Ochsner Diabetes Clinical Research Unit, Department of Endocrinology, Diabetes and Metabolism, Ochsner Medical Center, New Orleans, LA 70121, USA.
Cleve Clin J Med. 2009 Dec;76 Suppl 5:S4-11. doi: 10.3949/ccjm.76.s5.02.
The current epidemics of excessive weight and type 2 diabetes mellitus (T2DM) cause significant morbidity and mortality. T2DM frequently coexists with excess weight as well as hypertension and dyslipidemia, placing a significant percentage of the population at an elevated risk of cardiovascular disease. Maintaining effective glycemic control is linked with a diminished risk of developing microvascular complications, and recent studies have shown it may also reduce overall macro vascular complications. Reduction of associated risk factors, including those related to excessive weight, high blood pressure, and dyslipidemia, are also necessary to meaningfully decrease cardiovascular risk. Agents that can improve glycemia with weight neutrality or weight loss could offer additional benefit to overweight patients with T2DM. Although the major pathophysiologic defects in T2DM are recognized to be beta-cell dysfunction and peripheral insulin resistance, derangements in the incretin system may contribute as well. Antidiabetes agents targeting this system include dipeptidyl peptidase-4 (DPP-4) inhibitors and glucagon-like peptide-1 (GLP-1) receptor agonists. Both classes have been shown to significantly reduce hyperglycemia. GLP-1 receptor agonists also promote significant weight loss and have potentially beneficial effects on cardiovascular risk markers.
目前，超重和 2 型糖尿病（T2DM）的流行导致了大量的发病率和死亡率。T2DM 通常与超重、高血压和血脂异常并存，使相当一部分人口面临心血管疾病的高风险。保持有效的血糖控制与降低微血管并发症的风险相关，最近的研究表明，它也可能降低整体大血管并发症的风险。降低相关的风险因素，包括与超重、高血压和血脂异常相关的因素，对于显著降低心血管风险也是必要的。能够在不增加体重或减轻体重的情况下改善血糖的药物，可能会为超重的 T2DM 患者带来额外的益处。尽管 T2DM 的主要病理生理缺陷被认为是β细胞功能障碍和外周胰岛素抵抗，但肠促胰岛素系统的紊乱也可能起作用。针对该系统的抗糖尿病药物包括二肽基肽酶-4（DPP-4）抑制剂和胰高血糖素样肽-1（GLP-1）受体激动剂。这两类药物都已被证明能显著降低高血糖。GLP-1 受体激动剂还能显著减轻体重，并对心血管风险标志物有潜在的有益影响。
