胰岛素抵抗是肥胖的罪魁祸首?——从A型胰岛素抵抗谈2型糖尿病患者脂肪堆积

Is insulin resistance the main culprit of obesity?Discussion on fat accumulation in type 2 diabetes from type A insulin resistance

临床普遍认为2型糖尿病患者伴随的过度脂肪堆积归因于胰岛素抵抗,并主张通过多种手段改善胰岛素抵抗以遏制脂肪堆积。近年来围绕罕见先天性胰岛素抵抗的研究表明,由胰岛素受体基因突变引发的A型胰岛素抵抗综合征患者常表现为严重胰岛素抵抗及高胰岛素血症,但往往不伴明显脂肪堆积,提示2型糖尿病患者伴脂肪堆积可能并非仅受胰岛素抵抗推动,而倾向胰岛素需求及分泌增加等一系列代谢变化共同作用的结果。此研究结果或将对此类肥胖患者的临床干预及长期健康管理产生重要影响。

At present,it is generally believed that the excessive fat accumulation associated with type 2 diabetes is due to insulin resistance,and it is advocated to improve insulin resistance by various means to curb fat accumulation.However,in recent years,studies around rare congenital insulin resistance have shown that patients with type A insulin resistance syndrome caused by mutations in the insulin receptor gene can often show severe insulin resistance and hyperinsulinemia,but often without obvious fat accumulation.These studies suggest that type 2 diabetes with fat accumulation may not only be driven by insulin resistance,but also tend to be the result of a series of metabolic changes such as increased insulin demand and secretion.This research result may have significant implications for clinical interventions and long-term health management of obese patients.