破解糖尿病逆转困局！《柳叶刀》四大策略助患者重获健康

Core Viewpoint - The article discusses the evolving concept of diabetes remission, highlighting the increasing prevalence of diabetes globally and the need for new management strategies that focus on patient-centered approaches [5][6][19]. Summary by Sections Global Diabetes Prevalence - As of 2021, there are 537 million diabetes patients aged 20-79 worldwide, projected to exceed 783 million by 2045. The global medical expenditure related to diabetes reached $966 billion in 2021 [5]. Evolution of Diabetes Remission Concept - The traditional belief that type 2 diabetes is incurable has been challenged by new findings, particularly a 1992 study showing that 86.5% of patients achieved long-term normal blood sugar levels post metabolic surgery. The medical community reached a consensus in 2021 defining remission as maintaining HbA1c below 6.5% after stopping diabetes medication [8][10]. Controversies and Limitations of Current Standards - The current definition of diabetes remission faces challenges, including: 1. Over-reliance on blood sugar metrics, potentially overlooking other health risks [10]. 2. The requirement to stop medication may be inappropriate given the protective effects of new diabetes drugs [11]. 3. Psychological burdens on patients due to blood sugar fluctuations, leading to feelings of personal failure [12]. Four Scientific Strategies for Diabetes Remission - 1. Lifestyle Interventions: Strict dietary management and exercise can lead to remission, but maintaining these changes is challenging [13]. - 2. Very Low-Calorie Diets: Short-term diets (800-1200 kcal/day) can lead to significant weight loss and remission rates of 46% within a year, but require high adherence [14]. - 3. New Medications: GLP-1 receptor agonists and SGLT2 inhibitors not only control blood sugar but also provide cardiovascular protection, potentially redefining remission standards [15]. - 4. Metabolic Surgery: Effective for obese diabetes patients, with a remission rate of 72.3% within two years, but requires ongoing management to prevent weight regain [16]. Future Directions - The standards for diabetes remission need optimization, potentially moving towards: - Personalized definitions based on patient characteristics [17]. - Inclusion of protective medications in remission strategies [18]. - Dynamic assessments of remission as an ongoing process rather than a binary outcome [19].