Prevention of type 2 diabetes -: Insulin resistance and β-cell function
Prevention of type 2 diabetes -: Insulin resistance and β-cell function
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DOI：
10.2337/diabetes.53.suppl_3.s34
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发表时间：
2004-12-01
期刊：
影响因子：
7.7
通讯作者：
Rabasa-Lhoret, M
中科院分区：
文献类型：
--
作者：
Chiasson, JL;Rabasa-Lhoret, M
2型糖尿病在世界范围内呈流行性增加。其相关的发病率和死亡率给卫生保健系统造成了重大负担。基于对葡萄糖耐受不良的病理生理学的更好理解，已经进行了预防糖尿病的临床试验。现在已经证明，饮食和运动、二甲双胍、阿卡波糖和曲格列酮可以预防或至少延缓糖耐量受损（IGT）受试者的糖尿病发展。现在普遍认为胰岛素抵抗和β细胞功能障碍是参与糖尿病发展的主要因素。胰岛素抵抗与β细胞功能障碍在糖尿病发病机制中的相对作用引起了许多争论。这两个过程应该相互联系起来研究：它们的关系最好描述为双曲线性质。当考虑到这种关系时，很明显，处于发展2型糖尿病风险的受试者在发展葡萄糖耐受不良之前具有β细胞功能障碍。胰岛素抵抗可能主要由肥胖症的存在解释，并加速具有β细胞衰竭倾向的受试者向糖尿病的进展。当高血糖发生时，胰岛素敏感性和胰岛素分泌都受到损害。关于胰岛素敏感性和胰岛素分泌的糖尿病预防试验数据仍然很少。我们所拥有的少数数据表明，大多数干预措施主要对胰岛素抵抗有影响。通过减少胰岛素抵抗，它们保护和保存β细胞功能。目前还没有任何干预措施显示对β细胞功能有任何直接影响。
Type 2 diabetes is increasing worldwide in epidemic proportions. Its associated morbidity and mortality is imposing a major burden on the health care system. Based on a better understanding of the pathophysiology of glucose intolerance, clinical trials on the prevention of diabetes have been performed. It has now been demonstrated that diet and exercise, metformin, acarbose, and troglitazone can prevent or at least delay the development of diabetes in subjects with impaired glucose tolerance (IGT). It is now generally accepted that insulin resistance and beta-cell dysfunction are major factors involved in the development of diabetes. The relative contribution of insulin resistance versus beta-cell dysfunction on the pathogenesis of diabetes has aroused much debate. These two processes should be studied in relation to one another: their relationship is best described as hyperbolic in nature. When this relationship is taken into consideration, it becomes evident that subjects at risk of developing type 2 diabetes have beta-cell dysfunction before they develop glucose intolerance. Insulin resistance may be mostly explained by the presence of obesity and accelerate the progression to diabetes in subjects with the propensity to beta-cell failure. By the time hyperglycemia occurs, impairment in both insulin sensitivity and insulin secretion are present. There are still few data on insulin sensitivity and insulin secretion from the trials on the prevention of diabetes. The few data that we do have suggest that most interventions mostly have an effect on insulin resistance. By reducing insulin resistance, they protect and preserve the beta-cell function. No intervention has yet shown any direct effect on beta-cell function.