< International Circulation>:  The increased risk of cardiovascular disease in pre-diabetic patients is attributed to a multitude of factors. These include: insulin resistance， hyperglycaemia， dyslipidemia and hypertension. What progress has there been in the use of different pharmacological agents in patients with pre-diabetes?

 《国际循环》：前趋糖尿病患者的心血管疾病的风险增加的原因很多，包括：胰岛素抵抗、高血糖、血脂异常和高血压。前趋糖尿病患者所服用的各种药物有何进展？

     Prof Thomas Unger:  What you have described is more or less the metabolic syndrome patient and usually they have pre-diabetes or by definition of metabolic syndrome you have some kind of insulin resistance. In addition you also have many of these definitions such as obesity， hypertension， dyslipidemia and others which may vary. For example some people have put albuminuria in that category but that is a sign of organ damage. For treatment the patient requires a vigorous pharmacological regimen as well as lifestyle changes. We all know that by giving up smoking， losing weight， adopting a more frequent exercise habit and by having more rest is what we all recommend to our patients. But we all know the success rate is somewhat limited with these measures alone and so they have to accompany a vigorous drug regimen.  When it comes to drugs we are still left with the individual components of the metabolic syndrome. There is no wonder drug which can take care of all these problems but there are drugs which in addition to their original targets and indications which I would say go in the right direction.  You can see that with some of the sartans the AT1 receptor antagonists where some of them have anti insulin factor resistance in built. This may work directly via reduction AT-1 receptor activity but also in some cases modulation or increase in PPAR-Gamma similar to the glitazones but not identical since their modulation is different. Then you may think about statins which are given to the patient to combat dyslipidemia and to lower LDL and to increase HDL but they may also have additional benefits such as being able to lower blood pressure even though they are not blood pressure lowering agents but they go in the same direction. 

    Unger教授：你所描述的或多或少是代谢综合征的患者，通常他们有前期糖尿病或代谢综合征定义的胰岛素抵抗之类。此外你还  提到了代谢综合征所定义的肥胖，高血压，血脂异常等。例如，有些人把蛋白尿也归于代谢综合征，但事实上这是器官损伤的一个标志。这类患者需要同时服用有效的治疗药物和调整生活方式。我们都知道建议患者要戒烟，减肥，多进行锻炼和多休息，但我们也知道治疗的成功率单靠这些方法是不够的，他们也需要采取有效的药物治疗。至于选择何种药物，我们认为这仍需取决于代谢综合征的症状。没有任何特效药可以治疗所有这些病症，但有些药物除了原来有治疗效果外还可以用于其它治疗途径。你可以发现有些沙坦类和AT1受体拮抗剂也具有一些抗胰岛素抵抗的作用。这类药物降低AT-1受体活性，调节或增强PPAR –γ的作用与格列酮很相似，但是作用机制却不同。因此，当患者服用沙坦类药物治疗血脂异常时，一方面它可降低LDL增加HDL，同时也降低血压，尽管他们并不是降血压药，但却都有降压效果。

  Of course， when diabetes is there you should resort to real anti diabetic drugs. For pre-diabetic patients we have the anti- hypertensive and dyslipidemia drugs. Obesity is more difficult and up to now there is not a drug despite many attempts a real anti-obesity drug; obesity still has to be dealt with by eating less and lifestyle management and then when it comes to other facets of the syndrome they have to treat individually as well. The problem is really we call this metabolic syndrome but the indication of the respective patient as such is always an individual indication for drugs for an individual part of this disease.  We would like in the future drugs that could cover more of this complex so we would not be forced to treat the individual components individually.   

    当然，对于糖尿病患者就得采用降血糖药。对于前趋糖尿病患者，我们可以给予降压药和调血脂药。目前仍无特效药可以治疗肥胖，只能通过节食和调整生活方式控制体重。而当肥胖患者合并有代谢综合征时就需要给予药物治疗。真正的问题是，我们所称之的代谢综合征在各个患者体内的表征是各不相同，因此应针对患者的具体病症进行合理的药物治疗。我们希望将来会有一种药物能同时治疗这些病症而不必服用各种各样的药物。