Type 2 diabetes can be prevented with early pharmacological intervention.
Type 2 diabetes can be prevented with early pharmacological intervention.
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早期药理干预可以预防2型糖尿病。
DOI：
10.2337/dc11-s221
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发表时间：
2011-05
期刊：
影响因子：
16.2
通讯作者：
Abdul-Ghani M
中科院分区：
文献类型：
--
作者：
DeFronzo RA;Abdul-Ghani M
在美国，约有21 × 106人患有2型糖尿病，而糖耐量受损（IGT）的人数是其两倍。大约40-50%的IGT患者会在一生中发展为2型糖尿病。因此，使用IGT治疗高危人群以预防2型糖尿病具有重要的医学、经济、社会和人类意义。减肥，虽然有效减少IGT转化为2型糖尿病，但很难实现和维持。此外，40-50%的IGT受试者尽管成功减肥，但仍进展为2型糖尿病。相比之下，口服抗糖尿病药物治疗IGT可以改善胰岛素敏感性并保持β细胞功能（IGT和2型糖尿病中特有的病理生理异常），一致被证明可以防止IGT发展为2型糖尿病。最一致的结果是噻唑烷二酮类药物（曲格列酮预防糖尿病[TRIPOD]、吡格列酮预防糖尿病[PIPOD]、雷米普利和罗格列酮治疗糖尿病降低评估[DREAM]和Actos Now预防糖尿病[ACT Now]）， IGT转化为糖尿病的几率降低了50-70%。在美国糖尿病预防计划（DPP）中，二甲双胍使2型糖尿病的发病率降低了31%，并被美国糖尿病协会（ADA）推荐用于治疗IGT高危人群。胰高血糖素样肽-1类似物，增加胰岛素分泌，保持β细胞功能，促进体重减轻，也有望有效防止IGT进展为2型糖尿病。由于IGT水平较高的个体具有最大/接近最大的胰岛素抵抗，失去了70-80%的β细胞功能，并且糖尿病视网膜病变发生率为10%，因此应制定药物干预，并结合饮食和运动。
In the U.S., ∼21 × 106 individuals have type 2 diabetes, and twice as many have impaired glucose tolerance (IGT). Approximately 40–50% of individuals with IGT will progress to type 2 diabetes over their lifetime. Therefore, treatment of high-risk individuals with IGT to prevent type 2 diabetes has important medical, economic, social, and human implications. Weight loss, although effective in reducing the conversion of IGT to type 2 diabetes, is difficult to achieve and maintain. Moreover, 40–50% of IGT subjects progress to type 2 diabetes despite successful weight reduction. In contrast, pharmacological treatment of IGT with oral antidiabetic agents that improve insulin sensitivity and preserve β-cell function—the characteristic pathophysiological abnormalities present in IGT and type 2 diabetes—uniformly have been shown to prevent progression of IGT to type 2 diabetes. The most consistent results have been observed with the thiazolidinediones (Troglitazone in the Prevention of Diabetes [TRIPOD], Pioglitazone in the Prevention of Diabetes [PIPOD], Diabetes Reduction Assessment with Ramipril and Rosiglitazone Medication [DREAM], and Actos Now for the Prevention of Diabetes [ACT NOW]), with a 50–70% reduction in IGT conversion to diabetes. Metformin in the U.S. Diabetes Prevention Program (DPP) reduced the development of type 2 diabetes by 31% and has been recommended by the American Diabetes Association (ADA) for treating high-risk individuals with IGT. The glucagon-like peptide-1 analogs, which augment insulin secretion, preserve β-cell function, and promote weight loss, also would be expected to be efficacious in preventing the progression of IGT to type 2 diabetes. Because individuals in the upper tertile of IGT are maximally/near-maximally insulin resistant, have lost 70–80% of their β-cell function, and have an ∼10% incidence of diabetic retinopathy, pharmacological intervention, in combination with diet plus exercise, should be instituted.
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影响因子：
8.2
作者：
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通讯作者：
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