China-Japan Friendship Hospital, Beijing, China.
Guangdong Provincial Key Laboratory of Diabetology, Department of Endocrinology, The Third Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China.
Lancet Diabetes Endocrinol. 2014 Dec;2(12):992-1002. doi: 10.1016/S2213-8587(14)70136-6. Epub 2014 Sep 10.
Diabetes is a huge burden in China, where about 100 million people have been diagnosed with the disease. Treatments are needed that are optimal for treating Chinese patients with diabetes. Chinese patients with type 2 diabetes are characterised by having relatively low bodyweight and significant β-cell deterioration. β-cell failure results in deficiency of insulin secretion, particularly at the early phase of insulin secretion in Chinese patients. As a result, postprandial hyperglycaemia is more pronounced in Chinese patients with early type 2 diabetes than most other ethnic groups. These characteristics point to the key strategies when considering early therapy for Chinese patients with type 2 diabetes, including control of postprandial hyperglycaemia and β-cell preservation. Besides metformin, insulin secretagogues and α-glucosidase inhibitors that target postprandial hyperglycaemia are recommended for drug-naive patients. Short-term intensive insulin therapy is suggested for patients with severe hyperglycaemia at diagnosis to help restore β-cell function. Use of incretin-based drugs is also recommended when treatment fails with metformin, insulin secretagogues, and α-glucosidase inhibitors. Although data on antidiabetic drugs in Chinese patients are growing, there are still gaps in the evidence base. Research is needed to strengthen the evidence-based treatment guidelines for Chinese patients with type 2 diabetes.
在中国，糖尿病是一个巨大的负担，约有 1 亿人被诊断出患有这种疾病。需要找到针对中国糖尿病患者的最佳治疗方法。中国 2 型糖尿病患者的特点是体重相对较低，β细胞功能严重恶化。β细胞衰竭导致胰岛素分泌不足，尤其是在胰岛素早期分泌阶段，中国患者更为明显。因此，与大多数其他种族群体相比，中国早期 2 型糖尿病患者的餐后高血糖更为明显。这些特征表明，在考虑中国 2 型糖尿病患者的早期治疗策略时，需要关注餐后高血糖的控制和β细胞的保护。除了二甲双胍外，对于初治患者，还推荐使用针对餐后高血糖的胰岛素促分泌剂和α-葡萄糖苷酶抑制剂。对于诊断时血糖严重升高的患者，建议短期强化胰岛素治疗以帮助恢复β细胞功能。当使用二甲双胍、胰岛素促分泌剂和α-葡萄糖苷酶抑制剂治疗失败时，也推荐使用基于肠促胰岛素的药物。尽管中国患者的降糖药物数据在不断增加，但证据基础仍存在差距。需要开展研究来加强中国 2 型糖尿病患者的循证治疗指南。
