Therapeutic Use of Metformin in Prediabetes and Diabetes Prevention.
Therapeutic Use of Metformin in Prediabetes and Diabetes Prevention.
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DOI：
10.1007/s40265-015-0416-8
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发表时间：
2015-07
期刊：
影响因子：
11.5
通讯作者：
Hildemann S
中科院分区：
文献类型：
--
作者：
Hostalek U;Gwilt M;Hildemann S
血糖水平升高的非糖尿病患者有进展为临床2型糖尿病的风险，通常被称为“糖尿病前期”。术语前驱糖尿病通常是指75 g口服葡萄糖耐量试验后2 h的空腹血糖（空腹血糖受损）和/或血糖（葡萄糖耐量受损）高于正常值。目前的美国指南认为正常高HbA 1c也代表糖尿病前期状态。具有糖尿病前期水平的代谢异常的个体已经处于微血管和大血管损伤的高风险中，类似于糖尿病的长期并发症。阻止或逆转胰岛素敏感性和β细胞功能的进行性下降是预防高危受试者发生2型糖尿病的关键。旨在诱导体重减轻的生活方式干预、药物治疗（二甲双胍、噻唑烷二酮类、阿卡波糖、基础胰岛素和减肥药物）和减肥手术均显示可降低糖尿病前期受试者进展为2型糖尿病的风险。然而，生活方式干预对患者来说很难维持，并且随着时间的推移，体重减轻往往会恢复。二甲双胍可增强胰岛素在肝脏和骨骼肌中的作用，其延迟或预防糖尿病发作的疗效已在大型、精心设计的随机试验中得到证实，如糖尿病预防计划和其他研究。数十年的临床使用证明二甲双胍通常耐受性良好且安全。我们详细回顾了支持二甲双胍用于糖尿病预防的证据基础。
People with elevated, non-diabetic, levels of blood glucose are at risk of progressing to clinical type 2 diabetes and are commonly termed ‘prediabetic’. The term prediabetes usually refers to high–normal fasting plasma glucose (impaired fasting glucose) and/or plasma glucose 2 h following a 75 g oral glucose tolerance test (impaired glucose tolerance). Current US guidelines consider high–normal HbA1c to also represent a prediabetic state. Individuals with prediabetic levels of dysglycaemia are already at elevated risk of damage to the microvasculature and macrovasculature, resembling the long-term complications of diabetes. Halting or reversing the progressive decline in insulin sensitivity and β-cell function holds the key to achieving prevention of type 2 diabetes in at-risk subjects. Lifestyle interventions aimed at inducing weight loss, pharmacologic treatments (metformin, thiazolidinediones, acarbose, basal insulin and drugs for weight loss) and bariatric surgery have all been shown to reduce the risk of progression to type 2 diabetes in prediabetic subjects. However, lifestyle interventions are difficult for patients to maintain and the weight loss achieved tends to be regained over time. Metformin enhances the action of insulin in liver and skeletal muscle, and its efficacy for delaying or preventing the onset of diabetes has been proven in large, well-designed, randomised trials, such as the Diabetes Prevention Program and other studies. Decades of clinical use have demonstrated that metformin is generally well-tolerated and safe. We have reviewed in detail the evidence base supporting the therapeutic use of metformin for diabetes prevention.