專業(yè)英語上原文及翻譯整合

1、前言Familiarity breeds contempt. This was true for the fox in Aesops fable whose respect and fear for the mighty lion was dulled by seeing him day after day. Arguably the same has occurred with our attitude to diabetes. We hope that this collection of reviews by leading researchers in diabetes will he

2、lp rectify this situation. 熟生蔑。伊索寓言里面的狐貍正是如此，它對獅子的尊重和害怕隨著見到獅子的次數(shù)增多而日漸減少。同樣的問題發(fā)生在我們對糖尿病的態(tài)度上，我們希望糖尿病研究領(lǐng)域的主要研究者發(fā)表的這些論文匯集可以幫助改正這種情形。Diabetes is so prevalent that all readers of this Insight will know several diabetics, at least one of whom will be injecting insulin to keep their condition under control.

3、 At base, diabetes is caused by failure to maintain a stable level of blood glucose in the face of the normal fluctuations of supply and demand. However, the causes of this relatively straightforward dysfunction are anything but simple, and diabetes is not one but a spectrum of disorders. 糖尿病是這么的普遍，

4、以至于這篇洞察文章的所有閱者都將知道幾個(gè)糖尿病患者，至少他們中的一個(gè)將需要通過注射胰島素保持血糖環(huán)境在控制范圍內(nèi)。本質(zhì)上，糖尿病原因是由于機(jī)體在面對正常血液流動(dòng)的供需時(shí)不能維持一個(gè)穩(wěn)定的血糖水平。然而，這個(gè)相對直接的功能障礙的原因一點(diǎn)也不簡單，糖尿病不是一個(gè)而是一系列的紊亂。 The following articles discuss both type 1 diabetes, in which the insulin producing cells in the pancreas are killed early in life, and the more insidious type 2

5、 diabetes, where daily environmental and dietary stresses overload and ultimately destroy the bodys systems for regulating blood glucose. Both these forms, if uncontrolled, can lead to severe complications such as heart disease, kidney failure, blindness and even loss of limbs.The debate over the bi

6、ochemical causes of these complications and the best ways to prevent their development is also reflected in these pages. 下面的文章討論了1型糖尿病（在生命早期胰島中產(chǎn)生胰島素的細(xì)胞被殺死）和潛伏性更強(qiáng)的2型糖尿?。ㄈ粘Ｉ睢嬍硥毫ω?fù)荷過大最終破壞了調(diào)控血糖的系統(tǒng)）。這兩類糖尿病，如果不能有效控制，將會(huì)引發(fā)嚴(yán)重的并發(fā)癥，如心臟病、腎衰竭、失明和四肢癱瘓。引起這些并發(fā)癥的生化原因以及阻止它們發(fā)展的最好方法的討論，在這些文章中也有提及。 Despite a wealth of

7、knowledge about diabetes we must not be complacent. The World Health Organization predicts a doubling in its incidence in the next two decades, fuelled predominantly by modern lifestyles and an increasing incidence of obesity. It is also acquiring a variety of new names, including metabolic syndrome

8、, syndrome X, diabesity and insulin resistance. But whatever it is called diabetes is a complex and potentially debilitating condition which, like Aesops lion, must be taken very seriously. 盡管關(guān)于糖尿病的知識很多，但我們也不能因此滿足。世界衛(wèi)生組織預(yù)測在未來20年發(fā)病率會(huì)增加一倍，主要是因?yàn)楝F(xiàn)代的生活方式和肥胖的增加。因此它也有多種多樣的名稱，如代謝綜合征、X綜合征、糖胖病和胰島素障礙癥。但無論它被叫做什

9、么，糖尿病都是一個(gè)復(fù)雜而且是一種潛在的衰弱條件，正如伊索寓言里的獅子，必須得到重視。We are pleased to acknowledge the financial support of Bristol-Myers Squibb in producing this Insight. As always, Nature retains sole responsibility for editorial content and its peer review. 我們很開心地答謝美國貴寶公司對本雜志的資金支持。一如既往，自然對編輯內(nèi)容和同行審查保留唯一責(zé)任第一篇Global and socie

10、tal implications of the diabetes epidemicChanges in human behaviour and lifestyle over the last century have resulted in a dramatic increase in the incidence of diabetes worldwide. The epidemic is chiefly of type 2 diabetes and also the associated conditions known as diabesity and metabolic syndrome

11、. In conjunction with genetic susceptibility, particularly in certain ethnic groups, type 2 diabetes is brought on by environmental and behavioural factors such as a sedentary lifestyle, overly rich nutrition and obesity. The prevention of diabetes and control of its micro- and macrovascular complic

12、ations will require an integrated, international approach if we are to see significant reduction in the huge premature morbidity and mortality it causes. “Man may be the captain of his fate, but he is also the victim of his blood sugar”Wilfrid Oakley Trans. Med. Soc. Lond. 78, 16 (1962) 糖尿病流行的全球及社會(huì)意

13、義摘要：上個(gè)世紀(jì)人類行為和生活方式的改變已導(dǎo)致全球糖尿病發(fā)病率劇增。這流行病主要是2型糖尿病及與之相關(guān)的被稱為“肥胖性糖尿病”和“代謝綜合征”的身體狀況。結(jié)合遺傳易感性，尤其是在特定的種族群體中，2型糖尿病由環(huán)境和諸如久坐不動(dòng)的生活方式，營養(yǎng)過剩和肥胖等行為因素造成的。如果我們希望它造成的早期發(fā)病率和死亡率顯著減少，那么糖尿病的預(yù)防及它的微/宏血管并發(fā)癥的控制將需要一個(gè)綜合的國際化的方法?！叭祟愐苍S是命運(yùn)的主人，但是他也是他血糖的受害者”Wilfrid Oakley Trans. Med. Soc. Lond. 78, 16 (1962)Diabetes mellitus, long cons

14、idered a disease of minor significance to world health, is now taking its place as one of the main threats to human health in the 21st century. The past two decades have seen an explosive increase in the number of people diagnosed with diabetes worldwide2,3. Pronounced changes in the human environme

15、nt, and in human behaviour and lifestyle, have accompanied globalization, and these have resulted in escalating rates of both obesity and diabetes. Hence the recent adoption of the term diabesity4, first suggested by Shafrir several decades ago5. 糖尿病，長期以來一直被認(rèn)為是對世界健康較次要的一種疾病，如今被視為21世紀(jì)人類健康的主要威脅之一1。在過去

16、的二十年里，全球被確診為糖尿病的患者的數(shù)量暴增2,3。隨著全球化，人類環(huán)境、行為和生活方式發(fā)生了明顯的變化，這也導(dǎo)致肥胖及糖尿病發(fā)病率逐步上升。近期采用的“糖胖癥”這一術(shù)語4是由Shafrir于幾十年前首次提出5。 There are two main forms of diabetes6. Type 1 diabetes is due primarily to autoimmune-mediated destruction of pancreatic b-cell islets, resulting in absolute insulin deficiency. People with ty

17、pe 1 diabetes must take exogenous insulin for survival to prevent the development of ketoacidosis. Its frequency is low relative to type 2 diabetes, which accounts for over 90% of cases globally. Type 2 diabetes is characterized by insulin resistance and/or abnormal insulin secretion, either of whic

18、h may predominate. People with type 2 diabetes are not dependent on exogenous insulin, but may require it for control of blood glucose levels if this is not achieved with diet alone or with oral hypoglycaemic agents. 糖尿病有兩種主要的類型6。1型糖尿病主要是由于胰島B細(xì)胞島自身免疫受損導(dǎo)致胰島素的嚴(yán)重缺乏。1型糖尿病患者必須注射外源胰島素以預(yù)防酮酸毒癥的發(fā)展進(jìn)而存活下來。與患病率

19、超過全球90%的2型糖尿病相比，1型糖尿病的患病率相對較低。2型糖尿病的特點(diǎn)是胰島素耐受性和/或胰島素分泌異常，兩種其一都可能占主導(dǎo)地位。2型糖尿病患者并不依賴外源性胰島素，但在僅靠日常飲食調(diào)節(jié)和口服降血糖藥劑都不能實(shí)現(xiàn)血糖水平的穩(wěn)定的情況下就需要它來控制血糖水平的穩(wěn)定The diabetes epidemic relates particularly to type 2 diabetes, and is taking place both in developed and developing nations7. Paradoxically, part of the problem rela

20、tes to the achievements in public health during the 20th century, with people living longer owing to elimination of many of the communicable diseases8. Non-communicable diseases (NCD) such as diabetes and cardiovascular disease (CVD) have now become the main public health challenge for the 21st cent

21、ury, as a result of their impact on personal and national health and the premature morbidity and mortality associated with the NCDs1. 糖尿病尤其是2型糖尿病的流行在發(fā)達(dá)國家和發(fā)展中國家都有發(fā)生7。諷刺的是，一部分問題與20世紀(jì)公共衛(wèi)生方面取得的成就有關(guān)，即人們因?yàn)閭魅拘约膊〉南龎勖娱L了8。非傳染性疾病（NCD）如糖尿病和心血管疾?。–VD），由于個(gè)人、國家、早期患病率和死亡率的影響，現(xiàn)在已經(jīng)成為21世紀(jì)公共衛(wèi)生的主要挑戰(zhàn)1After taking so lo

22、ng to gain recognition, interest in diabetes is now mounting rapidly7 and it is an exciting time for researchers and clinicians involved in the study and treatment of the disease. The problem has crept up on an unsuspecting public health community.The global figure of people with diabetes is set to

23、rise from the current estimate of 150 million to 220 million in 2010, and 300 million in 2025 (Fig. 1)2,3. Most cases will be of type 2 diabetes, which is strongly associated with a sedentary lifestyle and obesity7. This trend of increasing prevalence of diabetes and obesity has already imposed a hu

24、ge burden on health-care systems and this will continue to increase in the future1,9. 經(jīng)過長期地獲取知識以后，現(xiàn)在糖尿病的關(guān)注度迅速增加7，而且對于參與這個(gè)疾病的研究和治療的研究人員及醫(yī)師而言這也是一個(gè)令人興奮的時(shí)刻。這個(gè)問題已經(jīng)蔓延至一個(gè)出乎人們意料的公共健康群體。糖尿病的全球患者數(shù)據(jù)顯示，患病數(shù)量勢必會(huì)從現(xiàn)在的1.5億發(fā)展到2010年的2.2億，繼而發(fā)展到2025年的3億人2,3 （圖1）。大多數(shù)病例將是與久坐不動(dòng)的生活方式和肥胖癥緊密關(guān)聯(lián)的2型糖尿病7。糖尿病及肥胖越加普遍這一趨勢已經(jīng)對衛(wèi)生保健系統(tǒng)造成

25、一個(gè)巨大負(fù)擔(dān)，而且這趨勢在今后仍然會(huì)繼續(xù)增加1,9Although type 2 diabetes is numerically more prevalent in the general population, type 1 diabetes is the most common chronic disease of children. But with the increasing prevalence of type 2 diabetes in children and adolescents, the order may be reversed within one to two de

26、cades10,11. 雖然2型糖尿病在數(shù)量上更普遍，但是1型糖尿病是兒童群體中最常見的慢性疾病。但是隨著2型糖尿病在兒童和青少年中日益流行，上述的規(guī)律可能會(huì)在十年至二十年內(nèi)被推翻10,11。Prevention of complications Prevention of complications is a key issue because of the huge premature morbidity and mortality associated with the disease1,12. In the past decade, several major studies have

27、 focused attention on the need for strict control of glycaemia to prevent and/or reduce the risk of both the specific microvascular and the less specific macrovascular complications7. 并發(fā)癥的預(yù)防因?yàn)榕c之相關(guān)的巨大的早期發(fā)病率和死亡率，并發(fā)癥的預(yù)防是一個(gè)關(guān)鍵問題1,12。在上個(gè)年代，一些主要的研究已將注意力集中在需要嚴(yán)格控制血糖來預(yù)防和/或減少特異微血管和較不特異宏血管的并發(fā)癥風(fēng)險(xiǎn)的必要性7。The Diabet

28、es Control and Complications Trial13 was a landmark study and the flagship for a number of studies that established the value of intensive control of blood glucose to prevent the retinal, renal and neuropathic complications of diabetes. The United Kingdom Prospective Diabetes Study (UKPDS)14 fulfill

29、ed the same role for type 2 diabetes. Subsequently, there were other important studies that underline the importance of active medical intervention (including control of blood pressure and lipids as well as glucose) for the reduction of the risk of diabetes complications. This applies to micro vascu

30、lar complications, as shown, for example, by the Stockholm15, MICRO-HOPE16 and Kumamoto studies17, and to macrovascular disease from the 4S18, CARE19and MICRO-HOPE16 studies. “糖尿病控制與并發(fā)癥”試驗(yàn)是眾多研究的一個(gè)里程碑和旗艦研究，它建立了強(qiáng)化血糖控制來防止視網(wǎng)膜、腎臟和神經(jīng)等糖尿病的并發(fā)癥的價(jià)值。對于2型糖尿病英國前瞻性糖尿病研究14也應(yīng)驗(yàn)了其同樣的地位。一些其他研究強(qiáng)調(diào)積極的藥物干擾（包括血壓、脂質(zhì)和葡萄糖的控制）

31、對于減少糖尿病并發(fā)癥的風(fēng)險(xiǎn)的重要性。這適用于微血管并發(fā)癥，例如，如文獻(xiàn)所示，由Stockholm研究的MICRO-HOPE16、Kumamoto的研究17、和來自4S18、CARE19和MICRO-HOPE16的關(guān)于宏血管疾病的研究。The concealed burden of impaired glucose toleranceType 2 diabetes is increasingly common, indeed epidemic, primarily because of increases in the prevalence of a sedentary lifestyle an

32、d obesity20. The possibility of preventing type 2 diabetes by interventions that affect the lifestyles of subjects at high risk for the disease is now the subject of a number of studies; these have focused on people with impaired glucose tolerance (IGT)2123. IGT is defined as hyperglycaemia (with gl

33、ucose values intermediate between normal and diabetes) following a glucose load (ref. 6 and Table 1), and affects at least 200 million people worldwide. It represents a key stage in the natural history of type 2 diabetes as these people are at much higher future risk than the general population for

34、developing diabetes24,25. Approximately 40% of subjects progress to diabetes over 510 years, but some revert to normal or remain IGT. 葡萄糖耐量受損的潛在負(fù)荷2型糖尿病日益普遍，事實(shí)上已十分流行，主要是因?yàn)槿藗兙米粍?dòng)的生活方式和肥胖的盛行。通過對高疾病風(fēng)險(xiǎn)的生活方式的干預(yù)來預(yù)防2型糖尿病，這種可能性如今已成為許多研究的主題，并都集中在葡萄糖耐量受損（IGT）的患者身上。IGT被定義為高血糖（介于正常與糖尿病之間的葡萄糖值），其伴隨有一定程度的糖負(fù)荷（參考文獻(xiàn)6

35、和表1），影響著全球至少2億人。高血糖代表了2型糖尿病在自然病程中的一個(gè)關(guān)鍵階段，因?yàn)檫@些人在之后發(fā)生糖尿病的風(fēng)險(xiǎn)遠(yuǎn)高于一般人群。大約40的患者在5-10年內(nèi)發(fā)展為糖尿病患者，但也有些恢復(fù)到正常水平或保持高血糖。 Subjects with IGT also have a heightened risk of macrovascular disease2529. Because of this, and the association with other known CVD risk factors including hypertension, dyslipidaemia and cent

36、ral obesity6,30, the diagnosis of IGT, particularly in apparently healthy and ambulatory individuals, has important prognostic implications29,31. IGT的被試者也有較高的宏血管疾病風(fēng)險(xiǎn)，因此，聯(lián)系諸如高血壓，血脂異常和中心肥胖等其他已知的心血管病危險(xiǎn)因素，IGT的診斷，特別是在表面上的健康及流動(dòng)個(gè)體中具有重要的預(yù)兆性意義。 Impaired fasting glucose (IFG) was introduced recently as anothe

37、r category of abnormal glucose metabolism6,32. It is defined on the basis of fasting glucose concentration (Table 1) and, like IGT, it is associated with risk of CVD and future diabetes. The American Diabetes Association had hoped that their recommendation of the adoption of IFG32 would simplify the

38、 screening for at-risk individuals, with the need for an oral glucose-tolerance test being circumvented. However, the desired outcome has yet to be achieved as IGT is a better predictor than IFG of risk of future diabetes and of mortality22,27,28,33. 空腹血糖受損（IFG）近期被作為另一類糖代謝異常引入。它是被定義在空腹血糖濃度的基礎(chǔ)上（表1），正

39、如IGT一樣，它與患心血管病和在未來患糖尿病的風(fēng)險(xiǎn)息息相關(guān)。美國糖尿病協(xié)會(huì)曾希望他們建議采用的IFG可以因?yàn)槠浔苊饪诜咸烟悄褪茉囼?yàn)而簡化對高危個(gè)體的篩查工作。然而，這種預(yù)期結(jié)果還未出現(xiàn)，因?yàn)镮GT相比于IFG是預(yù)測未來患糖尿病的風(fēng)險(xiǎn)和死亡率更好的預(yù)測因子。 Type 2 diabetes and the metabolic syndromeType 2 diabetes is a multifactorial disease that shows heterogeneity in many respects34. Our understanding of the disease and re

40、lated disorders such as IGT and IFG is undergoing a radical change, particularly as data suggest that the risk of complications commences many years before the onset of clinical diabetes30,35. Previously, it was regarded as a relatively distinct disease entity, but in reality, type 2 diabetes (and i

41、ts associated hyperglycaemia or dysglycaemia) is often a manifestation of a much broader underlying disorder7,36. This includes the metabolic syndrome (sometimes called syndrome X; Fig. 2) a cluster of CVD risk factors that, in addition to glucose intolerance (that is, IGT or diabetes), includes hyp

42、erinsulinaemia, dyslipidaemia, hypertension, visceral obesity, hypercoagulability and microalbuminuria. This new paradigm relating to type 2 diabetes also influences contemporary therapy for the disease7. Evidence now exists for a far more aggressive approach to treating not just the hyperglycaemia,

43、 but also other CVD risk factors such as hypertension, dyslipidaemia and central obesity in type 2 diabetic patients, with the hope of significantly reducing cardiovascular morbidity and mortality. 2型糖尿病和代謝綜合征2型糖尿病多因素疾病，、在許多方面顯示出異質(zhì)性。我們對疾病的認(rèn)識和相關(guān)異常如IGT和IFG的了解正在經(jīng)歷一個(gè)巨變，特別地，數(shù)據(jù)顯示：并發(fā)癥的風(fēng)險(xiǎn)在臨床糖尿病發(fā)病前幾年就已經(jīng)存在。以前

44、，它被認(rèn)為是一種相對明顯的疾病實(shí)體，而事實(shí)上，2型糖尿?。捌湎嚓P(guān)的高血糖或血糖障礙）往往是一個(gè)更廣泛的潛在失調(diào)的表現(xiàn)，其中包括代謝綜合征（有時(shí)也被稱為X綜合征; 圖2），即除葡萄糖耐受性（即IGT或糖尿?。┩庑难芗膊〉奈ｋU(xiǎn)因素的一個(gè)群集，包括高胰島素血癥、血脂異常、高血壓、腹型肥胖、高凝狀態(tài)、微量白蛋白尿。這種新的模式與2型糖尿病也影響當(dāng)前的治療疾病。證據(jù)表明現(xiàn)在存在更為積極的方法治療高血糖及其他心血管疾病的危險(xiǎn)因素，如高血壓，血脂異常和2型糖尿病患者中的中心型肥胖，以期顯著減少心血管疾病發(fā)病率和死亡率。There is continuing debate as to the primar

45、y aetiological factor for the syndrome. Genetic factors, visceral obesity, insulin resistance and endothelial dysfunction may all contribute either solely or jointly36,37. Irrespective of the aetiologic debate, a recent report from the WHO6 has highlighted both the need and the importance of a consi

46、stent definition of the metabolic syndrome and has suggested parameters. Although the criteria may change as new prospective data become available, this initiative provides a basis for the development of a standardized definition that will allow international comparisons of prevalence, incidence and

47、 natural history, as previously there was no internationally agreed definition. 糖尿病的主要致病因素一直存在爭議。遺傳因素、腹型肥胖、胰島素抗性、內(nèi)皮功能紊亂可能單獨(dú)或協(xié)同致病。撇開病因的辯論不提,世界衛(wèi)生組織的一份最新報(bào)告強(qiáng)調(diào)了統(tǒng)一代謝綜合癥定義的必要性和重要性，并且建議設(shè)定參數(shù)。即使將來逐漸獲得新的信息，以致標(biāo)準(zhǔn)改變，但是這種主動(dòng)性能為標(biāo)準(zhǔn)化定義的發(fā)展奠定基礎(chǔ)，而標(biāo)準(zhǔn)化的定義使得能夠在國際上比較糖尿病的患病率、發(fā)病率及自然病程，在早期并沒有一致的國際的糖尿病的定義。The reliability of this

48、 definition in terms of predicting the prevalence of, and the CVD risk associated with, the metabolic syndrome has been reported recently38. Cardiovascular mortality was assessed in 3,606 subjects from the Botnia study (a large-scale study of type 2 diabetes begun in Finland in 1990) with a median f

49、ollow-up of 6.9 years. In women and men, respectively, the metabolic syndrome was recorded in 10 and 15% of subjects with normal glucose tolerance, 42 and 64% of those with IFG/IGT, and 78 and 84% of those with type 2 diabetes. The risk for coronary heart disease and stroke was increased threefold i

50、n subjects with the syndrome, and cardiovascular mortality was markedly increased (12.0% in subjects with the syndrome versus 2.2% in those without; P 0.001). This study confirms the hope of the WHO report6 that the WHO definition of the metabolic syndrome will identify subjects with increased CVD m

51、orbidity and mortality. It offers a tool for comparison of results from different studies. 最近已經(jīng)報(bào)道了這個(gè)定義對預(yù)測代謝綜合癥患病率和與之相關(guān)的心血管疾病風(fēng)險(xiǎn)的可靠性。博特尼亞研究（1990年在芬蘭開始的2型糖尿病的大規(guī)模研究）通過對3606個(gè)對象平均6.9年的隨訪估算了心血管疾病的死亡率。正常葡萄糖耐受的對象男女比例分別為10%和15%，空腹高血糖或者糖耐量異常的男女比例分別為42%和64%，2型糖尿病的男女比例分別為78%和84%。有綜合癥的對象的冠心病和中風(fēng)風(fēng)險(xiǎn)增加了三倍，心血管死亡率顯著增加（

52、綜合癥患者的心血管死亡率為12%而沒有綜合癥的對象心血管死亡率為2.2%；P 0.001）。這次研究證實(shí)了世界衛(wèi)生組織報(bào)告的希望，即世界衛(wèi)生組織關(guān)于代謝綜合癥的定義會(huì)鑒定發(fā)病率和死亡率增加的心血管疾病患者。該研究還能為不同研究的結(jié)果提供比較的手段。Diabetes in children and youth Type 2 diabetes in children, teenagers and adolescents is a serious new aspect to the epidemic and an emerging public health problem of significa

53、nt proportions10,11,39. Although type 1 diabetes remains the main form of the disease in children worldwide, it seems possible that type 2 diabetes will be the predominant form within ten years in many ethnic groups and potentially in Europid groups (that is, of European descent). Type 2 diabetes ha

54、s already been reported in children from Japan, the United States, Pacific Islands, Hong Kong, Australia and the United Kingdom10,3941. Among children in Japan, it is already more common than type 1 diabetes, accounting for 80% of childhood diabetes; the incidence almost doubled between 197680 and 1

55、9915 (ref. 42). 兒童和青少年中的糖尿病兒童、青少年中流行的2型糖尿病是一個(gè)嚴(yán)峻的新方面，并且演變成相當(dāng)大比例的公眾健康問題。盡管世界上1型糖尿病仍然是兒童疾病中的主要形式，但是有一點(diǎn)似乎是可能的，即十年內(nèi)在許多種群，尤其是歐洲種群（也就是說歐洲后代）中2型糖尿病會(huì)成為主要形式。日本、美國、太平洋島嶼、香港、澳大利亞和英國的兒童中早已報(bào)道了2型糖尿病。日本兒童糖尿病中，2型糖尿病占80%，已經(jīng)比1型糖尿病更普遍了；1976到1980年和1991至1995年，發(fā)病率幾乎翻了一番。 The rising prevalence of obesity and type 2 diabete

56、s in children is symptomatic of the effects of globalization and industrialization affecting all societies1, with sedentary lifestyle and obesity11 the predominant factors involved. As a result of this new and alarming scenario, a joint consensus statement has been issued recently by the American Di

57、abetes Association and the American Academy of Pediatrics40. We now urgently need epidemiological data to outline the extent of the problem, as most of the reports so far are clinic based11,39. 兒童肥胖和2型糖尿病的越加流行是全球化和工業(yè)化效應(yīng)的癥狀，全球化和工業(yè)化以久坐的生活方式和肥胖這些主要因素影響著整個(gè)社會(huì)。鑒于這一新起的令人警醒的情況，美國糖尿病協(xié)會(huì)和美國兒科學(xué)會(huì)最近發(fā)布了聯(lián)合共識聲明。因?yàn)樵S多

58、報(bào)告至今都是臨床基礎(chǔ)的，所以現(xiàn)在我們急需流行病學(xué)的信息來概述該問題的程度。 Although type 2 diabetes in Europeans is usually characterized by onset (often asymptomatic) after 50 years of age, in Pacific islanders and other high-prevalence groups such as southern Asians, onset in the 2030-year age group is now increasingly common7,39. Th

59、e socioeconomic and public health impact of this downward shift in disease onset on society is much greater through effects on the work force and premature morbidity and mortality, as well as through the negative impact on fertility and reproduction43. 盡管歐洲人中2型糖尿病的癥狀通常是50歲以下發(fā)作（時(shí)常無癥狀），但是在太平洋島嶼和其他高發(fā)群體例如南亞人中，20至30歲的群體發(fā)作越來越普遍。疾病發(fā)作向下轉(zhuǎn)變造成的社會(huì)、經(jīng)濟(jì)、公眾健康方面的影響更加巨大，影響了勞動(dòng)力、早期患病率、死亡率以及不孕不育。 The appearance of type 2 diabetes in a young