Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, 130 North Bellefield Avenue, Pittsburgh, PA 15261, USA.
Curr Diab Rep. 2012 Jun;12(3):265-73. doi: 10.1007/s11892-012-0263-x.
Excess total and cardiovascular morbidity and mortality remain very high among those with type 2 diabetes versus those without diabetes. Clinical trials to lower blood glucose have been disappointing probably because the participants were too late in the natural history of diabetes and already had extensive vascular disease. Insulin resistance measured simply by elevated fasting blood insulin is an early marker of β-cell stress and peripheral insulin resistance. Metformin will prevent development of diabetes among patients with impaired fasting glucose but only for the short term. Metformin reduces risk of coronary heart disease. The drug is safe, low cost, and may also prevent cancer. The combination of diet and exercise followed by metformin in the early phase of "insulin resistance" may reduce or delay both atherosclerosis and arteriosclerosis complications associated with diabetes. Preventive therapy must begin much earlier than before clinical diagnosis of diabetes and aim to initially lower blood insulin levels or insulin resistance.
2 型糖尿病患者的总死亡率和心血管发病率仍明显高于非糖尿病患者。降低血糖的临床试验令人失望，可能是因为参与者处于糖尿病自然病程的晚期，已经存在广泛的血管疾病。单纯通过空腹血胰岛素升高来衡量的胰岛素抵抗是β细胞应激和外周胰岛素抵抗的早期标志物。二甲双胍可以预防空腹血糖受损患者发生糖尿病，但仅在短期有效。二甲双胍可以降低冠心病风险。该药安全、成本低，还可能预防癌症。在“胰岛素抵抗”的早期阶段，饮食和运动相结合，再加上二甲双胍，可以减少或延缓与糖尿病相关的动脉粥样硬化和动脉硬化并发症。预防性治疗必须比临床诊断糖尿病前更早开始，目的是最初降低血胰岛素水平或胰岛素抵抗。
