Dania Blaibel, Cornelius James Fernandez, Joseph M Pappachan
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引用次数: 0
摘要
众所周知,糖尿病(DM)控制不佳导致的慢性高血糖是糖尿病视网膜病变、神经病变(包括自主神经病变)和肾病等并发症的先兆,但在积极控制血糖、使糖化血红蛋白迅速降低的情况下,这些并发症却极少出现反常的加剧。虽然在这些并发症中,视网膜病变和治疗诱发的糖尿病神经病变的急性发作或恶化较为常见,但也极少出现其他问题,如白蛋白尿、糖尿病肾病、夏科氏神经性关节病、胃瘫和膀胱功能障碍。最近,《世界糖尿病杂志》(World Journal of Diabetes)发表了一篇由 Huret 等人撰写的病例报告,该病例发生在一名年轻的 1 型糖尿病女性患者身上,她在妊娠期间接受了严格的管理。全面了解微血管并发症的病理生物学、发病率、易患因素以及在快速控制血糖后急性发作或恶化的管理策略至关重要,这有助于减轻患者的发病率,提高疾病管理的依从性,并有可能避免围绕这一罕见临床问题的医疗法律问题。这篇社论深入探讨了在快速控制血糖期间,控制不佳的糖尿病患者微血管并发症急性加重的相关动态。
Acute worsening of microvascular complications of diabetes mellitus during rapid glycemic control: The pathobiology and therapeutic implications.
While chronic hyperglycaemia resulting from poorly controlled diabetes mellitus (DM) is a well-known precursor to complications such as diabetic retinopathy, neuropathy (including autonomic neuropathy), and nephropathy, a paradoxical intensification of these complications can rarely occur with aggressive glycemic management resulting in a rapid reduction of glycated haemoglobin. Although, acute onset or worsening of retinopathy and treatment induced neuropathy of diabetes are more common among these complications, rarely other problems such as albuminuria, diabetic kidney disease, Charcot's neuroarthropathy, gastroparesis, and urinary bladder dysfunction are also encountered. The World Journal of Diabetes recently published a rare case of all these complications, occurring in a young type 1 diabetic female intensely managed during pregnancy, as a case report by Huret et al. It is essential to have a comprehensive understanding of the pathobiology, prevalence, predisposing factors, and management strategies for acute onset, or worsening of microvascular complications when rapid glycemic control is achieved, which serves to alleviate patient morbidity, enhance disease management compliance, and possibly to avoid medico-legal issues around this rare clinical problem. This editorial delves into the dynamics surrounding the acute exacerbation of microvascular complications in poorly controlled DM during rapid glycaemic control.
期刊介绍:
The WJD is a high-quality, peer reviewed, open-access journal. The primary task of WJD is to rapidly publish high-quality original articles, reviews, editorials, and case reports in the field of diabetes. In order to promote productive academic communication, the peer review process for the WJD is transparent; to this end, all published manuscripts are accompanied by the anonymized reviewers’ comments as well as the authors’ responses. The primary aims of the WJD are to improve diagnostic, therapeutic and preventive modalities and the skills of clinicians and to guide clinical practice in diabetes. Scope: Diabetes Complications, Experimental Diabetes Mellitus, Type 1 Diabetes Mellitus, Type 2 Diabetes Mellitus, Diabetes, Gestational, Diabetic Angiopathies, Diabetic Cardiomyopathies, Diabetic Coma, Diabetic Ketoacidosis, Diabetic Nephropathies, Diabetic Neuropathies, Donohue Syndrome, Fetal Macrosomia, and Prediabetic State.