Göke B
Gastrointestinal Unit, Inselspital, University Hospital, Bern, Switzerland.
Diabetes Res Clin Pract. 1998 Jul;40 Suppl:S15-20. doi: 10.1016/s0168-8227(98)00037-0.
Insulin secretion is stimulated by ingestion of food. The combination of hyperinsulinaemia plus hyperglycaemia effectively promotes glucose uptake by the liver and by peripheral tissues, such as muscle and fat cells, and suppresses hepatic glucose output. These simultaneous processes maintain normal glucose homeostasis in a co-ordinated fashion. Type 2 diabetes mellitus is associated with impaired insulin in target tissues due to insulin resistance and/or insulin deficiency. At first, increased insulin secretion overcomes insulin resistance, but ultimately this fails, leading progressively to increased blood glucose levels. Individuals pass through a phase of impaired glucose tolerance (IGT) and increased fasting plasma glucose levels (IFG) before developing overt type 2 diabetes. Therefore, IGT/IFG is a dysglycaemic state that is intermediate between normal glucose tolerance and diabetes. In this article, we discuss the relative importance of hyperglycaemia, insulin resistance and beta-cell function in the development of glucose intolerance, taking the new diagnostic criteria into consideration. New recommendations from the Expert Committee on the Diagnosis and Classification of Diabetes Mellitus are discussed where appropriate.
食物摄入会刺激胰岛素分泌。高胰岛素血症与高血糖症相结合，可有效促进肝脏以及肌肉和脂肪细胞等外周组织对葡萄糖的摄取，并抑制肝脏葡萄糖输出。这些同步过程以协调的方式维持正常的葡萄糖稳态。2型糖尿病与靶组织中由于胰岛素抵抗和/或胰岛素缺乏导致的胰岛素受损有关。起初，胰岛素分泌增加可克服胰岛素抵抗，但最终这一过程会失败，导致血糖水平逐渐升高。个体在发展为显性2型糖尿病之前会经历糖耐量受损（IGT）和空腹血糖水平升高（IFG）阶段。因此，IGT/IFG是一种血糖异常状态，介于正常糖耐量和糖尿病之间。在本文中，我们考虑新的诊断标准，讨论高血糖、胰岛素抵抗和β细胞功能在葡萄糖不耐受发展中的相对重要性。在适当的地方讨论了糖尿病诊断与分类专家委员会的新建议。
