Department of Internal Medicine, Endocrinology Section, Clinical Center of Montenegro, Ljubljanska bb, 81000 Podgorica, Montenegro; Faculty of Medicine, University of Montenegro, Kruševac bb, 81000, Podgorica, Montenegro.
Faculty of Medicine, University of Montenegro, Kruševac bb, 81000, Podgorica, Montenegro.
J Diabetes Complications. 2020 Aug;34(8):107619. doi: 10.1016/j.jdiacomp.2020.107619. Epub 2020 May 11.
Obesity and overweight are contributing factors for diseases such as type 2 diabetes mellitus (T2DM), hypertension, hyperlipidemia, and ultimately, cardiovascular (CV) disease. Obesity is imposing an increasing health burden in rich and poor nations, with almost 30% of people globally now either obese or overweight - a staggering 2.1 billion. The link between obesity and T2DM is widely held to involve two adverse effects: obesity-induced insulin resistance and β-cell failure. This "unified field theory" raises questions about whether defects favoring progressive weight gain and metabolic impairment also contribute to β-cell decompensation. The concept of weight-centric management of T2DM is considered justified because of the strong negative impact of obesity on the effects of treatment of diabetes. Two pharmacotherapy options are considered: drugs developed primarily for blood glucose control that also exert a favorable effect on body weight and drugs developed primarily to induce weight loss that also have a favorable effect on glycemia. Treating hunger counter-regulatory mechanisms will have an additional effect on glucose control in T2DM. This narrative review addresses advances in pharmacotherapy for the management of obesity and obesity-related co-morbidities, with a focus on T2DM. It is also important to identify the correct balance between weight-centric and glucose-centric management of T2DM.
肥胖和超重是 2 型糖尿病（T2DM）、高血压、高血脂等疾病的促成因素，最终会导致心血管疾病。肥胖正在给富裕和贫穷国家的健康带来越来越大的负担，现在全球几乎有 30%的人要么肥胖要么超重——这一数字令人震惊，达到 21 亿。肥胖与 T2DM 之间的联系被广泛认为涉及两种不利影响：肥胖引起的胰岛素抵抗和β细胞衰竭。这种“统一场理论”提出了一个问题，即是否有利于体重逐渐增加和代谢损伤的缺陷也会导致β细胞失代偿。考虑到肥胖对糖尿病治疗效果的负面影响很大，因此认为以体重为中心的 T2DM 管理概念是合理的。有两种被认为是药理学治疗的选择：主要用于血糖控制的药物，也对体重有有利影响；以及主要用于诱导体重减轻的药物，也对血糖有有利影响。治疗饥饿的反向调节机制将对 T2DM 的血糖控制产生额外的影响。本叙述性综述讨论了肥胖和肥胖相关合并症的药物治疗进展，重点是 T2DM。同样重要的是要在 T2DM 的以体重为中心和以血糖为中心的管理之间找到正确的平衡。
