Leadership Sinai Centre for Diabetes, Mount Sinai Hospital, Toronto, Canada.
Diabetes Obes Metab. 2012 Oct;14 Suppl 3:161-6. doi: 10.1111/j.1463-1326.2012.01658.x.
The natural history of type 2 diabetes (T2DM) is characterized by progressive deterioration of pancreatic β-cell function, leading to worsening glycemia over time. As current antidiabetic therapies have not yet been shown to profoundly alter this natural history, many patients ultimately will require exogenous insulin therapy to obtain adequate glycemic control. Interestingly, the temporary use of short-term intensive insulin therapy early in the course of T2DM has recently emerged as a therapeutic option that may offer favourable long-term effects on β-cell function. Indeed, after receiving this treatment, many patients will experience sustained euglycemia without requiring any antidiabetic therapy. This apparent 'remission' of diabetes is likely secondary to improved β-cell function and can last for more than a year, although it is not sustained and hyperglycemia eventually will return. Nevertheless, owing to its effects on β-cell function, short-term intensive insulin therapy holds promise as a means for modifying the natural history of T2DM and warrants further study in this context. In this report, we will review the rationale and evidence underlying this interesting therapeutic option, and its implications for both clinical research and the management of patients with T2DM.
2 型糖尿病（T2DM）的自然病程以胰腺β细胞功能的进行性恶化为特征，导致随着时间的推移血糖恶化。由于目前的抗糖尿病疗法尚未被证明能显著改变这种自然病程，许多患者最终将需要外源性胰岛素治疗以获得充分的血糖控制。有趣的是，在 T2DM 病程早期临时使用短期强化胰岛素治疗最近已成为一种治疗选择，可能对β细胞功能产生有利的长期影响。事实上，接受这种治疗后，许多患者在无需任何抗糖尿病治疗的情况下即可持续保持血糖正常。这种糖尿病的“缓解”可能继发于β细胞功能的改善，可持续超过 1 年，尽管它不能持续，高血糖最终会再次出现。然而，由于短期强化胰岛素治疗对β细胞功能的影响，它有望成为改变 T2DM 自然病程的一种手段，值得在这方面进一步研究。在本报告中，我们将回顾这种有趣的治疗选择的基本原理和证据，及其对 T2DM 的临床研究和管理的影响。
