Collins Francis M
Queen City Physicians, Cincinnati, Ohio, USA.
Am J Manag Care. 2002 Oct;8(16 Suppl):S460-71.
Diabetes mellitus affects approximately 17 million adults in the United States and has profound implications in terms of long-term microvascular and macrovascular complications and their associated costs. In type 2 diabetes, insulin resistance and a relative beta-cell defect are the underlying pathologic problems leading to hyperglycemia. Notably, insulin resistance is also associated with obesity, dyslipidemia, and hypertension. Diabetes can be defined as a disease of accelerated cardiovascular deterioration associated with elevated blood glucose levels. Glycemic control has been shown to reduce the long-term complications associated with diabetes. Although medical nutrition therapy and appropriately prescribed increased physical activity are important components of a diabetes management plan, most patients need medication to lower glucose to near-normal levels. Therapeutic options for treating hyperglycemia include sulfonylureas and other insulin secretagogues, biguanides, alpha-glucosidase inhibitors, thiazolidinediones, and insulin. An antidiabetic agent that improves insulin sensitivity is an excellent choice for early treatment of type 2 diabetes because it may delay or prevent complications associated with this disease. Because of the progressive nature of type 2 diabetes, aggressive intervention early in the course of the disease, including combination therapy, is often necessary.
在美国，约有1700万成年人患有糖尿病，这种疾病会引发严重的长期微血管和大血管并发症，并产生相关费用。在2型糖尿病中，胰岛素抵抗和相对的β细胞缺陷是导致高血糖的根本病理问题。值得注意的是，胰岛素抵抗还与肥胖、血脂异常和高血压有关。糖尿病可被定义为一种与血糖水平升高相关的心血管加速恶化疾病。血糖控制已被证明可以减少与糖尿病相关的长期并发症。尽管医学营养治疗和适当规定的增加体力活动是糖尿病管理计划的重要组成部分，但大多数患者需要药物治疗来将血糖降至接近正常水平。治疗高血糖的选择包括磺脲类药物和其他胰岛素促泌剂、双胍类药物、α-葡萄糖苷酶抑制剂、噻唑烷二酮类药物和胰岛素。一种能提高胰岛素敏感性的抗糖尿病药物是2型糖尿病早期治疗的理想选择，因为它可能会延缓或预防与该疾病相关的并发症。由于2型糖尿病具有渐进性，在疾病早期进行积极干预，包括联合治疗，通常是必要的。
