Wilkin T J
Department of Endocrinology and Metabolism, Peninsula Medical School, Plymouth, UK.
Diabetologia. 2007 Aug;50(8):1587-92. doi: 10.1007/s00125-007-0665-5. Epub 2007 Apr 25.
Type 1 and type 2 diabetes are usually regarded as distinct disorders, but the convergence of their phenotypes over recent years, the relationship of body weight to the risk of type 1 diabetes, the diminishing importance of the type 1 susceptibility genes and the finding of autoantibodies in patients with type 2 diabetes, invite a different interpretation. The possibility that type 1 and type 2 diabetes, rather than being different, are merely poles of a single spectrum, where variation in the tempo of beta cell loss determines age at onset and symptoms at presentation, has important implications. Correct classification is crucial because it directs appropriate treatment and, where available, prevention. This article argues that type 1 diabetes is currently misclassified, provides evidence that insulin resistance drives type 1 diabetes as it does type 2, and proposes how the 'accelerator hypothesis' can be tested in a randomised controlled trial, which could demonstrate, for the first time, the safe and effective prevention of type 1 diabetes.
1型糖尿病和2型糖尿病通常被视为不同的疾病，但近年来它们的表型趋同、体重与1型糖尿病风险的关系、1型糖尿病易感基因重要性的降低以及2型糖尿病患者中自身抗体的发现，引发了不同的解读。1型糖尿病和2型糖尿病并非不同，而可能只是单一谱系的两极，其中β细胞丧失速度的差异决定发病年龄和就诊时的症状，这种可能性具有重要意义。正确分类至关重要，因为它指导恰当的治疗，并在可行时指导预防。本文认为1型糖尿病目前分类错误，提供了胰岛素抵抗驱动1型糖尿病（如同其驱动2型糖尿病一样）的证据，并提出如何在一项随机对照试验中检验“加速器假说”，该试验可能首次证明安全有效地预防1型糖尿病。
