Chockalingam Anand, Natarajan Pandiyan, Dorairajan Smrita, Khan Uzma
Division of Cardiovascular Medicine, University of Missouri, Columbia, MO, USA.
Cardiology Section, Harry S Truman VA Medical Center, Columbia, MO, USA.
touchREV Endocrinol. 2023 May;19(1):33-37. doi: 10.17925/EE.2023.19.1.33. Epub 2023 Mar 27.
Diabetes is the ninth leading cause of death, directly accounting for 1.5 million deaths annually worldwide. Despite several breakthrough discoveries, little progress has been made in type 2 diabetes outcomes over the past 100 years. Younger age (below 60 years), a diet high in calories and processed food, and severe obesity (body mass index >35 kg/m) may identify reversible beta cell dysfunction. Much of the clinical presentation pertains to flooding the body's adaptive limits with overnutrition. Recognizing this as a global societal trend brought about by lifestyle changes, sedentary work, mental stress and unlimited access to calorie-dense foods is crucial. Insulin resistance and genetic abnormalities cannot account for the dramatic increase in diabetes, from only 1% five decades ago to nearly 10% today. Obesity - and not insulin resistance - is at the core of the problem. As well as hyperglycaemia, end-organ damage can also be reversed with diet and weight loss in many affected individuals. We present the evolution of our understanding and compelling reasons to reframe diabetes in the severely obese to what it really is - overweight hyperglycaemia. This may shift societal perception, governmental funding, workplace reformations and individual engagement with healthy lifestyles. The objective of this review is to better understand global trends and the potential to improve outcomes by reframing the diabetes narrative towards remission. This may shift societal perception, governmental funding, workplace reformations and individual engagement with healthy lifestyles.
糖尿病是第九大主要死因，在全球每年直接导致150万人死亡。尽管有几项突破性发现，但在过去100年里，2型糖尿病的治疗结果进展甚微。较年轻的年龄（60岁以下）、高热量和加工食品的饮食以及严重肥胖（体重指数>35kg/m²）可能表明存在可逆的β细胞功能障碍。许多临床表现都与营养过剩超出身体的适应极限有关。认识到这是由生活方式改变、久坐工作、精神压力以及无限制获取高热量食物所导致的全球社会趋势至关重要。胰岛素抵抗和基因异常无法解释糖尿病从五十年前仅1%急剧增加到如今近10%的情况。肥胖——而非胰岛素抵抗——才是问题的核心。除高血糖外，许多受影响个体通过饮食和减重也可逆转终末器官损伤。我们阐述了我们理解的演变过程以及将严重肥胖人群中的糖尿病重新定义为超重高血糖的令人信服的理由。这可能会改变社会认知、政府资金投入、职场改革以及个人对健康生活方式的参与度。本综述的目的是更好地理解全球趋势以及通过将糖尿病的描述转向缓解来改善治疗结果的潜力。这可能会改变社会认知、政府资金投入、职场改革以及个人对健康生活方式的参与度。
