Standl E
Third Medical Department, City Hospital Schwabing, Munich, Germany.
Clin Invest Med. 1995 Aug;18(4):261-6.
Studies of macrovascular disease in non-insulin-dependent diabetes (NIDDM) have shown a significant increase in peripheral vascular, coronary, and carotid artery disease in diabetics compared to non-diabetics. This prevalence appears to be related to insulin levels and to the degree of hyperinsulinemia as measured in the blood of these patients. Indeed, a cluster of markers, including hyperinsulinemia, insulin resistance, hypertension, dyslipoproteinemia, and a high waist-hip ratio, has been associated with NIDDM and increased risk for macrovascular disease. Variously described as Metabolic Syndrome or Syndrome X, this syndrome may be operative for many years before NIDDM is diagnosed. Given the complexity of Metabolic Syndrome, a single-factor intervention for preventing macrovascular disease in NIDDM is unlikely. However, it seems advisable to screen, on a regular basis, all patients presenting a pre-NIDDM state, as well as those with overt NIDDM, for pertinent cardiovascular risk parameters and for emerging macrovascular disease. It is suggested that any attempt to prevent macrovascular disease in subjects with glucose intolerance should aim at decreasing insulin resistance and hyperinsulinemia.
对非胰岛素依赖型糖尿病（NIDDM）患者大血管疾病的研究表明，与非糖尿病患者相比，糖尿病患者的外周血管、冠状动脉和颈动脉疾病显著增加。这种患病率似乎与胰岛素水平以及这些患者血液中所测得的高胰岛素血症程度有关。事实上，包括高胰岛素血症、胰岛素抵抗、高血压、血脂异常以及高腰臀比在内的一系列指标，都与NIDDM以及大血管疾病风险增加有关。这种综合征被不同地描述为代谢综合征或X综合征，在NIDDM被诊断之前可能已经存在多年。鉴于代谢综合征的复杂性，针对NIDDM预防大血管疾病的单因素干预不太可能有效。然而，定期筛查所有处于NIDDM前期状态的患者以及明显患有NIDDM的患者，以检测相关的心血管风险参数和早期大血管疾病，似乎是明智的。建议对糖耐量异常的患者预防大血管疾病的任何尝试都应旨在降低胰岛素抵抗和高胰岛素血症。
