This review article describes the regulation of glucose homeostasis in subjects with and without diabetes based on the emergence of new information and discusses modes of action, attributes, and limitations of current diabetes therapies. In normal physiology, glucose homeostasis is tightly controlled by the interaction of pancreatic and gut hormones. Since the 1920s, diabetes has been viewed as a disease caused by deficient secretion of insulin, resulting in reduced glucose uptake and subsequent hyperglycemia. The discovery in the 1950s of the pancreatic hormone glucagon, which opposes insulin by increasing glucose appearance in the circulation, resulted in a bihormonal model of glucose homeostasis. More recently, with the discovery of the incretin hormones glucagon-like peptide-1 (GLP-1) and glucose-dependent insulinotropic peptide (GIP) in the 1970s and the pancreatic hormone amylin in the 1980s, it is now understood that several organs and hormones play roles in maintaining glucose homeostasis. Therapies for diabetes have focused on compensation for deficient insulin action through stimulation of insulin secretion, administration of insulin itself, reduction of peripheral insulin resistance, or decreased glucose absorption from the intestine. The discoveries of amylin and GLP-1 have furthered our understanding of the abnormalities involved in diabetes, enabling the development of additional therapeutic options.

这篇综述文章根据新信息的出现描述了糖尿病患者和非糖尿病患者的葡萄糖稳态调节，并讨论了当前糖尿病疗法的作用模式、属性和局限性。在正常生理学中，葡萄糖稳态受到胰腺和肠道激素相互作用的严格控制。自 1920 年代以来，糖尿病一直被视为一种由胰岛素分泌不足引起的疾病，导致葡萄糖摄取减少和随后的高血糖症。1950 年代发现的胰腺激素胰高血糖素通过增加循环中葡萄糖的出现来对抗胰岛素，从而产生了葡萄糖稳态的双激素模型。最近，随着 1970 年代肠促胰岛素激素胰高血糖素样肽 1 (GLP-1) 和葡萄糖依赖性促胰岛素肽 (GIP) 以及 1980 年代胰腺激素胰淀素的发现，现在人们了解到多种器官和激素发挥作用在维持葡萄糖稳态。糖尿病治疗的重点是通过刺激胰岛素分泌、给予胰岛素本身、减少外周胰岛素抵抗或减少肠道对葡萄糖的吸收来补偿胰岛素作用不足。胰淀素和 GLP-1 的发现加深了我们对糖尿病异常的理解，从而开发了其他治疗选择。现在了解到，有几个器官和激素在维持葡萄糖稳态方面发挥作用。糖尿病治疗的重点是通过刺激胰岛素分泌、给予胰岛素本身、减少外周胰岛素抵抗或减少肠道对葡萄糖的吸收来补偿胰岛素作用不足。胰淀素和 GLP-1 的发现加深了我们对糖尿病异常的理解，从而开发了其他治疗选择。现在了解到，有几个器官和激素在维持葡萄糖稳态方面发挥作用。糖尿病治疗的重点是通过刺激胰岛素分泌、给予胰岛素本身、减少外周胰岛素抵抗或减少肠道对葡萄糖的吸收来补偿胰岛素作用不足。胰淀素和 GLP-1 的发现加深了我们对糖尿病异常的理解，从而开发了其他治疗选择。