<International Circulation> :  Do you think there is still some confusion among clinicians regarding how tight control should be for both glucose and blood pressure values due to different results in clinical trials?

   《国际循环》：您认为对于临床医生而言，对这类患者血糖和血压控制的水平标准会不会发生混淆，因为我们发现临床试验存在争议，他们该如何掌握患者的血糖和血压控制的基准水平？

    Professor Chalmers : You are absolutely correct. There is a lot of confusion and you can not blame primary care physicians or even specialists for that matter because there is disparity among the results of clinical trials. My own view is that if you look at the disparity between ADVANCE and ACCORD in the glucose arm， overall there is a benefit but smaller than you would hope for in the more intensive glucose control group. Probably， the level of 6 aimed for in ACCORD is going too low but I would say it is definitely worth going below 7 and probably a good range is from 6.5~7.0 and you should aim to get below 7 but not all the way to 6. That is probably supported by the metanalyses that we published jointly with ACCORD， ADVANCE， VADT， and UKPDS. For blood pressure， my own view is that it would be a mistake to undue the 130/80mm/Hg recommendations because we would cause dreadful confusion among general practitioners if we go back to 140/90mm/Hg for the diabetic population without having specific evidence against it. If we do that we will probably get general practitioners thinking that blood pressure is not important anymore and we will do more harm than good. We do need trials that specifically address 130/80mm/Hg， which is not what ACCORD did because ACCORD addressed 120/80mm/Hg. Therefore， I feel we need more definitive evidence but in the meantime I would not change the goals.

    Chalmers教授：你的说法非常正确，的确存在许多混淆，但你并不能因此而责怪初级保健医生或专家，因为临床试验结果不一致导致血糖和血压控制标准的混淆。我认为如果你对这些试验结果差异进行比较，比如把近期和血糖水平一致的结果综合，这是有好处的，但会比你所期望更强的血糖控制力度要小。但将血糖水平控制到低于6很可能太低了。我认为低于7就非常有效，或是6.5-7之间。我可能会将血糖控制在低于7而非6。而且我们发表的meta分析连同更深入的BADT 和UK PDF分析的结果都支持上述观点。我认为取消将血压控制在130/80以下这个标准是错误的，因为这会在普通医疗实践中造成可怕的误导。如果我们在无任何特殊迹象情况下将糖尿病患者血压控制标准调回到140/90，开业医生会认为控制血压不再是关键，这样做是弊大于利的。我们需要试验证实130/80这一血压控制水平的重要性，我们需要更多确定的证据但同时我将不会改变这一标准。