Lifestyle precision medicine: the next generation in type 2 diabetes prevention?

Lifestyle precision medicine: the next generation in type 2 diabetes prevention?
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DOI:
10.1186/s12916-017-0938-x
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发表时间:
2017-09-22
期刊:
影响因子:
9.3
通讯作者:
Franks PW
Franks PW
中科院分区:
医学1区
文献类型:
--
作者:
Mutie PM;Giordano GN;Franks PW

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目前全球2型糖尿病流行背后的驱动力是超重和肥胖个人的胰岛素抵抗。饮食因素、缺乏运动和久坐行为是肥胖的主要可改变的危险因素。然而,许多超重/肥胖的人不会患上糖尿病,侧重于减肥和预防糖尿病的生活方式干预往往无效。传统上,慢性高血糖浓度一直是糖尿病的标志;然而,许多人要么保持‘糖尿病前期’,要么回归正常血糖。因此,对大规模解决糖尿病的创新战略的需求越来越大。生物标记物技术的出现使糖尿病预防(精确医学)有了更有针对性的治疗策略,尽管主要局限于药物治疗。与大多数药物不同的是,生活方式干预往往具有系统性的健康促进作用。因此,糖尿病患者追求生活方式精准医学似乎是合理的。在此,我们回顾了关于生活方式干预和糖尿病预防的文献,描述了可以在人类群体中规模化描述的生物系统,将它们与糖尿病的生活方式联系起来,并考虑了阻碍生活方式精准医学临床翻译的一些挑战。本文的在线版本(doi:10.1186/s12916-0170938-x)包含补充材料,授权用户可以使用。
The driving force behind the current global type 2 diabetes epidemic is insulin resistance in overweight and obese individuals. Dietary factors, physical inactivity, and sedentary behaviors are the major modifiable risk factors for obesity. Nevertheless, many overweight/obese people do not develop diabetes and lifestyle interventions focused on weight loss and diabetes prevention are often ineffective. Traditionally, chronically elevated blood glucose concentrations have been the hallmark of diabetes; however, many individuals will either remain ‘prediabetic’ or regress to normoglycemia. Thus, there is a growing need for innovative strategies to tackle diabetes at scale. The emergence of biomarker technologies has allowed more targeted therapeutic strategies for diabetes prevention (precision medicine), though largely confined to pharmacotherapy. Unlike most drugs, lifestyle interventions often have systemic health-enhancing effects. Thus, the pursuance of lifestyle precision medicine in diabetes seems rational. Herein, we review the literature on lifestyle interventions and diabetes prevention, describing the biological systems that can be characterized at scale in human populations, linking them to lifestyle in diabetes, and consider some of the challenges impeding the clinical translation of lifestyle precision medicine. The online version of this article (doi:10.1186/s12916-017-0938-x) contains supplementary material, which is available to authorized users.
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