had been continued that we would have been able to see that.  Saying that though, there is no way you can continue a trial where the intervention was clearly not positive and would not have been positive for a major end point or the major endpoint which is early mortality. 
      Dr. Goldberg:在ACCORD研究停止时人们对数据进行分析,研究中非常明确的一个问题是强化治疗组患者非致死性心梗显著减少。我和其他人都在想这是否提示降低血糖事实上可以很好的预防早期动脉粥样硬化的发展。如果研究继续进行,我们可能可以得出这一结论。尽管这样,对于一项干预没有明显阳性结果,或者主要终点没有阳性结果,或主要终点是早期死亡率的研究,我们不能继续进行下去。
      International Diabetes:  So do you think the ACCORD could be restructured to study that very point with perhaps mortality being lowered?
     《国际糖尿病》:那么你认为ACCORD研究是否可以进行重新设计,来研究其是否可以降低死亡率?
      Dr. Goldberg:  Gee I do not know.  They just spent

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网站用户: 靳素梅 时间:2010/6/26 10:43:11
问题很好,都是我们处于模糊的处境,很想知道。

网站用户: 王仁友 时间:2010/6/25 9:00:10
学习了

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