Rosenberg Daniel E, Jabbour Serge A, Goldstein Barry J
Division of Endocrinology, Diabetes and Metabolic Diseases, Department of Medicine, Jefferson Medical College of Thomas Jefferson University, Philadelphia, PA 19107, USA.
Diabetes Obes Metab. 2005 Nov;7(6):642-53. doi: 10.1111/j.1463-1326.2004.00446.x.
The prevalence of diabetes is increasing worldwide. Insulin resistance and diabetes mellitus are major predictors of cardiovascular ischaemic disease. Other risk factors for cardiovascular death including hypertension, dyslipidaemia, smoking and visceral obesity are especially lethal in diabetics. C-reactive protein, plasminogen activator inhibitor-1, matrix metalloproteinases and other emerging risk factors and their roles are continually being researched and discovered. Treatment of this syndrome must be aimed at lifestyle modification, glycaemic control and management of concomitant risk factors. Diet and exercise play a vital role in the treatment of diabetes and the metabolic syndrome. Weight reduction and increased physical activity will improve insulin resistance, hyperglycaemia, hypertension and dyslipidaemia. Hypertension management has been shown to be especially important in diabetics to prevent cardiovascular events. Likewise, multiple clinical trials show that reduction of cholesterol is even more vital in diabetics than the general population for risk reduction of coronary disease. There is a great deal of evidence that tight control of glycaemia is essential to treatment of this condition. There are a variety of available pharmacological agents available including metformin, insulin secretagogues, alpha-glucosidase inhibitors, thiazolidinediones and insulin. The mechanisms and side effects of these medications are discussed. As macrovascular disease is the major cause of morbidity and mortality, an early, aggressive, multi-factorial approach to treatment of the metabolic syndrome and diabetes is vital to prevent adverse cardiac outcomes.
糖尿病在全球范围内的患病率正在上升。胰岛素抵抗和糖尿病是心血管缺血性疾病的主要预测因素。心血管死亡的其他危险因素，包括高血压、血脂异常、吸烟和内脏肥胖，在糖尿病患者中尤其致命。C反应蛋白、纤溶酶原激活物抑制剂-1、基质金属蛋白酶以及其他新出现的危险因素及其作用正在不断被研究和发现。对该综合征的治疗必须针对生活方式的改变、血糖控制以及并存危险因素的管理。饮食和运动在糖尿病及代谢综合征的治疗中起着至关重要的作用。减轻体重和增加体力活动将改善胰岛素抵抗、高血糖、高血压和血脂异常。已证明高血压管理对糖尿病患者预防心血管事件尤为重要。同样，多项临床试验表明，降低胆固醇对糖尿病患者降低冠心病风险比一般人群更为关键。有大量证据表明严格控制血糖对治疗这种疾病至关重要。有多种可用的药物制剂，包括二甲双胍、胰岛素促泌剂、α-葡萄糖苷酶抑制剂、噻唑烷二酮类和胰岛素。讨论了这些药物的作用机制和副作用。由于大血管疾病是发病和死亡的主要原因，早期、积极、多因素的代谢综合征和糖尿病治疗方法对于预防不良心脏结局至关重要。
