Update in the CNS Response to Hypoglycemia
Update in the CNS Response to Hypoglycemia
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DOI：
10.1210/jc.2011-1927
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发表时间：
2012-01-01
影响因子：
5.8
通讯作者：
McCrimmon, Rory J.
中科院分区：
文献类型：
--
作者：
McCrimmon, Rory J.
低血糖仍然是1型和2型糖尿病患者管理的主要临床问题。基础科学研究才刚刚开始揭示以下机制：1)支持低血糖检测和启动反调节防御反应；2)在1型和2型糖尿病中，特别是在先前暴露于反复低血糖后，促进有缺陷的反调节的发展。在动物研究中，中枢神经系统已成为这些过程的关键。然而，作为临床干预未来发展的第一步，基于实验的研究需要通过对人类受试者的研究来转化。本更新回顾了过去2年发表的主要通过神经成像技术研究低血糖对人类受试者中枢神经系统影响的研究，并将这些数据与动物研究获得的数据及其对未来治疗的影响进行了比较。基于这些研究，越来越清楚的是，我们对大脑如何响应和适应复发性低血糖的理解仍然非常有限。目前的治疗方法几乎没有证据表明它们可以预防1型糖尿病的严重低血糖或提高对低血糖的认识。为了开发和测试新的治疗干预措施，迫切需要增加我们对1型糖尿病中有缺陷的反调节是如何以及为什么产生的理解。[J] .中华内分泌杂志，2009,31(1):1-8。
Hypoglycemia remains a major clinical issue in the management of people with type 1 and type 2 diabetes. Research in basic science is only beginning to unravel the mechanisms that: 1) underpin the detection of hypoglycemia and initiation of a counterregulatory defense response; and 2) contribute to the development of defective counterregulation in both type 1 and type 2 diabetes, particularly after prior exposure to repeated hypoglycemia. In animal studies, the central nervous system has emerged as key to these processes. However, bench-based research needs to be translated through studies in human subjects as a first step to the future development of clinical intervention. This Update reviews studies published in the last 2 yr that examined the central nervous system effects of hypoglycemia in human subjects, largely through neuroimaging techniques, and compares these data with those obtained from animal studies and the implications for future therapies. Based on these studies, it is increasingly clear that our understanding of how the brain responds and adapts to recurrent hypoglycemia remains very limited. Current therapies have provided little evidence that they can prevent severe hypoglycemia or improve hypoglycemia awareness in type 1 diabetes. There remains an urgent need to increase our understanding of how and why defective counterregulation develops in type 1 diabetes in order for novel therapeutic interventions to be developed and tested. (J Clin Endocrinol Metab 97: 1-8, 2012)