强化胰岛素替代的病理生理基础。

A Rolla
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引用次数: 35

摘要

I型和II型糖尿病的特征都是β细胞功能和质量的逐渐减少。在I型糖尿病中,自身免疫破坏导致β细胞功能迅速丧失,胰岛素治疗对于维持正常血糖至关重要。在II型糖尿病中,第一阶段胰岛素释放减少或缺失是最早的代谢缺陷,并伴有缺乏对餐后肝脏葡萄糖产生的抑制,餐后葡萄糖漂移增加和晚期胰岛素高分泌。此外,长期暴露于血糖升高,甚至间歇性餐后峰值,会导致β细胞功能进一步恶化(“糖毒性”)。到诊断出II型糖尿病时,β细胞的功能和质量已经下降了约50%。随着疾病和糖毒性的进展,由于细胞凋亡增加,β细胞质量持续减少,导致绝对胰岛素缺乏。到那时,患者需要胰岛素来维持血糖控制。越来越多的证据表明,在I型和II型糖尿病中,保持内源性β细胞功能的重要性。早期和强化血糖控制,使用重建生理胰岛素谱的方案,控制餐后和空腹血糖水平,最有希望保持β细胞功能,减少疾病进展,减少糖尿病的慢性并发症。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
The pathophysiological basis for intensive insulin replacement.

Both type I and type II diabetes are characterised by a progressive decrease in beta-cell function and mass. In type I diabetes, autoimmune destruction results in rapid loss of beta-cell function, and insulin therapy is essential to maintain normoglycaemia. In type II diabetes, a diminished or absent first-phase insulin release is the earliest metabolic defect, which is accompanied by lack of prandial suppression of hepatic glucose production, increased postprandial glucose excursions and late insulin hypersecretion. Furthermore, chronic exposure to elevated glucose, even to intermittent postprandial spikes, results in further deterioration of the beta-cell function ('glucotoxicity'). By the time type II diabetes is diagnosed, beta-cell function and mass have declined by about 50%. With the progression of the disease and glucotoxicity there is continuous decrease in beta-cell mass due to increased apoptosis that results in absolute insulin deficiency. By then, patients require insulin administration to maintain glucose control. An increasing body of evidence demonstrates the importance of preserving endogenous beta-cell function both in type I and type II diabetes. Early and intensive glycaemic control, using regimens which re-create a physiological insulin profile, controlling postprandial as well as fasting glucose levels, offers the most promise for preserving beta-cell function, decreasing disease progression, and reducing the chronic complications of diabetes.

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