2 型糖尿病青少年的胰岛素抵抗。
Insulin resistance in type 2 diabetic youth.
机构信息
Division of Endocrinology, Department of Pediatrics, University of Colorado Denver and the Children's Hospital Colorado, Denver, Colorado, USA.
出版信息
Curr Opin Endocrinol Diabetes Obes. 2012 Aug;19(4):255-62. doi: 10.1097/MED.0b013e3283557cd5.
PURPOSE OF REVIEW
This review focuses on recent literature on insulin resistance in youth with type 2 diabetes mellitus (T2DM). Insulin resistance is associated with a variety of cardiometabolic problems leading to increased morbidity and mortality across the lifespan.
RECENT FINDINGS
Functional pancreatic β-cell changes play a role in the transition from obesity to impaired glucose tolerance (IGT). Insulin resistance drives islet cell upregulation, manifested by elevated glucagon and c-peptide levels, early in the transition to IGT. Surrogate measurements of insulin resistance and insulin secretion exist but their accuracy compared to clamp data is imperfect. Recent large longitudinal studies provide detailed information on the progression from normoglycemia to T2DM and on the phenotype of T2DM youth. Defining prediabetes and T2DM remains a challenge in youth. Lifestyle interventions do not appear as effective in children as in adults. Metformin remains the only oral hypoglycemic agent approved for T2DM in youth.
SUMMARY
New insights exist regarding the conversion from insulin resistance to T2DM, measurement of insulin resistance and phenotypes of insulin resistance youth, but more information is needed. Surrogate measurements of insulin resistance, additional treatment options for insulin resistance and individualization of treatment options for T2DM adolescents in particular require further investigation.
目的综述
本文重点关注近期关于 2 型糖尿病（T2DM）青少年胰岛素抵抗的文献。胰岛素抵抗与多种心血管代谢问题相关，导致患者在整个生命周期中发病率和死亡率增加。
最近的发现
功能性胰腺β细胞变化在肥胖向糖耐量受损（IGT）的转变中起作用。胰岛素抵抗导致胰岛细胞上调，表现在早期 IGT 时升高的胰高血糖素和 C 肽水平。胰岛素抵抗和胰岛素分泌的替代测量方法存在，但与钳夹数据相比，其准确性并不完美。最近的大型纵向研究提供了从正常血糖到 T2DM 以及 T2DM 青少年表型的详细信息。在青少年中，定义糖尿病前期和 T2DM 仍然是一个挑战。生活方式干预在儿童中的效果似乎不如在成人中好。二甲双胍仍然是唯一批准用于青少年 T2DM 的口服降糖药。
总结
关于从胰岛素抵抗到 T2DM 的转变、胰岛素抵抗的测量以及胰岛素抵抗青少年的表型，已经有了新的认识，但还需要更多的信息。胰岛素抵抗的替代测量、额外的治疗选择以及 T2DM 青少年治疗选择的个体化都需要进一步研究。
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