Fonseca Vivian A
Section of Endocrinology, Tulane University Health Sciences Center, New Orleans, Louisiana 70112, USA.
Clin Cornerstone. 2007;8(2):10-8; discussion 19-20. doi: 10.1016/s1098-3597(09)60004-1.
Overt type 2 diabetes is usually preceded by a condition known as prediabetes, which is characterized by impaired fasting glucose (IFG) and impaired glucose tolerance (IGT). Both IFG and IGT exhibit elevated glucose levels that are not sufficient to be classified as diabetes but that represent the development of insulin resistance. Achieving glycemic control in patients with prediabetes through lifestyle and pharmacologic interventions can effectively prevent or delay the development of diabetes and its associated complications. The first step, however, is to identify patients at risk. Although patients can be identified with an oral glucose tolerance test (OGTT) or a fasting plasma glucose (FPG) screening, a normal FPG does not preclude an elevated OGTT and, therefore, the presence of prediabetes. For patients who progress to type 2 diabetes, intensive therapy aimed at reducing and maintaining glycosylated hemoglobin (A1C) levels <7% has been shown to reduce the risk of complications. An A1C level > or =7% should signal the need to initiate or change therapy to achieve glycemic goals.
显性2型糖尿病通常之前会出现一种称为糖尿病前期的状况，其特征为空腹血糖受损（IFG）和糖耐量受损（IGT）。IFG和IGT均表现出血糖水平升高，虽不足以归类为糖尿病，但代表了胰岛素抵抗的发展。通过生活方式和药物干预对糖尿病前期患者实现血糖控制，可有效预防或延缓糖尿病及其相关并发症的发生。然而，第一步是识别有风险的患者。虽然可通过口服葡萄糖耐量试验（OGTT）或空腹血糖（FPG）筛查来识别患者，但FPG正常并不能排除OGTT升高，因此不能排除糖尿病前期的存在。对于进展为2型糖尿病的患者，旨在降低并维持糖化血红蛋白（A1C）水平<7%的强化治疗已被证明可降低并发症风险。A1C水平>或 =7%应表明需要启动或改变治疗以实现血糖目标。
