Department of Cardiology, Chicago Medical School, VA Medical Center, North Chicago, Illinois 60064, USA.
Am J Ther. 2009 Nov-Dec;16(6):e51-9. doi: 10.1097/MJT.0b013e31815db924.
Insulin-resistant diabetes is becoming more prevalent among the general U.S. population. Approximately 20 million people had diabetes in 2005, of which one third of the population had impaired fasting glucose. The prevalence rate is 9%, a more alarming rate in the 20- to 39-year age group, which suggests a significant degree of how even the young are affected. We review how the prediabetic stage (impaired glucose tolerance-impaired fasting glucose and impaired glucose tolerance-impaired glucose tolerance) plays a vital role as a risk factor for cardiovascular disease, and the effectiveness of lifestyle modifications with drug therapy reduces the cardiovascular risk of early diabetes and its complications. A lifestyle modification like effective weight loss and exercise, with or without antidiabetic drugs, prevents the proatherogenic effects of diabetes. Controlled, randomized studies have shown that progression to diabetes among those with prediabetes is not inevitable; people with prediabetes who lose weight and increase their physical activity can prevent or delay diabetes and could even return their blood glucose levels to normal. Although prevention of prediabetes is a huge challenge, a tight glycemic control with lifestyle modifications and antihyperglycemics like thiazolidinediones play a vital role in increasing the insulin sensitivity of tissues and decreasing the cardiovascular risk factor of diabetes.
在普通美国人群中，胰岛素抵抗型糖尿病变得越来越普遍。2005 年，大约有 2000 万人患有糖尿病，其中三分之一的人空腹血糖受损。患病率为 9%，在 20 至 39 岁年龄组中更为惊人，这表明即使是年轻人也受到了相当大的影响。我们回顾了糖尿病前期（糖耐量受损-空腹血糖受损和糖耐量受损-糖耐量受损）作为心血管疾病危险因素的重要作用，以及生活方式改变与药物治疗相结合降低早期糖尿病及其并发症的心血管风险的效果。像有效减肥和运动这样的生活方式改变，无论是单独进行还是与抗糖尿病药物联合进行，都可以防止糖尿病的动脉粥样硬化作用。对照、随机研究表明，糖尿病前期患者进展为糖尿病并非不可避免；通过减肥和增加体力活动，糖尿病前期患者可以预防或延迟糖尿病的发生，甚至可以使血糖水平恢复正常。尽管预防糖尿病前期是一个巨大的挑战，但通过生活方式改变和噻唑烷二酮类等抗高血糖药物进行严格的血糖控制，对于提高组织的胰岛素敏感性和降低糖尿病的心血管风险因素起着至关重要的作用。
