Elson D F, Meredith M
University of Wisconsin Hospitals and Clinics, Madison, USA.
WMJ. 1998 Mar;97(3):49-54.
Type 2 diabetes mellitus is a common, chronic disease affecting nearly 6% of the adult US population. It remains a leading cause of morbidity and mortality in Wisconsin as well as the country. Multiple lines of evidence show that controlling blood glucose in patients with type 2 diabetes can significantly decrease the development of and/or progression of microvascular complications as well as the macrovascular complications of diabetes. There are now four different classes of oral medications which are available to treat diabetes-sulfonylureas, biguanides, thiazolidinediones, and alpha-glucosidase inhibitors. Each class works differently to treat the underlying defects of diabetes which include impaired insulin secretion, insulin resistance and exaggerated postprandial hyperglycemia. This article will compare and contrast the different agents available, including appropriate use of each agent as monotherapy and in combination therapy. It will also discuss use of insulin in the patient who has failed oral therapy. Rational use of these tools, tailored for the individuals metabolic abnormalities, should allow for good glycemic control in the majority of patients with type 2 diabetes mellitus. Relaxation, massage, opium, and moderate exercise were among the recommended options for treatment of diabetes mellitus nearly 100 years ago. In the late nineteenth century, diabetes was a poorly characterized disorder, which was increasing in prevalence even at that time. Today, the underlying defects contributing to the development of type 2 diabetes are better understood, and include peripheral insulin resistance, relative pancreatic beta-cell insufficiency, increased hepatic glucose output, and an exaggerated postprandial glucose excursion. However, despite our better understanding of the disease, the prevalence of type 2 diabetes continues to increase in the US, now afflicting over 6% of the population. As our population ages and the proportion of obese people increases, we can expect to see a marked increase in the prevalence of diabetes in the future. Fortunately, our treatment options for type 2 diabetes have expanded remarkably within the last few years. Along with these new treatment options comes the exciting, although likely expensive, possibility of prevention of type 2 diabetes in at risk individuals.
2型糖尿病是一种常见的慢性疾病，影响着近6%的美国成年人口。它仍是威斯康星州乃至美国发病和死亡的主要原因。多项证据表明，控制2型糖尿病患者的血糖可显著降低微血管并发症以及糖尿病大血管并发症的发生和/或进展。目前有四类不同的口服药物可用于治疗糖尿病——磺脲类、双胍类、噻唑烷二酮类和α-葡萄糖苷酶抑制剂。每类药物治疗糖尿病潜在缺陷的作用机制不同，这些潜在缺陷包括胰岛素分泌受损、胰岛素抵抗和餐后高血糖加剧。本文将比较和对比现有的不同药物，包括每种药物作为单一疗法和联合疗法的适当用法。还将讨论口服治疗失败患者使用胰岛素的情况。根据个体代谢异常情况合理使用这些药物，应能使大多数2型糖尿病患者实现良好的血糖控制。近100年前，放松、按摩、鸦片和适度运动是糖尿病治疗的推荐方法之一。在19世纪后期，糖尿病是一种特征尚不明确的疾病，即便在那时其患病率也在上升。如今，导致2型糖尿病发生的潜在缺陷已得到更好的理解，包括外周胰岛素抵抗、相对的胰腺β细胞功能不全、肝脏葡萄糖输出增加以及餐后血糖过度波动。然而，尽管我们对该疾病有了更好的认识，但2型糖尿病在美国的患病率仍在持续上升，目前超过6%的人口受其困扰。随着我们的人口老龄化以及肥胖人群比例增加，预计未来糖尿病患病率将显著上升。幸运的是，在过去几年中，我们治疗2型糖尿病的选择有了显著扩展。伴随着这些新的治疗选择而来的是，尽管可能成本高昂，但在高危个体中预防2型糖尿病的令人兴奋的可能性。
