BHF Centre of Excellence in Cardiovascular Research, The Rayne Institute, Department of Cardiology, King's College London, St Thomas' Hospital, Westminster Palace Road, London SE1 7EH, UK.
Ther Adv Chronic Dis. 2013 Sep;4(5):242-61. doi: 10.1177/2040622313494986.
Diabetes is a major and growing public health challenge which threatens to overwhelm medical services in the future. Type 2 diabetes confers significant morbidity and mortality, most notably with target organ damage to the eyes, kidneys, nerves and heart. The magnitude of cardiovascular risk associated with diabetes is best illustrated by its position as a coronary heart disease risk equivalent. Complications related to neuropathy are also vast, often working in concert with vascular abnormalities and resulting in serious clinical consequences such as foot ulceration. Increased understanding of the natural history of this disorder has generated the potential to intervene and halt pathological progression before overt disease ensues, after which point management becomes increasingly challenging. The concept of prediabetes as a formal diagnosis has begun to be translated from the research setting to clinical practice, but with continually updated guidelines, varied nomenclature, emerging pharmacotherapies and an ever-changing evidence base, clinicians may be left uncertain of best practice in identifying and managing patients at the prediabetic stage. This review aims to summarize the epidemiological data, new concepts in disease pathogenesis and guideline recommendations in addition to lifestyle, pharmacological and surgical therapies targeted at stopping progression of prediabetes to diabetes. While antidiabetic medications, with newer anti-obesity medications and interventional bariatric procedures have shown some promising benefits, diet and therapeutic lifestyle change remains the mainstay of management to improve the metabolic profile of individuals with glucose dysregulation. New risk stratification tools to identify at-risk individuals, coupled with unselected population level intervention hold promise in future practice.
糖尿病是一个主要且日益严重的公共卫生挑战，未来可能会使医疗服务不堪重负。2 型糖尿病会导致严重的发病率和死亡率，尤其是对眼睛、肾脏、神经和心脏等靶器官的损害。糖尿病相关心血管风险的严重程度可以通过其作为冠心病风险等效物的地位得到最好的说明。与神经病变相关的并发症也很多，通常与血管异常协同作用，导致严重的临床后果，如足部溃疡。对这种疾病自然史的深入了解，为在明显疾病发生之前进行干预和阻止病理进展提供了潜力，此后，管理变得越来越具有挑战性。糖尿病前期作为一种正式诊断的概念已经开始从研究领域转化为临床实践，但随着不断更新的指南、不同的命名法、新兴的药物治疗和不断变化的证据基础，临床医生可能不确定在识别和管理糖尿病前期患者方面的最佳实践。本综述旨在总结流行病学数据、疾病发病机制的新概念以及指南建议，以及针对阻止糖尿病前期进展为糖尿病的生活方式、药物和手术治疗。虽然抗糖尿病药物，包括新型抗肥胖药物和介入性减肥手术，已经显示出一些有希望的益处，但饮食和治疗性生活方式改变仍然是改善葡萄糖失调个体代谢特征的主要管理方法。新的风险分层工具可以识别高危人群，加上对未选择人群的干预，有望在未来的实践中得到应用。
