1型糖尿病中的胰岛素抵抗及其治疗策略

Insulin Resistance in Type 1 Diabetes and Its Treatment Strategies

摘要: 胰岛素抵抗(Insulin Resistance, IR)是2型糖尿病发病机制中最重要的因素，但也可能在1型糖尿病(Type 1 Diabetes, T1DM)中发生。在T1DM患者中发生IR可能对实现血糖目标产生负担，并可能恶化整体预后。1型糖尿病IR的发生是多因素的，它通常与超重或肥胖以及久坐的生活方式有关。除了血糖控制受损和胰岛素需求增加之外，IR的存在还会导致T1DM患者的心血管风险增加。有研究已经证明在改善T1DM患者胰岛素敏感性方面可行的最重要干预措施是生活方式优化，包括饮食控制、运动以及使用药物治疗，如二甲双胍、钠–葡萄糖共转运蛋白-2 (SGLT-2)抑制剂、胰高血糖素样肽-1受体激动剂(GLP1-Ras)和噻唑烷二酮。T1DM和IR共存的病理生理学是多因素的，文章旨在描述T1DM中IR可能的发病机制，并介绍针对T1DM患者IR所采取的干预措施，以期为T1DM中血糖控制及提高胰岛素敏感性提供新思路。

Abstract: Insulin resistance (IR) is the most important factor in the pathogenesis of type 2 diabetes mellitus, but may also occur in type 1 diabetes (T1DM). The occurrence of IR in patients with T1DM may be burdensome for achieving glycemic goals and may worsen the overall prognosis. The occurrence of IR in type 1 diabetes is multifactorial, and it is often associated with overweight or obesity and a sedentary lifestyle. In addition to impaired glycemic control and increased insulin requirements, the presence of IR increases increased cardiovascular risk in patients with T1DM. The most important interventions that have been shown to be feasible in improving insulin sensitivity in patients with T1DM are lifestyle optimization, including dietary control, exercise, and the use of pharmacological therapies such as metformin, sodium-glucose cotransporter protein-2 (SGLT2) inhibitors, glucagon-like peptide-1 receptor agonists (GLP1-RAs), and thiazolidinediones. The pathology of the coexistence of T1DM and IR is multifactorial. Physiology is multifactorial, and the aim of this paper is to describe the possible pathogenesis of IR in T1DM and to present interventions for IR in patients with T1DM, with the aim of providing new ideas for glycemic control and improving insulin sensitivity in T1DM.