Khavandi Kaivan, Brownrigg Jack, Hankir Mohammed, Sood Harpreet, Younis Naveed, Worth Joy, Greenstein Adam, Soran Handrean, Wierzbicki Anthony, Goldsmith David J
King's College London BHF Centre, The Rayne Institute, St. Thomas Hospital, Westminster Bridge Road, London SE1 7EH, UK.
Curr Vasc Pharmacol. 2014 Jan;12(1):155-67. doi: 10.2174/15701611113119990118.
In recent decades we have seen a surge in the incidence of diabetes in industrialized nations; a threat which has now extended to the developing world. Type 2 diabetes is associated with significant microvascular and macrovascular disease, with considerable impact on morbidity and mortality. Recent evidence has cast uncertainty on the benefits of very tight glycaemic goals in these individuals. The natural history of disease follows an insidious course from disordered glucose metabolism in a pre-diabetic state, often with metabolic syndrome and obesity, before proceeding to diabetes mellitus. In the research setting, lifestyle, pharmacological and surgical intervention targeted against obesity and glycaemia has shown that metabolic disturbances can be halted and indeed regressed if introduced at an early stage of disease. In addition to traditional anti-diabetic medications such as the glinides, sulphonylureas and the glitazones, novel therapies manipulating the endocannabinoid system, neurotransmitters, intestinal absorption and gut hormones have shown dual benefit in weight loss and glycaemic control normalisation. Whilst these treatments will not and should not replace lifestyle change, they will act as invaluable adjuncts for weight loss and aid in normalising the metabolic profile of individuals at risk of diabetes. Utilizing novel therapies to prevent diabetes should be the focus of future research, with the aim of preventing the challenging microvascular and macrovascular complications, and ultimately cardiovascular death.
近几十年来，我们发现工业化国家中糖尿病的发病率急剧上升，这一威胁现已蔓延至发展中世界。2型糖尿病与严重的微血管和大血管疾病相关，对发病率和死亡率有重大影响。最近的证据对这些患者设定非常严格的血糖目标是否有益提出了质疑。疾病的自然史是一个隐匿的过程，从糖尿病前期状态下的糖代谢紊乱开始，通常伴有代谢综合征和肥胖，然后发展为糖尿病。在研究中，针对肥胖和血糖的生活方式、药物和手术干预表明，如果在疾病早期进行干预，代谢紊乱可以得到控制甚至逆转。除了传统的抗糖尿病药物，如格列奈类、磺脲类和噻唑烷二酮类，操纵内源性大麻素系统、神经递质、肠道吸收和肠道激素的新型疗法在减肥和使血糖控制正常化方面都显示出双重益处。虽然这些治疗不会也不应该取代生活方式的改变，但它们将成为减肥的宝贵辅助手段，并有助于使有糖尿病风险的个体的代谢状况正常化。利用新型疗法预防糖尿病应该成为未来研究的重点，目标是预防具有挑战性的微血管和大血管并发症，最终预防心血管死亡。
