T. Koufakis, Dimitrios Patoulias, I. Zografou, Nikolaos Papanas, Djordje S Popovic
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引用次数: 0
摘要
在这篇社论中,我们对曾志伟等人发表在最近一期《世界糖尿病杂志》(World Journal of Diabetes in 2024)上的文章进行了评论。我们重点关注肥胖与 1 型糖尿病(T1DM)之间的流行病学、病理生理学和临床相互作用。超重和肥胖对现代社会的威胁与日俱增,T1DM 患者也不例外。长期外源性胰岛素用药、遗传和表观遗传因素、心理-社会和行为参数,再加上不健康的饮食模式和缺乏运动的现代生活方式,为 T1DM 患者肥胖率的不断上升埋下了伏笔。随着我们对导致肥胖和高血糖发生的内在机制的了解不断加深,很明显,这两种主要类型糖尿病的病理生理学存在重叠区。关于 "自身免疫性 "和 "代谢性 "表型之间严格分界线的陈旧观念增加了医生陷入无效治疗方法的风险,而不是个性化的糖尿病护理。在这种情况下,在胰岛素治疗的基础上使用具有减轻心肾风险和减轻体重潜力的辅助药物,可以减轻 T1DM 患者的肥胖负担。
Drawing lines in the sand: The growing threat of obesity in type 1 diabetes
In this editorial, we comment on the article by Zeng et al published in the recent issue of the World Journal of Diabetes in 2024. We focus on the epidemiological, pathophysiological, and clinical interplay between obesity and type 1 diabetes mellitus (T1DM). Overweight and obesity represent a growing threat for modern societies and people with T1DM could not be an exception to this rule. Chronic exogenous insulin administration, genetic and epigenetic factors, and psy-chosocial and behavioral parameters, along with the modern way of life that incorporates unhealthy eating patterns and physical inactivity, set the stage for the increasing obesity rates in T1DM. As our knowledge of the underlying mechanisms that lead to the development of obesity and hyperglycemia expands, it becomes clear that there are overlap zones in the pathophysiology of the two main types of diabetes. Stereotypes regarding strict dividing lines between “autoimmune” and “metabolic” phenotypes increase the risk of trapping physicians into ineffective therapeutic approaches, instead of individualized diabetes care. In this context, the use of adjuncts to insulin therapy that have the potential to alleviate cardiorenal risk and decrease body weight can reduce the burden of obesity in patients with T1DM.