Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, The University of Tennessee Health Science Center, Memphis, TN 38163, USA.
Metabolism. 2011 Jan;60(1):1-23. doi: 10.1016/j.metabol.2010.09.010.
The prevalence of type 2 diabetes continues to increase at an alarming rate around the world, with even more people being affected by prediabetes. Although the pathogenesis and long-term complications of type 2 diabetes are fairly well known, its treatment has remained challenging, with only half of the patients achieving the recommended hemoglobin A(1c) target. This narrative review explores the pathogenetic rationale for the treatment of type 2 diabetes, with the view of fostering better understanding of the evolving treatment modalities. The diagnostic criteria including the role of hemoglobin A(1c) in the diagnosis of diabetes are discussed. Due attention is given to the different therapeutic maneuvers and their utility in the management of the diabetic patient. The evidence supporting the role of exercise, medical nutrition therapy, glucose monitoring, and antiobesity measures including pharmacotherapy and bariatric surgery is discussed. The controversial subject of optimum glycemic control in hospitalized and ambulatory patients is discussed in detail. An update of the available pharmacologic options for the management of type 2 diabetes is provided with particular emphasis on newer and emerging modalities. Special attention has been given to the initiation of insulin therapy in patients with type 2 diabetes, with explanation of the pathophysiologic basis for insulin therapy in the ambulatory diabetic patient. A review of the evidence supporting the efficacy of the different preventive measures is also provided.
2 型糖尿病的患病率在全球范围内以惊人的速度持续上升，更多的人受到糖尿病前期的影响。尽管 2 型糖尿病的发病机制和长期并发症已经相当清楚，但治疗仍然具有挑战性，只有一半的患者达到了推荐的血红蛋白 A1c 目标。这篇叙述性评论探讨了 2 型糖尿病治疗的发病机制基础，以期更好地理解不断发展的治疗方式。讨论了包括血红蛋白 A1c 在糖尿病诊断中的作用在内的诊断标准。还特别关注了不同的治疗手段及其在糖尿病患者管理中的应用。讨论了支持运动、医学营养治疗、血糖监测以及包括药物治疗和减肥手术在内的抗肥胖措施作用的证据。详细讨论了住院和门诊患者最佳血糖控制的争议性问题。提供了管理 2 型糖尿病的现有药物选择的最新信息，特别强调了新出现的治疗方式。特别关注了在 2 型糖尿病患者中启动胰岛素治疗的问题，并解释了在门诊糖尿病患者中胰岛素治疗的病理生理基础。还提供了支持不同预防措施有效性的证据综述。
