Monnier Louis, Colette Claude
Department of Metabolic Diseases, Lapeyronie Hospital, 34295 Montpellier Cedex 5, France.
Diabetes Care. 2008 Feb;31 Suppl 2:S150-4. doi: 10.2337/dc08-s241.
Diabetes is characterized by glycemic disorders that include both sustained chronic hyperglycemia and acute glucose fluctuations. There is now cogent evidence for the deleterious effects of sustained chronic hyperglycemia that results in excessive protein glycation and generation of oxidative stress. The role of glucose variability from peaks to nadirs is less documented, but there are many reasons to think that both upward (postprandial) and downward (interprandial) acute fluctuations of glucose around a mean value activate the oxidative stress. As a consequence, it is strongly suggested that a global antidiabetic strategy should be aimed at reducing to a minimum the different components of dysglycemia (i.e., A1C, fasting and postprandial glucose, as well as glucose variability). All the therapeutic agents that act on postprandial glucose excursions seem of particular interest for reducing the latter parameter (i.e., the glucose instability). Particular attention should be paid to such emerging therapeutic agents as the glucagon-like peptide 1 agonists and the dipeptidyl peptidase (DPP)-IV inhibitors that act through the incretin pathway.
糖尿病的特征是血糖紊乱，包括持续性慢性高血糖和急性血糖波动。目前有确凿证据表明，持续性慢性高血糖会产生有害影响，导致蛋白质过度糖化并产生氧化应激。血糖从峰值到谷值的变异性作用记录较少，但有许多理由认为，围绕平均值的向上（餐后）和向下（餐间）急性血糖波动都会激活氧化应激。因此，强烈建议全球抗糖尿病策略应旨在将血糖异常的不同组成部分（即糖化血红蛋白、空腹和餐后血糖以及血糖变异性）降至最低。所有作用于餐后血糖波动的治疗药物似乎对降低后一参数（即血糖不稳定性）特别有意义。应特别关注诸如胰高血糖素样肽1激动剂和通过肠促胰岛素途径起作用的二肽基肽酶（DPP）-IV抑制剂等新兴治疗药物。
