Pratley Richard E, Weyer Christian
Novartis Pharmaceuticals Corporation, Clinical Research and Development, Diabetes and Obesity Section, One Health Plaza, East Hanover, NJ 07936, USA.
Curr Diab Rep. 2002 Jun;2(3):242-8. doi: 10.1007/s11892-002-0090-6.
Impaired glucose tolerance (IGT) is characterized by plasma glucose responses to an oral glucose challenge that are above normal but not at the level defining diabetes. IGT is a common condition that greatly increases risk for the subsequent development of type 2 diabetes. Individuals with IGT manifest abnormalities in both insulin action and early insulin secretion similar to those seen in patients with type 2 diabetes. These abnormalities not only precede diabetes, they predict it as well. Furthermore, the progression from IGT to diabetes is characterized by a dramatic decline in early insulin secretion. It is now evident that early insulin secretion plays an important role in the rapid and efficient suppression of endogenous glucose production following a meal. Loss of early insulin secretion initially leads to postprandial hyperglycemia which, as the disease progresses, worsens to clinical hyperglycemia. Obesity and a high fat diet may contribute to the development of both insulin resistance and insulin secretory dysfunction in susceptible individuals. Strategies that improve insulin resistance and enhance early insulin secretion may prevent the progression from IGT to diabetes. Already, there is substantial evidence the weight loss and exercise may reduce the risk of developing diabetes by up to 58%. Other trials using pharmacologic agents to decrease insulin resistance and increase early insulin secretion are underway. Prevention remains the best hope for a long-term solutions to the worldwide epidemic of diabetes.
糖耐量受损（IGT）的特征是口服葡萄糖耐量试验后血浆葡萄糖反应高于正常水平，但未达到糖尿病的诊断标准。IGT是一种常见病症，会显著增加后续发生2型糖尿病的风险。IGT患者在胰岛素作用和早期胰岛素分泌方面均表现出异常，与2型糖尿病患者相似。这些异常不仅先于糖尿病出现，还具有预测作用。此外，从IGT进展为糖尿病的过程中，早期胰岛素分泌会急剧下降。现在已经明确，早期胰岛素分泌在进食后快速有效地抑制内源性葡萄糖生成中起着重要作用。早期胰岛素分泌的丧失最初会导致餐后高血糖，随着疾病进展，会恶化为临床高血糖。肥胖和高脂饮食可能会促使易感个体发生胰岛素抵抗和胰岛素分泌功能障碍。改善胰岛素抵抗并增强早期胰岛素分泌的策略可能会阻止IGT进展为糖尿病。目前已有大量证据表明，体重减轻和运动可将患糖尿病的风险降低多达58%。其他使用药物降低胰岛素抵抗并增加早期胰岛素分泌的试验正在进行中。预防仍然是全球糖尿病流行长期解决方案的最大希望。
