- 期刊
糖尿病緩解之定義與新進展
Definition and Recent Advances in Achieving Remission of Diabetes
摘要
隨著各種糖尿病治療方式的新發展，原來認定糖尿病是終生疾病的看法受到挑戰，近期研究顯示糖尿病有達到緩解（remission）的機會。目前糖尿病緩解的定義有三種：部份緩解（partial remission）是指糖化血色素和空腹血糖值低於診斷糖尿病標準至少1年的時間，且不需要藥物或是其他侵入性治療，完全緩解（complete remission）為糖化血色素及空腹血糖值維持在正常範圍內至少1年的時間，且不需要藥物或是其他侵入性治療。若完全緩解時間超過5年以上，則稱為長期緩解（prolonged remission）。臨床證據顯示，肥胖的第2型糖尿病患者在接受減重手術後可顯著且持續地改善血糖控制，術後糖尿病的緩解率約達78%，同時能降低血壓和血脂，但手術相關的長期併發症和營養素的流失，仍需要持續的追蹤與照護。透過生活型態介入治療，在Look AHEAD研究之結果分析發現，改變生活型態與加強減重控制後，可降低糖化血色素、改善血脂肪（包括高密度脂蛋白、三酸甘油脂）和血壓的控制，於第1年介入治療後可達11.5%的糖尿病緩解率，其中，罹病時間較短及起始糖化血色素較低的病人能達到近20%的緩解率。糖尿病的早期診斷及早期積極胰島素治療，除了對控制血糖和降低心血管疾病危險因子有正面助益外，甚至有可能達到一定時間之糖尿病緩解。隨著移植醫學進步，胰臟及胰島移植成功的第1型糖尿病患有機會達到一段時間不需使用胰島素且血糖維持正常的糖尿病緩解，相關的慢性併發症有可能停止惡化甚至改善，但須終身使用免疫抑制劑及長期追蹤。而免疫療法在第1型糖尿病患也可促成及維持短時間的疾病緩解。至於糖尿病緩解之長期效益，仍需要更多研究來證實。
並列摘要
With the advances in the treatment for diabetes mellitus, growing evidence shows that remission of diabetes might be achievable. The current definition of partial remission is hyperglycemia below diagnostic thresholds of diabetes for at least 1 year's duration without active pharmacologic therapy or ongoing procedures. Complete remission of diabetes is a recovery of hyperglycemia (normal glycemic measures) in the absence of any antidiabetic medication at least 1 year, and if longer than 5 years it is defined as prolonged remission. Several studies have shown that bariatric surgery provides substantial and sustained effect on glycemic control in obese type 2 diabetic patients. The rate of remission is about 78% postoperatively, and cardiovascular risk, such as hypertension or dyslipidemia, can be improved after operation, although the long-term surgical complication and nutritional deficiency require continuous monitoring. Lifestyle intervention, as reported by ”Look AHEAD study”, demonstrated that A1C, lipids, systolic and diastolic blood pressure, can all be lowered with a 11.5% remission rate of diabetes after one year, though less than that by bariatric surgery. Early diagnosis and intensive insulin treatment in newly diagnosed diabetic patients provide benefits on glycemic and cardiovascular risk factor control, also shed some light on potential remission of diabetes. As improvement of transplantation medicine, type 1 diabetic patients possibly achieve a period of remission after successful pancreas or islet transplantation, and associated chronic complication may also be stabilized or ameliorated. In addition, immunotherapy has been shown to induce or maintain short-term remission of type 1 diabetes. However, the long-term benefits of diabetes remission await further investigation.