Kishida Ken, Funahashi Tohru, Shimomura Iichiro
Department of Metabolism and Atherosclerosis, Graduate School of Medicine, Osaka University, 2-2 B-5, Yamada-oka, Suita, Osaka 565-0871, Japan.
Curr Diabetes Rev. 2012 Mar;8(2):84-91. doi: 10.2174/157339912799424546.
Type 2 diabetes mellitus (T2DM) is a complex heterogeneous group of metabolic disorders including hyperglycemia and impaired insulin action and/or insulin secretion. Obesity T2DM has become a serious problem in Japan as in Western countries, with over-eating and physical inactivity. Obese Asians have mild degree of adiposity, compared with Western subjects. Unlike total body fat, body fat distribution, especially excess accumulation of visceral fat, correlates with various diabetogenic, atherogenic, prothrombotic and proinflammatory metabolic abnormalities, which increase the risk of atherosclerotic cardiovascular disease (ACVD). Obese patients with T2DM have poor glycemic control with disordered eating behaviors, and complications of hypertension and dyslipidemia, leading to ACVD. The major therapies in obese T2DM, hyperinsulinemia and low insulin sensitivity, available for weight loss, especially visceral fat reduction, include caloric restriction, physical activity and behavior modification. On the other hand, the major therapies in non-obese T2DM with insufficient insulin secretion, are insulin-secretory agents and injectable insulin. For clinically meaningful prevention/reduction in the rate of future ACVD in T2DM, it may be important to stratify T2DM subjects into those with and without visceral obesity and design specific management protocols for each group.
2型糖尿病（T2DM）是一组复杂的异质性代谢紊乱疾病，包括高血糖以及胰岛素作用受损和/或胰岛素分泌受损。与西方国家一样，在日本，由于暴饮暴食和缺乏运动，肥胖型2型糖尿病已成为一个严重问题。与西方受试者相比，亚洲肥胖者的肥胖程度较轻。与全身脂肪不同，身体脂肪分布，尤其是内脏脂肪的过度堆积，与各种致糖尿病、致动脉粥样硬化、促血栓形成和促炎代谢异常相关，这些异常会增加动脉粥样硬化性心血管疾病（ACVD）的风险。肥胖的2型糖尿病患者血糖控制不佳，存在饮食行为紊乱，以及高血压和血脂异常等并发症，进而导致ACVD。肥胖型2型糖尿病的主要治疗方法，即高胰岛素血症和低胰岛素敏感性，可用于减肥，尤其是减少内脏脂肪，包括热量限制、体育活动和行为改变。另一方面，胰岛素分泌不足的非肥胖型2型糖尿病的主要治疗方法是胰岛素分泌剂和注射用胰岛素。为了在临床上有意义地预防/降低2型糖尿病患者未来ACVD的发生率，将2型糖尿病患者分为有内脏肥胖和无内脏肥胖两类，并为每组设计特定的管理方案可能很重要。
