PDF(Pubmed)
Abstract：
With changes in lifestyle behaviors, including dietary structure and habits, the prevalence of Youth-onset Type 2 Diabetes Mellitus (YODM) has increased 2 to 3 times compared to 30 years ago. YODM patients experience complications earlier, progress faster, and exhibit more severe symptoms. However, limited and inconclusive direct evidence, coupled with poor patient compliance, poses challenges in the clinical management of YODM. Apart from the continuous decline in pancreatic β-cell function and quantity, tissue-specific insulin resistance (IR) is also a typical characteristic of YODM. The main mechanisms of IR in YODM involve different aspects such as obesity, dietary imbalance, abnormal substance metabolism, chronic inflammation, oxidative stress, and hormonal fluctuations during adolescence. For the comprehensive management of YODM, besides achieving good control of blood glucose levels, it may be necessary to apply the most appropriate methods considering the uniqueness of the patient population and the specifics of the disease. Early identification and detection of the disease are crucial. Precise screening of patients with well-functioning pancreatic insulin β-cells, primarily characterized by IR and obesity, represents the population most likely to achieve diabetes remission or reversal through lifestyle modifications, medications, or even surgical interventions. Additionally, considering potential emotional disorders or the impact of adolescent hormones in these patients, health education for patients and caregivers is essential to make them aware of the long-term benefits of well-controlled blood glucose. In conclusion, adopting comprehensive management measures to achieve diabetes remission or reversal is the ideal goal. Controlling high blood glucose, obesity, and other risk factors related to diabetes complications is the next priority to delay the occurrence and progression of complications. A comprehensive perspective on IR provides insights and references for identifying YODM and its management strategies.
摘要：
随着生活方式行为的改变，包括饮食结构和习惯，与30年前相比，青年型2型糖尿病（YODM）的患病率增加了2至3倍。YODM患者更早出现并发症，进步更快,并表现出更严重的症状。然而,有限和不确定的直接证据，再加上患者依从性差，对青少年糖尿病的临床管理提出了挑战。除了胰岛β细胞功能和数量的持续下降，组织特异性胰岛素抵抗(IR)也是YODM的典型特征。IR在YODM中的主要机制涉及肥胖、饮食失衡，物质代谢异常,慢性炎症，氧化应激，青春期的荷尔蒙波动。对于YODM的全面管理，除了实现血糖水平的良好控制，考虑到患者人群的独特性和疾病的特殊性，可能有必要应用最合适的方法。疾病的早期识别和检测至关重要。胰腺胰岛素β细胞功能良好的患者的精确筛查，主要特征为IR和肥胖，代表最有可能通过改变生活方式实现糖尿病缓解或逆转的人群，药物,甚至是外科手术。此外,考虑到潜在的情绪障碍或青少年激素对这些患者的影响，对患者和护理人员的健康教育对于使他们意识到良好控制血糖的长期益处至关重要。总之,采取综合管理措施实现糖尿病缓解或逆转是理想的目标。控制高血糖，肥胖，和其他与糖尿病并发症相关的危险因素是延缓并发症发生和进展的下一个优先事项。关于IR的全面观点为识别YODM及其管理策略提供了见解和参考。
