[Summary] There is a huge population of adults with pre-diabetes in China ,and the majority of whom are impaired glucose tolerance(IGT) patients. IGT is not only a risk factor for type 2 diabetes ,but is also closely related to diabetic microvascular and macrovascular complications. Preventing or delaying the development of diabetes by intervention on IGT has become imperative. When lifestyle intervention alone cannot achieve the ideal goal of diabetes prevention ,pharmacological intervention should be considered. This review will discuss thepathophysiology of IGT ,and the effectiveness ,safety and pharmacoeconomics of IGT pharmacological intervention.

Cardiovascular disease is the main cause of death in patients with type 2 diabetes. The protection of glucagon-like peptide-1 ( GLP-1 ) on endothelial function, ischemic myocardial damage, and heart failure have been reviewed. Based on the recently finished serial clinical studies, the effects that long-acting GLP-1 analogues liraglutide improved body weight, blood pressure, lipids, and other cardiovascular risk factors were discussed.

Normal β-cell is responsible for the glucose-induced insulin secretion.The β-cell plasticity plays an important role in glucose homeostasis,the mechanisms of which involve cell proliferation and apoptosis.β- cell dysfunction is a key factor in the impaired glncose metabolism,especially in the demand of increased insulin secretion to compensate insulin resistance.Impaired insulin secretion occurs in the early stages of type 2 diabetes and is characterized by the abnormal early phase secretion.

With the progress of type 2 diabetes,there are more challenges for treatment.Traditional medications may not meet type 2 diabetes complicated clinical needs.Glucagon like peptide-1 ( GLP-1 ) has multiple physiological effects.Studies show that the liraglutide as the native GLP-1 analogue provides well glucose control in different stages of type 2 diabetes treatment,as well as β cell protection,body weight decrease and the prevalence of prediabetes reduction.Early usage of liraglutide especially suggests significant benefits,which will be summarized below.

In recent years, increasing attention is drawn to the metabolic syndrome (MS). In a workshop held in April 2005, International Diabetes Federation (IDF) developed a new global definition of MS which put the emphasis on central obesity as the essential component. This new definition mirrored the latest advance in both pathogenesis and epidemiology of MS, and will benefit the prevention against MS and its related diseases. There is no doubt that the new definition deserve clinical use worldwide even it is not perfect.

Despite autoimmune hypophysitis remains relatively rare, it still poses a significant problem.Currently, about a half of the hypophysitis patients are misdiagnosed as pituitary adenoma and undergo unnecessary surgery. It is increasingly being recognized the identification of the real pituitary autoantigens and development of serologic tests in the differential diagnosis of pituitary masses before surgery. It is necessary to establish disease registration for patients with autoimmnune hypophysitis and get enough well-characterized cases for both basic and clinical studies fostering innovation in the field.

Overall there is strong evidence that pharmacdosic therapy of hypertension in patients with diabetes is effective in producing substantial decrease in macrovascular and microvascular diseases.According to clinical evidence and guidelines,patients with diabetes mellitus and hypertension should receive drug treatment in addition to lifestyle/behavioral intervention.Combination therapy of rennin-ansiotensin system inhibitor with calcium channel blocker or low dose thiazide diuretics is quite efficient to reach the blood pressure target.As considering patient compliance with drug therapy,single pill combination may yield more benefits.

Recently, several large, long-term rendomized controlled trails (ACCORD, ADVANCE, VADT) and long-term epidemiologic follow-up studies (UKPDS, STENO-2) have compared the effects of intensive versus standard glycemic control on cardiovascular disease events. Based on reviewing aforementioned studies, the present article would suggest that intensive glycemia control is still considered as one of the principal therapies for the prevention of cardiovascular events in diabetes while stressing on safety and individualization for glucose-lowering strategy.

The epidemic studies indicate that hyperglycemia is very popular among the patients with coronary heart disease(CHD).and acting on their prognosis.Hyperglycemia acts as an independent risk for cardiovascular events.Therefore cardiologists should be also responsible for the hypcrglycemia management. Several epidemic studies of CHD with hyperglyeemia have been fruitfully done in China.How to further investigate and try to form a strategy in the hyperglycemic management in patients with CHD becomes a task to be fulfilled in the future.ACE(Aearbose Cardiovascular Evaluation)is thus a new exploration.