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[ADA2015]纪念是为了更好地出发
——糖尿病治疗史回顾
——美国亨利福特医院Fred W. Whitehouse教授访谈
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作者:F.W.Whitehouse 2015/6/17 11:12:00    加入收藏
内容概要:波士顿当地时间2015年6月9日上午,ADA2015年会将呈现一场别开生面的关于“糖尿病研究和治疗50年回顾”的报告,《国际糖尿病》记者提前采访了报告讲者之一,来自美国底特律亨利福特医院德高望重的Fred W. Whitehouse教授。Whitehouse教授与我们分享他对糖尿病50年治疗史变迁的观点。

  <International Diabetes>:  Dr. Whitehouse, so looking back on the diabetes therapy history 50 years ago, what is the most impressive event?

  Dr. Fred Whitehouse: If you go back just 50 years the most impressive thing is the diabetes – the results of the diabetes control and complications trial which sealed the fact that controlling the blood sugar decreases the risk of vascular disease. Eye trouble, kidney trouble, heart trouble. But if you go further back, the most impressive thing that’s happened in the 20th century is the availability of insulin. Because what doctors did before insulin was discovered was sign death certificates.

   回顾糖尿病治疗50年发展史印象最深刻的事件

 
  如果只是回顾过去50年糖尿病的治疗史,令我最为印象深刻的是糖尿病控制与并发症试验(DCCT)结果,这些结果表明控制血糖可降低血管疾病的发生风险,降低眼部、肾脏及心脏疾病发生风险。如果再向前追溯,令我最为印象深刻的事件则是发生于20世纪的胰岛素的应用。因为在胰岛素问世之前,医生能做的就是签署死亡证明。

  <International Diabetes>:  So, in your opinion, which events have made great contribution to diabetes therapy and should be remembered as the greatest event?

  Dr. Fred Whitehouse: Well I think that the issue of the availability of the hemoglobin A1c which gives you a long average, the ability to easily inject insulin, the ability to have oral agents that will affect positively the blood sugar and keep the blood sugar lower. The one disappointing thing is the lack of benefit for a large number of people with diabetes of transplantations, either pancreas or eyelid cell transplantation. And I think that the idea of being able to measure the blood sugar and know whether it’s high or low or where, is a very good thing, rather than the urine tests. The toughest thing in diabetes is the food. And the more food that becomes available, wherever, the heavier the people will be. The heavier the people will be, the more likely they will have type 2 diabetes. And complications can occur with type 2 diabetes just like type 1.

  对糖尿病治疗作出巨大贡献的最伟大事件
 
  我认为,糖化血红蛋白的应用应该是最伟大的事件。糖化血红蛋白能反映较长一段时间内的平均血糖水平,有助于更方便地注射胰岛素,有助于口服降糖药物的应用,对血糖控制有积极影响,有助于将血糖降低。目前,令人失望的是,在大量的糖尿病移植(胰腺移植或胰岛细胞移植)患者中还缺乏糖化血红蛋白具有获益的证据。我认为,与尿检相比,测定血糖水平,了解血糖水平高低的理念是非常好的。对糖尿病治疗而言,最难以控制的是食物。可用的食物种类越多,人们往往体重越重,全世界皆是如此。人们的体重越重,就越容易罹患2型糖尿病,2型糖尿病患者也越容易像1型糖尿病那样出现并发症。

  <International Diabetes>: So we just – I think you just mentioned the urine sugar and self-monitoring blood sugar level and HbA1c, do you think glucose monitoring become more exact and effective nowadays because of that?

  Dr. Fred Whitehouse: It’s pretty exact now if you do it right. A lot of people are not careful enough in doing it and some people don’t like to stick their fingers and therefore they don’t do it as often as they should. So if there were a way to monitor the blood sugar without poking the finger, that would be nice, that would a gadget that would be improved. People have tried that by putting things on the eyeglasses and things of this nature but it doesn’t work.

  如何评价当前的血糖监测
 
  如果能够正确地进行监测,当然可以做到非常准确。很多人在进行血糖监测时不够仔细,有些人不愿意扎手指,因而未能按照要求的频率进行监测。如果能有一种不需要扎手指就能监测血糖的方法,就非常好并能改善血糖监测现状。人们曾试图在眼镜上放置某些设备来监测血糖或者类似的没有侵入性的方法,但却无效。截止到目前为止,我们还没有找到不采集血样来监测血糖的方法。我猜可能在我有生之年都不会实现了。
 

  <International Diabetes>:  So could be that belong to the future development or what other ideas or discoveries you want to mention?

  Dr. Fred Whitehouse: I don’t know of any other ideas of how to measure the blood without getting blood but maybe some people do. But it hasn’t happened so far and my guess is it’s not going to happen in my lifetime.

 

  <International Diabetes>: So, uh, Dr. Whitehouse, in the face of diabetes popular all around the world, what lessons should doctors and researchers learn from the past 50 year of diabetes therapy history in order to better stop and control diabetes in the future?

  Dr. Fred Whitehouse: Well I think that first is that in the lifetime of the doctors who are now seeing people with diabetes that they shouldn’t expect a cure. They should be prepared to hold these people’s hands and manage them throughout their lifetime. I doubt that there’ll be a cure. Now I hope I’m dead wrong but it’s a very complex disease and under those circumstances, it’s a disease where people have to accept its existence. It’s a 24/7 disease, it’s not like other diseases, as I said, where you can take a pill in the morning and then you’re free for the day. And it’s very difficult and if you don’t do it right, then you get into trouble. So what can they expect? Easier ways, perhaps, of taking insulin. Now there’s inhaling insulin again, we see this downstairs. There may be ways in which insulin can be absorbed from the gut. That’s been tried in the past and has not worked but it can be tried again. And maybe there are ways in which you can give insulin a single injection but it will last a longer period of time. Instead of one day or two days, maybe a week. Who knows? The combination - the ideal combination, short of a cure, of giving insulin would probably be to have a long acting insulin, maybe once a week, and then inhale insulin whenever you’re going to eat. The problem with inhaling insulin is that nobody knows what this complex protein might do with its carrier to the lung function. Now five years’ experience with the previous one did not show any problem. But people would have to take that on and understand that it’s a risk.

 

  医生及研究者应从过去50年糖尿病治疗史中总结的教训
 
  我认为,首先负责治疗糖尿病患者的医生应知道糖尿病是不能治愈的,需要做好与患者携手并对糖尿病患者进行终生管理的准备。糖尿病是一种非常复杂的疾病,医生及患者必须接受它存在及不能治愈的现实。正如我之前所说,糖尿病是一种终身性疾病及全天候疾病(每天24小时/每周7天),不能像其他疾病那样仅需早上服用一片药就行。糖尿病的控制是非常困难的,如果不能进行正确的控制,则会带来问题。
 
  就糖尿病的治疗而言,我们可以期待些什么?举例来说,我们可以期待更简单的胰岛素应用方法。现在,我们已经有了吸入型胰岛素。此外,科学家一直在就口服胰岛素进行研究,但尚未取得成果,不过还是可以继续进行尝试。另外,我们也可以期待未来能研发出单次注射其作用即可持续较长一段时间的超长效胰岛素。这样胰岛素不是一天或两天应用一次,可能会是一周应用一次。另外,由每周应用一次的长效胰岛素及餐时应用的吸入型胰岛素组成的胰岛素联合治疗方案也备受期待。目前,吸入型胰岛素的问题是没有人知道这种复杂的蛋白质对肺功能会有何影响。从吸入型胰岛素的5年应用经验来看,并未发现什么问题。但是,人们还是需要对此开展相关研究,不能忽视吸入型胰岛素影响影响肺功能的潜在风险。
 
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