糖尿病分型与治疗：我们还需要走多远

由于糖尿病病因至今未明，虽然临床上多采用ADA糖尿病分型方法，但随着对糖尿病病因及发病机制的研究，出现了许多难以用传统的标准进行分类的疾病状态。有人提出淡化糖尿病分型的争论。笔者认为高血糖仅是一种表现，并不是疾病的本质，慢性低活度炎症状态可能是核心机制之一，机体的这种慢性低活度炎症状态可能与糖尿病肾病、抗感染免疫失控以及创伤愈合障碍有关。短时间内控制急性高血糖状态对挽救生命是关键的，但要实现长期是代谢紊乱控制、纠正不良生活习惯、减轻腹内脂肪堆积，进而降低改善机体的慢性炎症状态可能是最全面且安全的唯一措施。

Classifieation and Treatment of Diabetes Meilitus

Classification by ADA/1997 criteria is the current state of for diabetes classification. This criterion is challenged because many clinical circumstances were found difficult to define, therefore, “Declassifying diabetes” was proposed. Hyperglycemia is only a symptom, and can be caused by many conditions; chronic low grade inflammation in metabolic syndrome and type 2 diabetes might be the core mechanism. This mechanism is associated with diabetic nephropathy, deregulated antimicrobial activity, repair and healing activity. Rapid correcting acute stress hyperglycemia is critical in decreasing mortality. From view of long term metabolic control life style rectification is vital in reducing abdominal adiposity, normalizing inflammatory state and thereby decreasing insulin resistance.