Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Research Center, Stockholm, Sweden.
Department of Emergency Care and Internal Medicine, Uppsala University Hospital, Uppsala, Sweden.
Adv Exp Med Biol. 2021;1307:1-5. doi: 10.1007/5584_2020_553.
The number of people living with diabetes, the number of deaths attributable to it, and the cost of treating the disease and its complications are increasing exponentially. Centuries of research led to the discovery of insulin and other drugs based on pathophysiology from "the triumvirate to ominous octet". The agonists of the glucagon-like peptide-1 (GLP-1) receptor, and the inhibitors of the sodium-glucose transport protein 2 (SGLT2) are the new drugs that improve cardiovascular outcomes and provide renal protection, and they are being used increasingly for evidence-based treatment of type 2 diabetes. Bariatric surgery, when indicated, results in excellent weight- and metabolic-control, and in many instances even remission of diabetes. Technological advances like Flash glucose monitoring, continuous subcutaneous insulin infusion (CSII), and continuous glucose monitoring (CGM) have improved glycemic control, reduced episodes of severe hypoglycemia, and improved quality of life. For the treatment of diabetic macular edema intravitreal injection of several anti-VEGF agents are being used. Numerous people living in the middle- and low-income countries cannot afford the costs of care of diabetes. Institutions like the World Health Organization, the World Bank and the International Monetary Fund should roll out plans to convince the politicians to invest more in improving the diabetes care facilities.
糖尿病患者人数、归因于该病的死亡人数以及治疗该病及其并发症的成本正在呈指数级增长。几个世纪的研究导致了基于“三联征到凶险八因子”的病理生理学的胰岛素和其他药物的发现。胰高血糖素样肽-1 (GLP-1) 受体激动剂和钠-葡萄糖转运蛋白 2 (SGLT2) 抑制剂是改善心血管结局并提供肾脏保护的新药,它们越来越多地被用于基于证据的 2 型糖尿病治疗。如果有指征,减肥手术可带来出色的体重和代谢控制,并且在许多情况下甚至可使糖尿病得到缓解。像 Flash 血糖监测、持续皮下胰岛素输注 (CSII) 和连续血糖监测 (CGM) 等技术进步改善了血糖控制,减少了严重低血糖发作的次数,并提高了生活质量。为了治疗糖尿病性黄斑水肿,正在使用几种抗血管内皮生长因子 (VEGF) 药物进行玻璃体内注射。许多中低收入国家的人无法负担糖尿病护理的费用。世界卫生组织、世界银行和国际货币基金组织等机构应制定计划,说服各国政府加大对改善糖尿病护理设施的投资。