DeFronzo Ralph A, Triplitt Curtis L, Abdul-Ghani Muhammad, Cersosimo Eugenio
Diabetes Spectr. 2014 May;27(2):100-12. doi: 10.2337/diaspect.27.2.100.
In Brief Impaired insulin secretion, increased hepatic glucose production, and decreased peripheral glucose utilization are the core defects responsible for the development and progression of type 2 diabetes. However, the pathophysiology of this disease also includes adipocyte insulin resistance (increased lipolysis), reduced incretin secretion/sensitivity, increased glucagon secretion, enhanced renal glucose reabsorption, and brain insulin resistance/neurotransmitter dysfunction. Although current diabetes management focuses on lowering blood glucose, the goal of therapy should be to delay disease progression and eventual treatment failure. Recent innovative treatment approaches target the multiple pathophysiological defects present in type 2 diabetes. Optimal management should include early initiation of combination therapy using multiple drugs with different mechanisms of action. This review examines novel therapeutic options that hold particular promise.
简而言之，胰岛素分泌受损、肝脏葡萄糖生成增加以及外周葡萄糖利用减少是2型糖尿病发生和发展的核心缺陷。然而，这种疾病的病理生理学还包括脂肪细胞胰岛素抵抗（脂解增加）、肠促胰岛素分泌/敏感性降低、胰高血糖素分泌增加、肾脏葡萄糖重吸收增强以及脑胰岛素抵抗/神经递质功能障碍。尽管目前糖尿病管理侧重于降低血糖，但治疗目标应是延缓疾病进展和最终治疗失败。最近的创新治疗方法针对2型糖尿病存在的多种病理生理缺陷。最佳管理应包括早期开始使用具有不同作用机制的多种药物进行联合治疗。本综述探讨了具有特别前景的新型治疗选择。
