Phillips Lawrence S, Ratner Robert E, Buse John B, Kahn Steven E
Atlanta VA Medical Center, Decatur, GA Division of Endocrinology and Metabolism, Department of Medicine, Emory University School of Medicine, Atlanta, GA
American Diabetes Association, Alexandria, VA.
Diabetes Care. 2014 Oct;37(10):2668-76. doi: 10.2337/dc14-0817.
As diabetes develops, we currently waste the first ∼10 years of the natural history. If we found prediabetes and early diabetes when they first presented and treated them more effectively, we could prevent or delay the progression of hyperglycemia and the development of complications. Evidence for this comes from trials where lifestyle change and/or glucose-lowering medications decreased progression from prediabetes to diabetes. After withdrawal of these interventions, there was no "catch-up"-cumulative development of diabetes in the previously treated groups remained less than in control subjects. Moreover, achieving normal glucose levels even transiently during the trials was associated with a substantial reduction in subsequent development of diabetes. These findings indicate that we can change the natural history through routine screening to find prediabetes and early diabetes, combined with management aimed to keep glucose levels as close to normal as possible, without hypoglycemia. We should also test the hypothesis with a randomized controlled trial.
随着糖尿病的发展，我们目前在自然病程的头约10年里处于浪费状态。如果我们在糖尿病前期和早期糖尿病首次出现时就发现它们并更有效地进行治疗，我们就可以预防或延缓高血糖的进展以及并发症的发生。这方面的证据来自于一些试验，在这些试验中，生活方式改变和/或降糖药物减少了从糖尿病前期进展为糖尿病的情况。在撤掉这些干预措施后，之前接受治疗的组中没有出现“追赶”——糖尿病的累积发生率仍然低于对照组。此外，在试验期间即使短暂地实现血糖正常水平也与随后糖尿病的发生大幅减少相关。这些发现表明，我们可以通过常规筛查来发现糖尿病前期和早期糖尿病，并结合旨在使血糖水平尽可能接近正常且无低血糖的管理措施来改变自然病程。我们还应该通过一项随机对照试验来验证这一假设。
