Endothelium, acting as a barrier, protects tissues against factors that provoke insulin resistance and type 2 diabetes and itself responds to the insult of insulin resistance inducers with altered function. Endothelial insulin resistance and vascular dysfunction occur early in the evolution of insulin resistance-related disease, can co-exist with and even contribute to the development of metabolic insulin resistance, and promote vascular complications in those affected. The impact of endothelial insulin resistance and vascular dysfunction varies depending on the blood vessel size and location, resulting in decreased arterial plasticity, increased atherosclerosis and vascular resistance, and decreased tissue perfusion. Women with insulin resistance and diabetes are disproportionately impacted by cardiovascular disease, likely related to differential sex-hormone endothelium effects. Thus, reducing endothelial insulin resistance and improving endothelial function in the conduit arteries may reduce atherosclerotic complications, in the resistance arteries lead to better blood pressure control, and in the microvasculature lead to less microvascular complications and more effective tissue perfusion. Multiple diabetes therapeutic modalities, including medications and exercise training, improve endothelial insulin action and vascular function. This action may delay the onset of type 2 diabetes and/or its complications, making the vascular endothelium an attractive therapeutic target for type 2 diabetes and potentially type 1 diabetes.

中文翻译：

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糖尿病发病机制和治疗：内皮细胞成熟


内皮细胞作为屏障，保护组织免受引发胰岛素抵抗和 2 型糖尿病的因素的影响，并且内皮细胞本身也会对胰岛素抵抗诱导剂的损伤做出反应，从而改变功能。内皮胰岛素抵抗和血管功能障碍发生在胰岛素抵抗相关疾病演变的早期，可以与代谢性胰岛素抵抗共存，甚至促进代谢性胰岛素抵抗的发展，并促进受影响者的血管并发症。内皮胰岛素抵抗和血管功能障碍的影响因血管大小和位置而异，导致动脉可塑性降低、动脉粥样硬化和血管阻力增加以及组织灌注减少。患有胰岛素抵抗和糖尿病的女性尤其容易受到心血管疾病的影响，这可能与不同的性激素内皮效应有关。因此，减少导管动脉中的内皮胰岛素抵抗和改善内皮功能可以减少动脉粥样硬化并发症，在阻力动脉中可以导致更好的血压控制，而在微脉管系统中则可以减少微血管并发症和更有效的组织灌注。多种糖尿病治疗方式，包括药物和运动训练，可以改善内皮胰岛素作用和血管功能。这一作用可能会延迟 2 型糖尿病和/或其并发症的发病，使血管内皮成为 2 型糖尿病和潜在的 1 型糖尿病有吸引力的治疗靶点。