Lehmann R, Spinas G A
Abteilung für Endokrinologie und Stoffwechsel, Departement Innere Medizin, Universitätsspital Zürich.
Ther Umsch. 1994 Oct;51(10):693-700.
Despite recent progress in therapy and management of diabetes mellitus, diabetes remains a serious disease with life-threatening complications. It is by far the most common metabolic disease and affects 5% of the population in industrialized countries. Noninsulin-dependent diabetes mellitus (NIDDM) is a complex disorder characterized by insulin resistance and impaired insulin secretion and is associated with an increased risk of coronary heart disease, peripheral vascular disease, arterial hypertension and dyslipidemia. Predisposing factors for NIDDM are obesity and a family history of diabetes. Greater physical activity has been associated inversely with the prevalence of NIDDM in several cross-sectional studies. Physical activity increases the sensitivity to insulin, and regular endurance exercise can induce and maintain weight loss, improve glucose tolerance and ameliorate most of the abnormalities in the metabolic syndrome. Type I diabetes mellitus arises as a consequence of immunologically mediated pancreatic islet beta-cell destruction in genetically susceptible individuals. It is an insidious process that may occur over years. During the stage of disease evolution (prediabetes), individuals may be identified by the presence of immunological markers and a decline of beta-cell function. The autoimmune nature of the disease process has led to attempts to stop this process by immune intervention strategies. A variety of immune interventions has been used, some immunosuppressive and some immunomodulatory. Several screening programs are used in order to identify high-risk subjects (i.e. first-degree relatives of individuals with type I diabetes) who may benefit from an early intervention. The ultimate goal of all these efforts is to prevent the development of overt type I diabetes mellitus in those at risk for the disease, using strategies that are both safe and specific. This review summarizes the results of the various studies conducted to date and outlines the approaches currently being tested.
尽管近年来在糖尿病的治疗和管理方面取得了进展，但糖尿病仍然是一种严重的疾病，伴有危及生命的并发症。它是目前最常见的代谢性疾病，在工业化国家影响着5%的人口。非胰岛素依赖型糖尿病（NIDDM）是一种复杂的病症，其特征为胰岛素抵抗和胰岛素分泌受损，并与冠心病、外周血管疾病、动脉高血压和血脂异常的风险增加相关。NIDDM的易感因素是肥胖和糖尿病家族史。在多项横断面研究中，增加体力活动与NIDDM的患病率呈负相关。体力活动可提高胰岛素敏感性，定期进行耐力运动可诱导并维持体重减轻、改善糖耐量并改善代谢综合征中的大多数异常情况。1型糖尿病是由遗传易感个体中免疫介导的胰岛β细胞破坏所致。这是一个可能持续数年的隐匿过程。在疾病演变阶段（糖尿病前期），可通过免疫标志物的存在和β细胞功能的下降来识别个体。疾病过程的自身免疫性质促使人们尝试通过免疫干预策略来阻止这一过程。已使用了多种免疫干预措施，有些具有免疫抑制作用，有些具有免疫调节作用。为了识别可能从早期干预中获益的高危受试者（即1型糖尿病患者的一级亲属），采用了多种筛查项目。所有这些努力的最终目标是使用安全且特异的策略，预防有患病风险的人群发生显性1型糖尿病。本综述总结了迄今为止进行的各项研究的结果，并概述了目前正在测试的方法。
