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依据糖尿病控制与并发症试验(DCCT),强化胰岛素治疗以减少并发症的观念被广泛的采纳,这使得1型糖尿病的管理水平获得了显著的提高。然而,匹兹堡糖尿病并发症流行病(EDC)研究显示,“现实”世界中(EDC中的患者)30年的微血管并发症发生比例是DCCT研究中接受强化胰岛素治疗组的两倍。临床试验证据与临床之间仍然存在着巨大的差距。这种差距可能被归结于患者和医师需要面对糖尿病日常管理的诸多挑战,这包括达到血糖控制水平,解决对低血糖的恐惧与发生,以及适当的胰岛素治疗和剂量调整。作为医师,我们怎样能帮助1型糖尿病患者管理血糖水平并解决上述这些问题?本文中,有效控制糖尿病全球合作机制(the Global Partnership for Effective Diabetes Management)提出了帮助提高1型糖尿病管理的实践建议。
Based on the Diabetes Control and Complications Trial (DCCT), the notion of intensive insulin therapy to reduce complications has been widely adopted, resulting in a significant improvement in the management of type 1 diabetes. However, the Pittsburgh Diabetes Complications Epidemiology (EDC) study showed that the 30-year incidence of microvascular complications in the “real world” (patients in EDC) was twice as high as those receiving intensive insulin in the DCCT study. There is still a huge gap between clinical trial evidence and clinical practice. This disparity may be due to the many challenges that patients and physicians need to face with the day to day management of diabetes, including achieving levels of glycemic control, addressing fears and occurrence of hypoglycaemia, and appropriate insulin therapy and dose adjustments. As a physician, how can we help people with type 1 diabetes manage their blood glucose levels and address these issues? In this article, the Global Partnership for Effective Diabetes Management presents practical advice to help manage type 1 diabetes.