Gagliardi Lucia, Wittert Gary
Endocrine and Metabolic Unit, Royal Adelaide Hospital, Adelaide, SA, Australia.
Curr Diabetes Rev. 2007 May;3(2):95-101. doi: 10.2174/157339907780598207.
Type 2 Diabetes Mellitus (T2DM) is a disease of over nutrition; the onset and progression of which, is associated with excess fat accumulation in the abdomen, muscles and liver. In this review, we focus on management of obesity as the primary strategy for management of disorders of glucose metabolism. Modest weight loss (~7%) achieved by diet and exercise can prevent, or delay, the onset of T2DM. In those with established T2DM, weight loss reduces fasting and post-prandial plasma glucose levels, HbA(1c), and the need for pharmacotherapy. The beneficial effects on glucose metabolism of caloric restriction, and aerobic and resistance exercise, may occur independently of weight loss. When substantial weight loss is required, meal replacements allow a large reduction in energy consumption whilst maintaining micronutrient intake. Pharmacotherapy for obesity, as part of an integrated management plan, is useful for maintaining weight loss and optimising glycaemic control. The most effective long-term therapy for obesity remains bariatric surgery, which is associated with resolution of T2DM in over 80% of patients. The currently available pharmacotherapies for T2DM mostly result in weight gain. Pramlintide and exenatide are new therapies which hold promise, because in addition to improved glycaemic control, they also result in weight loss.
2型糖尿病（T2DM）是一种营养过剩性疾病；其发病和进展与腹部、肌肉和肝脏中脂肪过度堆积有关。在本综述中，我们将重点关注肥胖管理，将其作为葡萄糖代谢紊乱管理的主要策略。通过饮食和运动实现适度体重减轻（约7%）可预防或延缓T2DM的发病。在已确诊T2DM的患者中，体重减轻可降低空腹和餐后血糖水平、糖化血红蛋白（HbA1c），并减少药物治疗需求。热量限制、有氧运动和抗阻运动对葡萄糖代谢的有益作用可能独立于体重减轻而发生。当需要大幅减轻体重时，代餐可在维持微量营养素摄入的同时大幅减少能量消耗。肥胖的药物治疗作为综合管理计划的一部分，有助于维持体重减轻并优化血糖控制。肥胖最有效的长期治疗方法仍然是减重手术，超过80%的患者术后T2DM得到缓解。目前可用的T2DM药物大多会导致体重增加。普兰林肽和艾塞那肽是有前景的新疗法，因为除了改善血糖控制外，它们还能减轻体重。
