Irons Brian K, Mazzolini Timothy A, Greene Ronald Shane
Department of Pharmacy Practice, School of Pharmacy, Texas Tech University Health Sciences Center, Lubbock, TX 79430-8162, USA.
Pharmacotherapy. 2004 Mar;24(3):362-71. doi: 10.1592/phco.24.4.362.33170.
The frequency of type 2 diabetes mellitus is increasing at an alarming rate. Prediabetes, also referred to as impaired glucose tolerance (IGT) and/or impaired fasting glucose, is a major risk factor for development of type 2 diabetes mellitus. In addition, IGT has been associated with an increased risk of cardiovascular disease and mortality. Several studies have measured the effects of various interventions in patients with IGT on the development of type 2 diabetes mellitus. Intensive lifestyle modifications through alterations in diet and improvement in exercise have delayed the development of type 2 diabetes mellitus by 58% in patients with IGT. Therapy with metformin, troglitazone, or acarbose also has reduced the progression of IGT to diabetes mellitus by 31%, 49% and 25%, respectively. The mechanisms by which lifestyle interventions and drugs reduce the progression may be through alterations in insulin sensitivity. The American Diabetes Association recommends screening for prediabetes in patients who are 45 years or older and those with a body mass index of 25 kg/m2 or greater who have additional diabetes mellitus risk factors. Pharmacists can promote awareness, counsel patients on intervention strategies to delay the onset of diabetes mellitus, and screen high-risk patients.
2型糖尿病的发病率正以惊人的速度增长。糖尿病前期，也称为糖耐量受损（IGT）和/或空腹血糖受损，是2型糖尿病发生的主要危险因素。此外，IGT与心血管疾病风险增加和死亡率升高有关。多项研究测量了针对IGT患者的各种干预措施对2型糖尿病发生的影响。通过饮食改变和运动改善进行强化生活方式调整，已使IGT患者中2型糖尿病的发生延迟了58%。使用二甲双胍、曲格列酮或阿卡波糖进行治疗，也分别使IGT进展为糖尿病的比例降低了31%、49%和25%。生活方式干预和药物降低疾病进展的机制可能是通过改变胰岛素敏感性。美国糖尿病协会建议，对45岁及以上、体重指数为25kg/m2或更高且有其他糖尿病风险因素的患者进行糖尿病前期筛查。药剂师可以提高认识，就延缓糖尿病发病的干预策略为患者提供咨询，并对高危患者进行筛查。
