Institute of Physiology, Faculty of Medicine, University of Coimbra, Subunit 1, polo 3, Azinhaga de Santa Comba, Celas, 3000-354 Coimbra, Portugal ; IBILI, University of Coimbra, Coimbra, Portugal.
EPMA J. 2010 Mar;1(1):138-63. doi: 10.1007/s13167-010-0010-9. Epub 2010 Mar 13.
Diabetes mellitus is a widespread disease prevalence and incidence of which increases worldwide. The introduction of insulin therapy represented a major breakthrough in type 1 diabetes; however, frequent hyper- and hypoglycemia seriously affects the quality of life of these patients. New therapeutic approaches, such as whole pancreas transplant or pancreatic islet transplant, stem cell, gene therapy and islets encapsulation are discussed in this review. Regarding type 2 diabetes, therapy has been based on drugs that stimulate insulin secretion (sulphonylureas and rapid-acting secretagogues), reduce hepatic glucose production (biguanides), delay digestion and absorption of intestinal carbohydrate (alpha-glucosidase inhibitors) or improve insulin action (thiazolidinediones). This review is also focused on the newer therapeutically approaches such as incretin-based therapies, bariatric surgery, stem cells and other emerging therapies that promise to further extend the options available. Gene-based therapies are among the most promising emerging alternatives to conventional treatments. Some of these therapies rely on genetic modification of non-differentiated cells to express pancreatic endocrine developmental factors, promoting differentiation of non-endocrine cells into β-cells, enabling synthesis and secretion of insulin in a glucose-regulated manner. Alternative therapies based on gene silencing using vector systems to deliver interference RNA to cells (i.e. against VEGF in diabetic retinopathy) are also a promising therapeutic option for the treatment of several diabetic complications. In conclusion, treatment of diabetes faces now a new era that is characterized by a variety of innovative therapeutic approaches that will improve quality-life and allow personalized therapy-planning in the near future.
糖尿病是一种广泛存在的疾病，其患病率和发病率在全球范围内都有所增加。胰岛素治疗的引入代表了 1 型糖尿病治疗的重大突破；然而，频繁的高血糖和低血糖严重影响了这些患者的生活质量。本文综述了新的治疗方法，如全胰腺移植或胰岛移植、干细胞、基因治疗和胰岛包封。对于 2 型糖尿病，治疗一直基于刺激胰岛素分泌的药物（磺酰脲类和速效促分泌素）、减少肝葡萄糖生成（双胍类）、延缓肠道碳水化合物的消化和吸收（α-葡萄糖苷酶抑制剂）或改善胰岛素作用（噻唑烷二酮类）。本文还重点介绍了一些新的治疗方法，如基于肠促胰岛素的治疗、减肥手术、干细胞和其他有前途的治疗方法，这些方法有望进一步扩大治疗选择。基于基因的治疗方法是传统治疗方法最有前途的替代方法之一。这些治疗方法中的一些依赖于对未分化细胞进行基因修饰，以表达胰腺内分泌发育因子，促进非内分泌细胞向β细胞分化，使胰岛素以葡萄糖调节的方式合成和分泌。基于基因沉默的替代疗法，使用载体系统将干扰 RNA 递送到细胞（例如，糖尿病视网膜病变中的 VEGF），也是治疗多种糖尿病并发症的一种有前途的治疗选择。总之，糖尿病的治疗现在面临着一个新时代，其特征是各种创新的治疗方法，这些方法将改善生活质量，并允许在不久的将来进行个性化的治疗计划。
