Birkeland K I, Vaaler S, Hanssen K F
Endokrinologisk avdeling, Medisinsk klinikk, Aker sykehus, Oslo.
Tidsskr Nor Laegeforen. 1996 Apr 20;116(10):1233-5.
Consensus has not been reached about the optimal treatment of type 2 diabetes, and several authors have questioned the use of insulin for this disorder. The reasons are that an association has been found between hyperinsulinaemia and cardiovascular disease in non-diabetic men, and the sparse evidence of a beneficial effect from tight glycaemic control in prevention of late complications in type 2 diabetes. We discuss the pathophysiology of atherosclerosis in type 2 diabetes, and review some of the recent literature. We find it likely that, in the metabolic cardiovascular syndrome found in many patients with type 2 diabetes, insulin resistance is more important than the accompanying hyperinsulinaemia. Furthermore, evidence is emerging of a strong association between hyperglycaemia and atherosclerotic vascular disease in patients with type 2 diabetes. We conclude that insulin treatment should be used in type 2 diabetic patients when the hyperglycaemia cannot be controlled by oral agents.
关于2型糖尿病的最佳治疗方法尚未达成共识，一些作者对胰岛素用于治疗这种疾病提出了质疑。原因是在非糖尿病男性中发现高胰岛素血症与心血管疾病之间存在关联，以及关于严格血糖控制对预防2型糖尿病晚期并发症有益作用的证据不足。我们讨论了2型糖尿病中动脉粥样硬化的病理生理学，并回顾了一些近期文献。我们发现，在许多2型糖尿病患者中发现的代谢性心血管综合征中，胰岛素抵抗可能比伴随的高胰岛素血症更重要。此外，越来越多的证据表明2型糖尿病患者的高血糖与动脉粥样硬化性血管疾病之间存在密切关联。我们得出结论，当口服药物无法控制高血糖时，2型糖尿病患者应使用胰岛素治疗。
