Diabetes New Frontiers, Independent Research, Timiryazeva 2b, Almaty 050013, Kazakhstan.
Med Hypotheses. 2010 Jun;74(6):1002-5. doi: 10.1016/j.mehy.2010.01.016. Epub 2010 Feb 9.
This article presents a novel view on the diabetes aetiology from the standpoint of a single epidemiological factor. It has been observed that, irrespective of the type of diabetes, sufferers have a stable, persistent behavioural habit: to take a rest or to have a nap within two hours of a meal. Such habitual behaviour is termed as postprandial hypokinesia (PPH). The working hypothesis is that, after food intake and with the body in a recumbent/semirecumbent position on the back, the stomach replete with food places mechanical pressure against the pancreas. As a consequence, systematic disturbances in the microcirculatory flow of the islets of Langerhans (ischemia) cause hypoxia to develop which, ultimately, sets in train a pathological process (and later, an autoimmune reaction). The intensity and effect of structurally-functional disturbances are determined by the degree of hypoxia. Literature sources support the islets of Langerhans being physiologically susceptible to hypoxia. Moreover, the same effects of experimental hypoxia on the islets of Langerhans are also observed in the pathogenesis of diabetes. Accumulated scientific research makes possible to construct an ischemic/hypoxic model of diabetes development. The core pathological process then should involve all the following pathologies: inflammation of the islets of Langerhans, dysfunction of an insulin islet apparatus, apoptosis/necrosis of the cells in the insulin islets. All three are also observed in diabetes. From this perspective, conventional types of diabetes can be regarded as different states, apparently progressing, of a single pathological process attributed to the level reached in the compensatory capacity exhaustion. It follows that, with the elimination of PPH, conditions for the pathological process to be reversed are created: the reparation of injured tissues and the recovery of function to synthesise and secrete insulin are likely. Those patients under observation, who eliminated the PPH behaviour from their lifestyle, encountered a positive dynamic in terms of an increased capacity for work, improvement in general condition, normalization of glycemia level, a decrease in medication as well as remission. The major implication of the hypothesis, if correct and accepted, is that the use of medication on a stand-alone basis without alterations to a lifestyle would not be sufficient to produce successful treatment and cure of diabetes. Behavioural therapy should be used as a primary causal therapeutic action. Education on the consequences of the PPH factor should be used as a primary preventive measure.
本文从单一流行病学因素的角度对糖尿病病因提出了新的观点。研究发现，无论哪种类型的糖尿病，患者都有一个稳定且持久的行为习惯：在进食后两小时内休息或小睡。这种习惯性行为被称为餐后低动力（PPH）。工作假说认为，进食后，身体处于仰卧或半仰卧的背部姿势，充满食物的胃会对胰腺施加机械压力。结果，胰岛朗格汉斯（缺血）的微循环流动会出现系统性紊乱，导致缺氧，最终引发病理过程（随后是自身免疫反应）。结构功能障碍的强度和效果取决于缺氧程度。文献资料支持胰岛朗格汉斯在生理学上易受缺氧影响。此外，在胰岛朗格汉斯的实验性缺氧中也观察到了相同的效果，这些效果也在糖尿病的发病机制中观察到。积累的科学研究使得构建糖尿病发展的缺血/缺氧模型成为可能。核心病理过程随后应涉及所有以下病理学：胰岛朗格汉斯炎症、胰岛素胰岛装置功能障碍、胰岛细胞凋亡/坏死。所有这三种情况也都在糖尿病中观察到。从这个角度来看，传统类型的糖尿病可以被视为单一病理过程的不同状态，显然是在代偿能力衰竭的程度上进展。因此，消除 PPH 后，就会创造出逆转病理过程的条件：受损组织的修复和合成及分泌胰岛素功能的恢复。那些观察到的患者，他们从生活方式中消除了 PPH 行为，在工作能力增强、一般状况改善、血糖水平正常化、药物减少以及缓解方面出现了积极的动态。如果假设正确并被接受，其主要意义是，仅使用药物而不改变生活方式，不足以成功治疗和治愈糖尿病。行为疗法应该作为主要的因果治疗手段。应该将关于 PPH 因素后果的教育作为主要的预防措施。
