Yale J F
McGill Nutrition and Food Science Centre, Royal Victoria Hospital, Montreal, Quebec, Canada.
Int J Clin Pract Suppl. 2000 Oct(113):35-9.
The importance of type 2 diabetes is due to its high prevalence, the difficulties in achieving optimal glucose control (financial, time, quality of life) and the high frequency of chronic microvascular and macrovascular complications that add very significantly to the morbidity, mortality and overall cost of the disease. Numerous risk factors have been identified that predict the future onset of type 2 diabetes in individuals and an early stage of the disease (impaired glucose tolerance) can often be identified. Insulin resistance is central to the pathogenesis and is initially compensated by an increased insulin secretion. Over time, insulin secretion progressively fails and diabetes appears. Several approaches have been proposed for the prevention of diabetes. Lifestyle changes (nutritional therapy and physical activity) have been shown to reduce the frequency of diabetes in small studies and are being assessed in the NIH-funded Diabetes Prevention Trial. Metformin, which reduces insulin resistance and hyperinsulinaemia, is being assessed in this same trial. Acarbose, which has been shown to reduce post-prandial insulin secretion and improve insulin resistance, is being assessed in the STOP-NIDDM trial. The ACE inhibitor ramipril has been shown in the HOPE study to reduce the appearance of diabetes by one third when given to patients with vascular disorders and this class of agents has been shown to improve insulin resistance. Another very promising approach is the use of thiazolidinediones (rosiglitazone, pioglitazone) to improve the insulin resistance and possibly preserve the beta cells by reducing the need for increased insulin secretion. These lifestyle changes and medications have been shown to be safe in the treatment of type 2 diabetes. There is a high probability that one of these approaches will be effective in delaying or preventing type 2 diabetes, and prevention may become a clinical reality in the near future.
2型糖尿病的重要性在于其高患病率、实现最佳血糖控制存在困难（经济、时间、生活质量方面）以及慢性微血管和大血管并发症的高发生率，这些并发症显著增加了该疾病的发病率、死亡率和总体成本。已确定了许多预测个体未来发生2型糖尿病的危险因素，并且常常能够识别疾病的早期阶段（糖耐量受损）。胰岛素抵抗是发病机制的核心，最初通过增加胰岛素分泌来代偿。随着时间的推移，胰岛素分泌逐渐衰竭，糖尿病便会出现。已提出了几种预防糖尿病的方法。在小型研究中，生活方式改变（营养治疗和体育活动）已显示可降低糖尿病的发生率，并且正在美国国立卫生研究院资助的糖尿病预防试验中进行评估。二甲双胍可降低胰岛素抵抗和高胰岛素血症，正在同一项试验中进行评估。阿卡波糖已显示可减少餐后胰岛素分泌并改善胰岛素抵抗，正在“停止非胰岛素依赖型糖尿病”（STOP-NIDDM）试验中进行评估。血管紧张素转换酶（ACE）抑制剂雷米普利在“心脏结局预防评估”（HOPE）研究中显示，给予血管疾病患者时可使糖尿病的发生率降低三分之一，并且这类药物已显示可改善胰岛素抵抗。另一种非常有前景的方法是使用噻唑烷二酮类药物（罗格列酮、吡格列酮）来改善胰岛素抵抗，并可能通过减少对增加胰岛素分泌的需求来保护β细胞。这些生活方式改变和药物在治疗2型糖尿病方面已显示是安全的。这些方法中的一种很有可能有效地延迟或预防2型糖尿病，并且预防在不久的将来可能会成为临床现实。
