Diabetes and heart disease: the contribution of epidemiology and genetics

摘要

Clinically speaking, diabetes is a disease of the blood sugar. We are taught to follow the blood glucose as the primary evidence of whether the patient is in good metabolic control or not. Although there is no doubt that blood glucose is a useful and reliable marker for diabetic control, nevertheless, it is only an inexpensive surrogate for the disordered metabolism that affects a variety of factors, including lipids, amino acids, blood viscosity, clotting, ion transport, and carbohydrates, to name only a few. Blood glucose has taken the front and center role as a surrogate marker for diabetes because it is inexpensive to measure, convenient, and reasonably reliable: diabetic patients with more or less normal blood glucose measurements can be reasonably (but not always) assumed to show few apparent alterations in other substrate pathways.