tailieunhanh - Medical Management of Diabetes and Heart Disease - part 7

Yếu tố nguy cơ tim mạch và hội chứng prediabetic. Ann Med 1996; 28:363-370. 32. Haffner SM. Prediabetic vấn đề: phát triển bệnh tiểu đường không phụ thuộc insulin và những bất thường liên quan | 176 Thanigaraj and Perez 31. Haffner SM. Cardiovascular risk factors and the prediabetic syndrome. Ann Med 1996 28 363-370. 32. Haffner SM. The prediabetic problem development of non-insulin-dependent diabetes mellitus and related abnormalities. J Diabetes Complic 1997 11 69-76. 33. Celentano A Vaccaro O Tammaro P Galderisi M Crivaro M Oliviero M Impera-tore G Palmieri V lovino V Riccardi G et al. Early abnormalities of cardiac function in non-insulin-dependent diabetes mellitus and impaired glucose tolerance. Am J Cardiol 1995 76 1173-1176. Copyright Marcel Dekker Inc. All rights reserved. Marcel Dekker Inc. 270 Madison Avenue New York New York 10016 11 Treatment of Diabetes Implications for Heart Disease Thomas A. Buchanan Howard N. Hodis and Wendy J. Mack University of Southern California Keck School of Medicine Los Angeles California I. OVERVIEW There are three general levels of glycemic control that can be set as goals in the management of patients with type 1 or type 2 diabetes 1 keep patients out of ketoacidosis and hyperosmolar coma 2 prevent symptoms of hyperglycemia . polyuria and catabolism fatigue weight loss and hyperphagia and 3 prevent long-term complications associated with diabetes. In the absence of extenuating social or medical circumstances that make prevention of long-term complications irrelevant . terminal illness or infeasible . inability of the patient to cooperate with a complex care program the third level should be the standard of care for people with diabetes. The effectiveness of good glycemic control in slowing or preventing the development of diabetic retinopathy nephropathy and neuropathy has been demonstrated in several well-controlled clinical trials and is beyond question. Whether good glycemic control has a beneficial effect on the risk of atherosclerosis and its clinical manifestations remains controversial. In this chapter we will illustrate that improved glycemic control is beneficial for reducing the risk of .