为何·如何:2型糖尿病“精准”运动干预的2个基本问题

Why·How:Two Essential Questions for“Precision”Exercise Interventions for Type 2 Diabetes

运动干预作为2型糖尿病(T2DM)关键防治策略在世界范围内已被普遍接受。遗憾的是,各种身体活动指南推荐的“一刀切”干预方案,并不能让所有患者获得相同收益。究其原因:(1)T2DM的病因、发病机制和临床表现具有高度异质性;(2)T2DM患者对运动干预的应答反应存在异质性。这两个异质性影响了T2DM运动干预治疗的有效性,而要提高有效性,需要对糖尿病进行精确分型和精准干预。因此,有必要了解精准运动干预的原理和实施过程。总结T2DM的分子遗传基础、运动干预的分子机制和患者对运动应答的异质性,并对当前T2DM的精准分型、诊断、治疗、监测的研究进展进行评述,重点关注T2DM患者对运动应答反应个体差异的原因和机制,提出将运动处方各参数作为T2DM精准治疗关键变量的建议。

Exercise intervention as a key prevention and treatment strategy for type 2 diabetes mellitus(T2DM)has been generally accepted worldwide.Unfortunately,the“one-size-fits-all”interventions recommended by various physical activity guidelines do not result in the same benefits for all patients.The reasons are:first,the etiology,pathogenesis and clinical manifestations of T2DM are highly heterogeneous;second,the response of T2DM patients to exercise intervention is heterogeneous.These two heterogeneities affect the effectiveness of exercise intervention in T2DM,and to improve the effectiveness,precise typing and precise intervention for diabetes are required.Therefore,it is necessary to understand the principle and implementation process of precision motion intervention.In this review,we summarize the molecular genetic basis of T2DM,the molecular mechanism of exercise intervention,and the heterogeneity of patients’response to exercise,and comment on the current research progress in accurate typing,diagnosis,treatment,and monitoring of T2DM.,focusing on the causes and mechanisms of individual differences in T2DM patients’response to exercise,and put forward suggestions for using exercise prescription parameters as key variables in the precise treatment of T2DM.