摘要
治愈2型糖尿病是目前尚未攻克的难题。按现有的临床指南,确诊患者为临床2型糖尿病后才给予除控制饮食、适当锻炼之外的干预治疗,迄今没有治愈成功的先例。本文根据有关研究及文献综述分析,提出借鉴可治愈某些癌症的思路攻克治愈2型糖尿病的难题,即"早发现、早治疗",高度重视"糖尿病前期",发现该病的"早期预警信号";检测血糖的同时监测血胰岛素水平,在该病的早期阶段就积极开始二甲双胍等直接针对胰岛素抵抗的药物治疗。建议开展严谨全面的基础研究和临床观察课题,充分利用系统/计算生物学等交叉学科处理组学大数据的优势,检验证实有关观点,为更新修改有关的临床指南提供坚实的依据。希望在攻克这一难题上有所突破。
Type 2 diabetes mellitus （T2DM） is a complex, chronic, progressive, and self-incurable disease. How to cure this disease now is still an unsolved difficult problem. One of the possible reasons of the incurability is that it may be too late to treat this disease with prescribed antidiabetics only when patients are confirmedly diagnosed as T2DM upon the existing clinical guidelines. Disturbance of the insulin signaling pathway at cellular and molecular levels causes insulin resistance, and is one of the important molecular pathophysiological mechanisms of T2DM; while in the case of cancers their molecular pathophysiology also includes abnormalities of the insulin signaling pathway. Some types of cancers have now become curable, and one of the key measures curing them is to ＂detect them earlier, and treat them earlier＂. By reviewing our previous studies and other relevant literatures,we propose to apply the same idea,＂ detecting it earlier,and treating it earlier＂ ,to explore the solution for curing T2DM. We emphasize paying more attentions to ＂ prediabetes＂ , or the early stage of T2DM,and suggest that hyperinsulinemia rather than hyperglycemia is an ＂ early warning signal＂ of T2DM. Therefore, only testing the blood glucose levels is not enough but testing and monitoring the blood insulin levels is much needed. We also suggest that mefformin,as an agent directly acting against insulin resistance,shall be administrated as early as in the prediabetes stage, and sufficient close of this medication shall be applied upon correcting hyperinsulinemia. To examine and prove the above hypothesis,certain comprehensive basic researches and clinical study, with the assistance of computational and systems biology to analyze big data,are recomnlended. Once such studies provide solid evidence supporting the above suggestions, the current clinical guidelines should be updated and modified. These efforts may make a breakthrough in tackling the problems of curing T2DM and in reducing its incidence.
作者
彭小丁
李雷
PENG Xiao-ding;LI M Lei(Department of Biochemistry and Molecular Genetics,The University of Illinois at Chicago,Chicago 60607,USA;Academy of Mathematics and Systems Scienee,Chinese Academy of Sciences,Beijing 100190,China;University of Chinese Academy of Sciences,Beijing 100049,China;Excellenee in Animal Evolution and Genetics,Chinese Academy of Scienees,Kunming 650223,China)
出处
《医学综述》
2018年第20期4060-4067,共8页
Medical Recapitulate
基金
中国科学院战略性先导科技专项基金(B类)(XDB13040600)
中国科学院国家数学与交叉科学中心基金
中国科学院系统控制重点实验室基金
关键词
2型糖尿病
胰岛素抵抗
高胰岛素血症
高血糖
早期诊治
二甲双胍
系统生物学
Type 2 diabetes mellitus
Insulin resistance
Hyperinsulinenfia
Hyperglycenfia
Early diagnosis and treatment
Melformin
Systems biology
