Boden Institute of Obesity, Nutrition and Exercise, University of Sydney, Sydney, NSW, Australia.
Diabetes Obes Metab. 2010 Jun;12(6):463-73. doi: 10.1111/j.1463-1326.2009.01182.x.
A pathogenic relationship exists between type 2 diabetes and obesity. Over the last decade, the escalation in diabetes cases has paralleled the rapid increase in obesity rates, constituting a global health crisis. Environmental risk factors attributed to the global increase in obesity include the consumption of high-calorie, high-fat foods and inadequate physical activity. Obese individuals may also have a genetic predisposition for obesity. Both diabetes and obesity confer an elevated risk of developing a range of complications and comorbidities, including cardiovascular disease, hypertension and stroke, which can complicate disease management. This review examines the aetiology of the linkages between diabetes and obesity and the range of available therapies. Recent clinical evidence substantiating the efficacy and safety of incretin-based antidiabetic therapies is analysed, in addition to data on antiobesity therapeutic strategies, such as antiobesity agents, behaviour modification and bariatric surgery. Glucose control is often accompanied by weight-neutral or modest weight reduction effects with DPP-4 inhibitor treatment (sitagliptin, vildagliptin, saxagliptin) and weight loss with GLP-1 receptor agonist therapy (exenatide, liraglutide). Studies of antiobesity agents including orlistat, sibutramine and rimonabant have shown attrition rates of 30-40%, and the long-term effects of these agents remain unknown. Bariatric surgical procedures commonly performed are laparoscopic adjustable banding of the stomach and the Roux-en-Y gastric bypass, and have produced type 2 diabetes remission rates of up to 73%. Therapeutic strategies that integrate glycaemic control and weight loss will assume greater importance as the prevalence of diabetes and obesity increase.
2 型糖尿病与肥胖之间存在着病因学关系。在过去十年中，糖尿病病例的增加与肥胖率的迅速上升并行不悖，构成了全球健康危机。导致肥胖全球增加的环境风险因素包括摄入高热量、高脂肪食物和缺乏身体活动。肥胖个体也可能存在肥胖的遗传易感性。糖尿病和肥胖都会增加一系列并发症和合并症的风险，包括心血管疾病、高血压和中风，这可能使疾病管理复杂化。这篇综述探讨了糖尿病和肥胖之间关联的病因学以及现有的各种治疗方法。此外，还分析了最近支持基于肠促胰岛素的抗糖尿病疗法疗效和安全性的临床证据，以及抗肥胖治疗策略的数据，如抗肥胖剂、行为改变和减重手术。DPP-4 抑制剂（西他列汀、维格列汀、沙格列汀）治疗常伴随着血糖控制和体重中性或适度减轻的效果，GLP-1 受体激动剂治疗（艾塞那肽、利拉鲁肽）则伴随着体重减轻。奥利司他、西布曲明和利莫那班等抗肥胖剂的研究显示，其淘汰率为 30-40%，这些药物的长期效果仍不清楚。常用的减重手术包括腹腔镜胃带调节和 Roux-en-Y 胃旁路手术，已产生高达 73%的 2 型糖尿病缓解率。随着糖尿病和肥胖症的流行，将血糖控制和体重减轻相结合的治疗策略将变得更加重要。
