USC Clinical Diabetes Programs, Keck School of Medicine of USC, University of Southern California, Los Angeles, CA , USA.
Cleve Clin J Med. 2009 Dec;76 Suppl 5:S20-7. doi: 10.3949/ccjm.76.s5.04.
Lifestyle modifications in conjunction with antidiabetes medications can produce near-normal blood glucose concentrations in patients with type 2 diabetes mellitus (T2DM). Because these patients have increased cardiovascular morbidity and mortality, treatment strategies should also address the cardiovascular aspects of the disease, including blood pressure, lipids, and body weight. Since the prevalence of these abnormalities is increasingly secondary to poor diet and sedentary lifestyles and because most patients with T2DM are overweight/obese, clinicians are encouraged to help patients reduce body weight while correcting hyperglycemia by selecting treatment options that improve both parameters. The glucose-lowering properties of insulin and sulfonylureas are well known but they are also associated with weight gain. Thiazolidinediones are associated with weight gain as well as edema. However, this weight gain may be more peripheral than central, which may mitigate the risks associated with increased body fat. Metformin, the consensus first-line drug for the treatment of patients with T2DM, is weight neutral. Newer antidiabetes agents include incretin-based medications, such as the glucagon-like peptide-1 receptor agonists, which tend to decrease weight, and the dipeptidyl peptidase-4 inhibitors, which are weight neutral.
生活方式的改变结合抗糖尿病药物可以使 2 型糖尿病（T2DM）患者的血糖浓度接近正常。由于这些患者心血管发病率和死亡率增加，治疗策略也应针对疾病的心血管方面，包括血压、血脂和体重。由于这些异常的发生越来越多地与不良饮食和久坐的生活方式有关，而且大多数 T2DM 患者超重/肥胖，因此鼓励临床医生通过选择既能改善这两个参数又能改善血糖的治疗方案，帮助患者减轻体重，同时纠正高血糖。胰岛素和磺酰脲类药物的降血糖作用是众所周知的，但它们也与体重增加有关。噻唑烷二酮类药物也与体重增加和水肿有关。然而，这种体重增加可能更多的是外周性的，而不是中心性的，这可能减轻与体脂增加相关的风险。二甲双胍是治疗 T2DM 患者的共识一线药物，对体重无影响。较新的抗糖尿病药物包括基于肠促胰岛素的药物，如胰高血糖素样肽-1 受体激动剂，这些药物往往会减轻体重，以及二肽基肽酶-4 抑制剂，它们对体重无影响。
