2型糖尿病的缓解：百家争鸣与脚踏实地

doi:10.3969/j.issn.1006-5725.2024.16.002

Abstract

Abstract:

In the early stages of type 2 diabetes， inducing remission of hyperglycemia has become a global hotspot in the field of diabetes management. In recent years， scholars from both domestic and international communities have established several remission intervention methods， including short-term intensive insulin therapy， lifestyle intervention， and metabolic surgery. They have also proposed theories such as beta-cell dedifferentiation and liver-pancreas “twin cycle” hypothesis， which have accelerated the growth of clinical and research information in this field. This review summarizes the clinical evidence， basic mechanisms， applicable populations， and exacutive principle points in the field of diabetes remission， with the aim of deepening the understanding of clinical practitioners about diabetes remission and laying the foundation for better practice and research in related fields.

Key words: type 2 diabetes mellitus, remission, abetes mellitus

CLC Number:

R587.1

Liehua LIU,Yanbing. LI. Remission of type 2 diabetes： Contending perspectives and practical approaches[J]. The Journal of Practical Medicine, 2024, 40(16): 2206-2210.

References 39

1	SUN H， SAEEDI P， KARURANGA S， et al. IDF Diabetes Atlas： Global， regional and country-level diabetes prevalence estimates for 2021 and projections for 2045［J］. Diabetes Res Clin Pract， 2022， 183：109119. doi:10.1016/j.diabres.2023.110945 doi: 10.1016/j.diabres.2023.110945
2	WANG L， GAO P， ZHANG M， et al. Prevalence and Ethnic Pattern of Diabetes and Prediabetes in China in 2013［J］. JAMA， 2017， 317（24）：2515-2523. doi:10.1001/jama.2017.7596 doi: 10.1001/jama.2017.7596
3	LAITEERAPONG N， HAM S A， GAO Y， et al. The Legacy Effect in Type 2 Diabetes： Impact of Early Glycemic Control on Future Complications （The Diabetes & Aging Study）［J］. Diabetes Care， 2019， 42（3）：416-426. doi:10.2337/dci18-0036 doi: 10.2337/dci18-0036
4	LIND M， IMBERG H， COLEMAN R L， et al. Historical HbA（1c） Values May Explain the Type 2 Diabetes Legacy Effect： UKPDS 88［J］. Diabetes Care， 2021， 44（10）：2231-2237. doi:10.2337/dc20-2439 doi: 10.2337/dc20-2439
5	纪立农. 活的更长、活得更好——糖尿病与“健康中国2030”［J］. 中国糖尿病杂志， 2019， 27（1）：1-2.
6	HOLMAN N， WILD S H， KHUNTI K， et al. Incidence and Characteristics of Remission of Type 2 Diabetes in England： A Cohort Study Using the National Diabetes Audit［J］. Diabetes Care， 2022， 45（5）：1151-1161. doi:10.2337/dc21-2136 doi: 10.2337/dc21-2136
7	MINGRONE G， PANUNZI S， DE GAETANO A， et al. Metabolic surgery versus conventional medical therapy in patients with type 2 diabetes： 10-year follow-up of an open-label， single-centre， randomised controlled trial［J］. Lancet， 2021， 397（10271）：293-304. doi:10.1016/s0140-6736(20)32649-0 doi: 10.1016/s0140-6736(20)32649-0
8	SAUL H， DEENEY B， SWAITHES L， et al. Even short periods of diabetes remission are linked to lower risk of heart attack and stroke［J］. BMJ， 2024， 384：516. doi:10.1136/bmj.q516 doi: 10.1136/bmj.q516
9	RIDDLE M C， CEFALU W T， EVANS P H， et al. Consensus Report： Definition and Interpretation of Remission in Type 2 Diabetes［J］. Diabetes Care， 2021， 44（10）：2438-2444. doi:10.2337/dci21-0034 doi: 10.2337/dci21-0034
10	中国胰岛素分泌研究组. 短期胰岛素强化治疗逆转2型糖尿病专家共识［J］. 中华糖尿病杂志， 2021， 13（10）：949-959.
11	《缓解型糖尿病中国专家共识》编写专家委员会. 缓解2型糖尿病中国专家共识［J］. 中国全科医学， 2021， 24（32）：4037-4048.
12	叶健华，赵玉钏. 2型糖尿病缓解标准与治疗策略［J］. 实用医学杂志， 2023， 39（14）：1729-1732. doi:10.3969/j.issn.1006-5725.2023.14.001 doi: 10.3969/j.issn.1006-5725.2023.14.001
13	LI Y， XU W， LIAO Z， et al. Induction of long-term glycemic control in newly diagnosed type 2 diabetic patients is associated with improvement of beta-cell function［J］. Diabetes Care， 2004， 27（11）：2597-2602. doi:10.2337/diacare.27.11.2597 doi: 10.2337/diacare.27.11.2597
14	WENG J， LI Y， XU W， et al. Effect of intensive insulin therapy on beta-cell function and glycaemic control in patients with newly diagnosed type 2 diabetes： a multicentre randomised parallel-group trial［J］. Lancet， 2008， 371（9626）：1753-1760. doi:10.1016/s0140-6736(08)60762-x doi: 10.1016/s0140-6736(08)60762-x
15	WANG H， KUANG J， XU M， et al. Predictors of Long-Term Glycemic Remission After 2-Week Intensive Insulin Treatment in Newly Diagnosed Type 2 Diabetes［J］. J Clin Endocrinol Metab， 2019， 104（6）：2153-2162. doi:10.1210/jc.2018-01468 doi: 10.1210/jc.2018-01468
16	KRAMER C K， ZINMAN B， CHOI H， et al. Predictors of sustained drug-free diabetes remission over 48 weeks following short-term intensive insulin therapy in early type 2 diabetes［J］. BMJ Open Diabetes Res Care， 2016， 4（1）：e000270. doi:10.1136/bmjdrc-2016-000270 doi: 10.1136/bmjdrc-2016-000270
17	KRAMER C K， ZINMAN B， RETNAKARAN R. Short-term intensive insulin therapy in type 2 diabetes mellitus： a systematic review and meta-analysis［J］. Lancet Diabetes Endocrinol， 2013， 1（1）：28-34. doi:10.1016/s2213-8587(13)70006-8 doi: 10.1016/s2213-8587(13)70006-8
18	中华医学会糖尿病学分会. 中国2型糖尿病防治指南（2020年版）［J］. 中华糖尿病杂志， 2021， 13（4）：315-409.
19	PAN Y， HAN X， KAM H， et al. Nomogram for Predicting 5-Year Diabetes Remission After Roux-en-Y Gastric Bypass Surgery in Chinese Patients with Obesity［J］. Obes Surg， 2022， 32（5）：1556-1562. doi:10.1007/s11695-022-05952-x doi: 10.1007/s11695-022-05952-x
20	IKRAMUDDIN S， KORNER J， LEE W J， et al. Lifestyle Intervention and Medical Management With vs Without Roux-en-Y Gastric Bypass and Control of Hemoglobin A1c， LDL Cholesterol， and Systolic Blood Pressure at 5 Years in the Diabetes Surgery Study［J］. JAMA， 2018， 319（3）：266-278. doi:10.1001/jama.2017.20813 doi: 10.1001/jama.2017.20813
21	LEAN M E， LESLIE W S， BARNES A C， et al. Primary care-led weight management for remission of type 2 diabetes （DiRECT）： an open-label， cluster-randomised trial［J］. Lancet， 2018， 391（10120）：541-551. doi:10.1016/s0140-6736(17)33102-1 doi: 10.1016/s0140-6736(17)33102-1
22	TAHERI S， ZAGHLOUL H， CHAGOURY O， et al. Effect of intensive lifestyle intervention on bodyweight and glycaemia in early type 2 diabetes （DIADEM-I）： an open-label， parallel-group， randomised controlled trial［J］. Lancet Diabetes Endocrinol， 2020， 8（6）：477-489. doi:10.1016/s2213-8587(20)30117-0 doi: 10.1016/s2213-8587(20)30117-0
23	LEAN M E， LESLIE W S， BARNES A C， et al. 5-year follow-up of the randomised Diabetes Remission Clinical Trial （DiRECT） of continued support for weight loss maintenance in the UK： an extension study［J］. Lancet Diabetes Endocrinol， 2024， 12（4）：233-246. doi:10.1016/s2213-8587(23)00385-6 doi: 10.1016/s2213-8587(23)00385-6
24	TAYLOR R， AL-MRABEH A， SATTAR N. Understanding the mechanisms of reversal of type 2 diabetes［J］. Lancet Diabetes Endocrinol， 2019， 7（9）：726-736. doi:10.1016/s2213-8587(19)30076-2 doi: 10.1016/s2213-8587(19)30076-2
25	AL-MRABEH A， HOLLINGSWORTH K G， SHAW J， et al. 2-year remission of type 2 diabetes and pancreas morphology： a post-hoc analysis of the DiRECT open-label， cluster-randomised trial［J］. Lancet Diabetes Endocrinol， 2020， 8（12）：939-948. doi:10.1016/s2213-8587(20)30303-x doi: 10.1016/s2213-8587(20)30303-x
26	TAYLOR R， AL-MRABEH A， ZHYZHNEUSKAYA S， et al. Remission of Human Type 2 Diabetes Requires Decrease in Liver and Pancreas Fat Content but Is Dependent upon Capacity for β Cell Recovery［J］. Cell Metab， 2018， 28（4）：547-556.e3. doi:10.1016/j.cmet.2018.07.003 doi: 10.1016/j.cmet.2018.07.003
27	ALBAUGH V L， AXELROD C， BELMONT K P， et al. Physiology Reconfigured： How Does Bariatric Surgery Lead to Diabetes Remission？［J］. Endocrinol Metab Clin North Am， 2023， 52（1）：49-64. doi:10.1016/j.ecl.2022.06.003 doi: 10.1016/j.ecl.2022.06.003
28	YOSHINO M， KAYSER B D， YOSHINO J， et al. Effects of Diet versus Gastric Bypass on Metabolic Function in Diabetes［J］. N Engl J Med， 2020， 383（8）：721-732. doi:10.1056/nejmoa2003697 doi: 10.1056/nejmoa2003697
29	CINTI F， BOUCHI R， KIM-MULLER J Y， et al. Evidence of β-Cell Dedifferentiation in Human Type 2 Diabetes［J］. J Clin Endocrinol Metab， 2016， 101（3）：1044-1054. doi:10.1210/jc.2015-2860 doi: 10.1210/jc.2015-2860
30	WANG Z， YORK N W， NICHOLS C G， et al. Pancreatic beta cell dedifferentiation in diabetes and redifferentiation following insulin therapy［J］. Cell Metab， 2014， 19（5）：872-882. doi:10.1016/j.cmet.2014.03.010 doi: 10.1016/j.cmet.2014.03.010
31	WANG Z， YORK N W， NICHOLS C G， et al. Pancreatic β cell dedifferentiation in diabetes and redifferentiation following insulin therapy［J］. Cell Metab， 2014， 19（5）：872-882. doi:10.1016/j.cmet.2014.03.010 doi: 10.1016/j.cmet.2014.03.010
32	SACHS S， BASTIDAS-PONCE A， TRITSCHLER S， et al. Targeted pharmacological therapy restores β-cell function for diabetes remission［J］. Nat Metab， 2020， 2（2）：192-209. doi:10.1038/s42255-020-0171-3 doi: 10.1038/s42255-020-0171-3
33	FURTH-LAVI J， HIJA A， TORNOVSKY-BABEAY S， et al. Glycemic control releases regenerative potential of pancreatic beta cells blocked by severe hyperglycemia［J］. Cell Rep， 2022， 41（9）：111719. doi:10.1016/j.celrep.2022.111719 doi: 10.1016/j.celrep.2022.111719
34	LIU L， KE W， XU L， et al. Evaluating the role of time in range as a glycemic target during short-term intensive insulin therapy in patients with newly diagnosed type 2 diabetes［J］. J Diabetes， 2023， 15（2）：133-144. doi:10.1111/1753-0407.13355 doi: 10.1111/1753-0407.13355
35	XU L， ZHANG P， HUANG Z， et al. Hypoglycemia during Short-Term Intensive Insulin Therapy and Its Association with Long-Term Glycemic Remission in Patients with Newly Diagnosed Type 2 Diabetes［J］. J Diabetes Res， 2020， 2020：1-10. doi:10.1155/2020/4097469 doi: 10.1155/2020/4097469
36	JACOB E， AVERY A. Energy-restricted interventions are effective for the remission of newly diagnosed type 2 diabetes： A systematic review of the evidence base［J］. Obes Sci Pract， 2021， 7（5）：606-618. doi:10.1002/osp4.504 doi: 10.1002/osp4.504
37	MCINNES N， HALL S， HRAMIAK I， et al. Remission of Type 2 Diabetes Following a Short-term Intensive Intervention With Insulin Glargine， Sitagliptin， and Metformin： Results of an Open-label Randomized Parallel-Design Trial［J］. Diabetes Care， 2022， 45（1）：178-185. doi:10.2337/dc21-0278 doi: 10.2337/dc21-0278
38	RETNAKARAN R， CHOI H， YE C， et al. Two-year trial of intermittent insulin therapy vs metformin for the preservation of β-cell function after initial short-term intensive insulin induction in early type 2 diabetes［J］. Diabetes Obes Metab， 2018， 20（6）：1399-1407. doi:10.1111/dom.13236 doi: 10.1111/dom.13236
39	刘烈华，许丽娟，柯伟健，等. 短程胰岛素强化治疗后二甲双胍联合吡格列酮序贯治疗对新诊断2型糖尿病患者的作用［J］. 中华糖尿病杂志， 2020， 12（9）：696-701. doi:10.3760/cma.j.cn115791-20200224-00096 doi: 10.3760/cma.j.cn115791-20200224-00096

[1]	Rui WANG,Changqin LIU,Cui ZHANG,Qinglu YANG,Jiaolan YANG,Pengyun YIN,Xiaohui LI,Yongshun SUN,Zhanju LIU,Xiaomin. SUN. Short term clinical efficacy and influencing factors of ustekinumab monoclonal antibody in the treatment of Crohn′s disease [J]. The Journal of Practical Medicine, 2024, 40(7): 989-995.
[2]	Yan LI,Qi WANG,Lu ZHENG,Lihui FENG,Li MA,Jian WEI,Liangshu. LIU. Correlation between IL-17 gene polymorphism and type 2 diabetes mellitus in Han population in southeast Shanxi Province [J]. The Journal of Practical Medicine, 2024, 40(5): 695-701.
[3]	Jianmei SHI,Xixi WANG,Xiaojie WEI. Role of ferritinophagy in the pathogenesis of diabetes and its complications： A review of literature [J]. The Journal of Practical Medicine, 2024, 40(3): 417-422.
[4]	Menglu ZHU,Fengjiao ZHANG,Zhiqiang KANG. Effects of telomere length and plasma AGEs on bone mineral density in type 2 diabetic patients [J]. The Journal of Practical Medicine, 2024, 40(20): 2860-2866.
[5]	Chunmei ZHANG,Xinhui HUANG,Jinqiu HU,Xiaoyan BI,Fuli. YA. Sulforaphane protects human platelets from high glucose⁃induced cellular apoptosis through down-regulating PI3K/Akt signaling pathway [J]. The Journal of Practical Medicine, 2024, 40(18): 2530-2536.
[6]	Xin HUANG,Pu ZHANG,Yu GAO,Kai CHEN,Xiaofeng LI,Huiyang GU,Xue. LIANG. Multivariate analysis and prediction model of mild cognitive impairment in patients with atrial fibrillation and diabetes mellitus [J]. The Journal of Practical Medicine, 2024, 40(16): 2236-2243.
[7]	Tingting YANG,Yidan HUANG,Rongrong YANG,Ying YANG,Jing. ZHANG. Study on the relationship between serum LRG1， LDH with periodontal indexes and periodontal lesions in patients with type 2 diabetes and chronic periodontitis [J]. The Journal of Practical Medicine, 2024, 40(16): 2250-2255.
[8]	Jing GUI,Feng WANG,Hui YANG,Yumao CAI,Chuangyue. HONG. Investigation of oxidised low⁃density lipoprotein as a risk assessment indicator in patients with type 2 diabetes mellitus combined with pulmonary tuberculosis [J]. The Journal of Practical Medicine, 2024, 40(14): 1995-2002.
[9]	Dechao LI,Mingjin ZHANG,Yibi LAN,Chunlei MA,Weijin. FU. Expression of allograft inflammatory factor⁃1 in the testicular model of diabetes mellitus rats [J]. The Journal of Practical Medicine, 2024, 40(1): 65-71.
[10]	LIN Danhong, QUAN Huibiao, OU Qianying, CEN Chaoping, CHEN Kaining.. Effect of liraglutide on testosterone level and sexual function in overweight or obese men with type 2 diabe⁃ tes mellitus [J]. The Journal of Practical Medicine, 2023, 39(7): 894-898.
[11]	NIU Chunyan, CHEN Yao, SONG Yongqiang.. Key points of the American Association of Clinical Endocrinology Clinical Practice Guideline for the diagno⁃ sis and management of nonalcoholic fatty liver disease in primary care and endocrinology clinical settings co ⁃sponsored [J]. The Journal of Practical Medicine, 2023, 39(3): 267-273.
[12]	Yan YANG,Zhen WANG,Defeng. WANG. Clinical research progress of bexagliflozin： A new hypoglycemic drug [J]. The Journal of Practical Medicine, 2023, 39(22): 3015-3020.
[13]	BAI Chuan⁃ min, YANG Huijun, WU Bin.. Research progress on relationship between adipokines Adipsin and type 2 diabetes mellitus [J]. The Journal of Practical Medicine, 2023, 39(2): 133-136.
[14]	XU Qingbo, YANG Yu, YANG Li, XIE Liling, ZHANG Dongguang, HUANG Hui.. Research progress of gut microbiota and type 1 diabetes mellitus [J]. The Journal of Practical Medicine, 2023, 39(2): 142-147.
[15]	ZHOU Yingni, SHI Min, LAI Jingbo, LI Xiaomiao, LIU Xiangyang. . Efficacy of PEX168 combined with metformin in newly diagnosed obese patients with type 2 diabetes melli⁃ tus [J]. The Journal of Practical Medicine, 2023, 39(2): 170-174.

Remission of type 2 diabetes： Contending perspectives and practical approaches

RichHTML

PDF (PC)

Knowledge

Abstract

Cite this article

share this article

References 39

Related Articles 15

Recommended Articles

Metrics

Comments