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*Only for medical professionals to read and refer to choose the appropriate program to help more diabetic patients get reversal as soon as possible
.
The prevalence of diabetes in China is as high as 11.
2% [1], and the rate of glycemic control in diabetic patients is less than 50% [2]
.
The harm caused by poor blood sugar control has caused many diabetic patients to complain
.
Fortunately, with the advancement of medical technology and the improvement of people's awareness of diabetes, reversing diabetes is no longer an extravagant hope [3]
.
Studies have shown that short-term insulin-intensive therapy (SIIT), life>
.
In order to better guide the clinical practice of SIIT reversal of T2DM, the "Expert Consensus on Reversing Type 2 Diabetes with Short-Term Intensive Insulin Therapy" (hereinafter referred to as the "Consensus") came into being
.
Based on this, the "medical community" invited Professor Cao Xiaopei, a member of the editorial board of the "Consensus" and the Department of Endocrinology of the First Affiliated Hospital of Sun Yat-sen University, to further interpret how to choose the SIIT program and whether other hypoglycemic drugs can be combined in the treatment.
readers
.
The medical community: "China's Guidelines for the Prevention and Treatment of Type 2 Diabetes (2020) Edition" pointed out that the SIIT program includes a basal-meal insulin injection program, continuous subcutaneous insulin infusion (CSII), and premixed insulin analogs 2 to 3 times a day.
Injection scheme [5], can you share with us the characteristics of different schemes? Prof.
Xiaopei Cao: These three programs have their own merits, and we need to choose according to the characteristics of the patients
.
The basal-meal insulin injection scheme can better simulate the physiological insulin secretion pattern, and is a more classic insulin intensive treatment scheme, which is more economical while effectively controlling glucose
.
For some people with large blood sugar fluctuations, when it is difficult to control blood sugar stability with the 4-times-a-day subcutaneous insulin injection regimen, it is recommended to use CSII for treatment [6]
.
The treatment plan of CSII is relatively more flexible, and the dose of insulin can be adjusted according to the length of the patient's meal and the amount of meal
.
CSII can simulate the physiological secretion pattern of insulin to the greatest extent [6], so as to achieve better glucose control effect
.
Studies have shown [6] that for newly diagnosed T2DM patients, CSII and multiple daily insulin injections (MDI) have no significant difference in glycemic control and clinical remission rate of diabetes, but CSII has a lower risk of hypoglycemia and can improve patients quality of life
.
The biggest advantage of the 2-3 daily premixed insulin analog injection regimen is that it is a relatively simple intensive treatment regimen
.
For patients with severe high glucose toxicity who require intensive basal-meal insulin or CSII therapy, but are unwilling to accept these two intensive therapy regimens, initial therapy with premixed insulin analogs 2-3 times a day can be tried [6]
.
The medical community: "China's Guidelines for the Prevention and Treatment of Type 2 Diabetes (2020) Edition" pointed out that SIIT treatment can be implemented for newly diagnosed T2DM patients with glycated hemoglobin ≥9.
0% or fasting blood glucose ≥11.
1 mmol/L with obvious symptoms of hyperglycemia [5] ], what clinical benefits do you think SIIT brings to T2DM patients? Prof.
Xiaopei Cao: For such T2DM patients with obvious symptoms of hyperglycemia, both domestic and foreign diabetes-related guidelines recommend the use of insulin for treatment
.
Using the SIIT program, on the one hand, can control blood sugar to a normal or near-normal level to the greatest extent, avoiding the further deterioration of high glucose toxicity and causing acute complications of diabetes; on the other hand, it can alleviate the damage of high glucose toxicity to islet cells, improve Insulin sensitivity, promoting β-cell recovery, nearly half of the patients achieved clinical remission period of more than 1 year [4], and also helped to simplify their follow-up treatment plan for patients who failed to achieve clinical remission
.
For T2DM patients with a certain course of disease who still have significantly elevated blood sugar or large blood sugar fluctuations after using a combination of oral drugs, SIIT can relieve hyperglycemia toxicity in a short period of time, and partially restore pancreatic islet function.
The fine adjustment of the program can maintain the long-term blood sugar target and reduce the occurrence of various long-term complications [4]
.
The treatment mode of "intensification first and simplification later" can be realized while effectively controlling sugar
.
Medical community: Based on your clinical experience, do you think it is possible to combine hypoglycemic drugs other than insulin in the SIIT program? Prof.
Xiaopei Cao: For newly diagnosed T2DM patients, the primary purpose of applying the SIIT program is to rapidly lower blood sugar in a short period of time.
If oral drugs or other injections are added at this time, it may be due to different onset times of the drugs, or the patient's sensitivity to the drugs.
Different reactions bring some unnecessary interference to the rapid adjustment of blood sugar
.
Therefore, if the newly diagnosed T2DM patients, the average blood sugar and blood sugar fluctuation levels during the treatment period are controlled at close to normal levels, there is no need to use other hypoglycemic drugs in combination [4]
.
Some patients can consider the combination of hypoglycemic drugs other than insulin such as metformin, sodium-glucose cotransporter-2 inhibitor (SGLT-2i) or glucagon-like peptide-1 receptor agonist (GLP-2i) in the SIIT regimen.
1RA)
.
The combination of these hypoglycemic agents helps to reduce insulin dosage during intensive therapy, improve glycemic control and reduce glycemic fluctuations [4]
.
Studies have shown that compared with SIIT alone, patients treated with metformin or rosiglitazone have a higher rate of glycemic compliance [4]
.
In another randomized controlled trial, we can also see that 2-3 weeks of SIIT combined with liraglutide for 12 weeks resulted in a more significant improvement in β-cell function during treatment compared with SIIT alone [4]
.
It is not recommended to use insulin secretagogues in combination during SIIT.
The effects of the two are superimposed on each other, which may increase the risk of hypoglycemia.
The stimulating effect of sulfonylureas on β cells is related to the mechanism of SIIT's maximum inhibition of endogenous insulin secretion.
Inconsistent [4], this is what we need to pay attention to in clinical medication
.
Summary: In the face of the rapidly increasing prevalence of diabetes, the concept of reversal is undoubtedly a "cardiac" for Chinese patients with diabetes, so that drug-free remission is no longer an extravagant hope
.
In the process of reversing T2DM with SIIT, a "personalized" treatment plan is selected according to different patient conditions, so that patients can minimize the time of exposure to hyperglycemia, thereby reducing the risk of long-term chronic complications associated with it [4], optimizing diabetes in China Manage the status quo
.
Expert Profile Professor Cao Xiaopei, Chief Physician, Doctoral Supervisor Deputy Director of the Department of Endocrinology, The First Affiliated Hospital of Sun Yat-sen University, Chairman of the Diabetes Professional Committee of Guangdong Medical Education Association, Deputy Director of the Endocrinologist Branch of Guangdong Medical Association Member of the Standing Committee of the Branch, Deputy Director of the Endocrinology and Metabolism Professional Committee of Guangdong Preventive Medicine Association, Vice Chairman of the Diabetes Professional Committee of the Guangdong Women's Physician Association, Member of the Standing Committee of the Fatty Liver Disease Committee of the Guangdong Provincial Health Management Association, Member of the Diabetes Branch of the Chinese Society of Microcirculation, Diabetes and Pregnancy of the Diabetes Branch of the Chinese Medical Association Organizing Committee Member, Adrenal Research Group, Endocrinology Branch, Chinese Medical Association, USA Postdoctoral fellow at the University of Pennsylvania, USA, Visiting Scholar at Texas Medical Center, USA Received more than 20 grants from the American Juvenile Diabetes Association Research Fund, the National Natural Science Foundation of China, and the International and Regional Cooperation Fund, and won the American Juvenile Diabetes Scientific Research Award of the Foundation Committee and Science and Technology Progress Award of the Ministry of Education References: [1]Li Y,Teng D,Shi X,et al.
BMJ,2020,369;m997.
[2]Wang L,Gao P,Zhang M,et al.
JAMA,2017,317(24);2515-2523.
[3]Yang Xue,Chen Guofang,Liu Chao.
Chinese Journal of Diabetes,2021;13(07):666-672.
[4]China Insulin Secretion Research Group .
Chinese Journal of Diabetes.
2021; 13(10): 949-959.
[5] Diabetes Branch of Chinese Medical Association.
Chinese Journal of Diabetes.
2021; 13(4): 315-409.
[6] Li Yanbing, et al.
Drug Evaluation .
2017;14(9):5-12.
-End-"This article is only used to provide scientific information to medical and health professionals, and does not represent the platform's position" Contribution / reprint / business cooperation, please contact: pengsanmei@yxj.
org .
cn
.
The prevalence of diabetes in China is as high as 11.
2% [1], and the rate of glycemic control in diabetic patients is less than 50% [2]
.
The harm caused by poor blood sugar control has caused many diabetic patients to complain
.
Fortunately, with the advancement of medical technology and the improvement of people's awareness of diabetes, reversing diabetes is no longer an extravagant hope [3]
.
Studies have shown that short-term insulin-intensive therapy (SIIT), life>
.
In order to better guide the clinical practice of SIIT reversal of T2DM, the "Expert Consensus on Reversing Type 2 Diabetes with Short-Term Intensive Insulin Therapy" (hereinafter referred to as the "Consensus") came into being
.
Based on this, the "medical community" invited Professor Cao Xiaopei, a member of the editorial board of the "Consensus" and the Department of Endocrinology of the First Affiliated Hospital of Sun Yat-sen University, to further interpret how to choose the SIIT program and whether other hypoglycemic drugs can be combined in the treatment.
readers
.
The medical community: "China's Guidelines for the Prevention and Treatment of Type 2 Diabetes (2020) Edition" pointed out that the SIIT program includes a basal-meal insulin injection program, continuous subcutaneous insulin infusion (CSII), and premixed insulin analogs 2 to 3 times a day.
Injection scheme [5], can you share with us the characteristics of different schemes? Prof.
Xiaopei Cao: These three programs have their own merits, and we need to choose according to the characteristics of the patients
.
The basal-meal insulin injection scheme can better simulate the physiological insulin secretion pattern, and is a more classic insulin intensive treatment scheme, which is more economical while effectively controlling glucose
.
For some people with large blood sugar fluctuations, when it is difficult to control blood sugar stability with the 4-times-a-day subcutaneous insulin injection regimen, it is recommended to use CSII for treatment [6]
.
The treatment plan of CSII is relatively more flexible, and the dose of insulin can be adjusted according to the length of the patient's meal and the amount of meal
.
CSII can simulate the physiological secretion pattern of insulin to the greatest extent [6], so as to achieve better glucose control effect
.
Studies have shown [6] that for newly diagnosed T2DM patients, CSII and multiple daily insulin injections (MDI) have no significant difference in glycemic control and clinical remission rate of diabetes, but CSII has a lower risk of hypoglycemia and can improve patients quality of life
.
The biggest advantage of the 2-3 daily premixed insulin analog injection regimen is that it is a relatively simple intensive treatment regimen
.
For patients with severe high glucose toxicity who require intensive basal-meal insulin or CSII therapy, but are unwilling to accept these two intensive therapy regimens, initial therapy with premixed insulin analogs 2-3 times a day can be tried [6]
.
The medical community: "China's Guidelines for the Prevention and Treatment of Type 2 Diabetes (2020) Edition" pointed out that SIIT treatment can be implemented for newly diagnosed T2DM patients with glycated hemoglobin ≥9.
0% or fasting blood glucose ≥11.
1 mmol/L with obvious symptoms of hyperglycemia [5] ], what clinical benefits do you think SIIT brings to T2DM patients? Prof.
Xiaopei Cao: For such T2DM patients with obvious symptoms of hyperglycemia, both domestic and foreign diabetes-related guidelines recommend the use of insulin for treatment
.
Using the SIIT program, on the one hand, can control blood sugar to a normal or near-normal level to the greatest extent, avoiding the further deterioration of high glucose toxicity and causing acute complications of diabetes; on the other hand, it can alleviate the damage of high glucose toxicity to islet cells, improve Insulin sensitivity, promoting β-cell recovery, nearly half of the patients achieved clinical remission period of more than 1 year [4], and also helped to simplify their follow-up treatment plan for patients who failed to achieve clinical remission
.
For T2DM patients with a certain course of disease who still have significantly elevated blood sugar or large blood sugar fluctuations after using a combination of oral drugs, SIIT can relieve hyperglycemia toxicity in a short period of time, and partially restore pancreatic islet function.
The fine adjustment of the program can maintain the long-term blood sugar target and reduce the occurrence of various long-term complications [4]
.
The treatment mode of "intensification first and simplification later" can be realized while effectively controlling sugar
.
Medical community: Based on your clinical experience, do you think it is possible to combine hypoglycemic drugs other than insulin in the SIIT program? Prof.
Xiaopei Cao: For newly diagnosed T2DM patients, the primary purpose of applying the SIIT program is to rapidly lower blood sugar in a short period of time.
If oral drugs or other injections are added at this time, it may be due to different onset times of the drugs, or the patient's sensitivity to the drugs.
Different reactions bring some unnecessary interference to the rapid adjustment of blood sugar
.
Therefore, if the newly diagnosed T2DM patients, the average blood sugar and blood sugar fluctuation levels during the treatment period are controlled at close to normal levels, there is no need to use other hypoglycemic drugs in combination [4]
.
Some patients can consider the combination of hypoglycemic drugs other than insulin such as metformin, sodium-glucose cotransporter-2 inhibitor (SGLT-2i) or glucagon-like peptide-1 receptor agonist (GLP-2i) in the SIIT regimen.
1RA)
.
The combination of these hypoglycemic agents helps to reduce insulin dosage during intensive therapy, improve glycemic control and reduce glycemic fluctuations [4]
.
Studies have shown that compared with SIIT alone, patients treated with metformin or rosiglitazone have a higher rate of glycemic compliance [4]
.
In another randomized controlled trial, we can also see that 2-3 weeks of SIIT combined with liraglutide for 12 weeks resulted in a more significant improvement in β-cell function during treatment compared with SIIT alone [4]
.
It is not recommended to use insulin secretagogues in combination during SIIT.
The effects of the two are superimposed on each other, which may increase the risk of hypoglycemia.
The stimulating effect of sulfonylureas on β cells is related to the mechanism of SIIT's maximum inhibition of endogenous insulin secretion.
Inconsistent [4], this is what we need to pay attention to in clinical medication
.
Summary: In the face of the rapidly increasing prevalence of diabetes, the concept of reversal is undoubtedly a "cardiac" for Chinese patients with diabetes, so that drug-free remission is no longer an extravagant hope
.
In the process of reversing T2DM with SIIT, a "personalized" treatment plan is selected according to different patient conditions, so that patients can minimize the time of exposure to hyperglycemia, thereby reducing the risk of long-term chronic complications associated with it [4], optimizing diabetes in China Manage the status quo
.
Expert Profile Professor Cao Xiaopei, Chief Physician, Doctoral Supervisor Deputy Director of the Department of Endocrinology, The First Affiliated Hospital of Sun Yat-sen University, Chairman of the Diabetes Professional Committee of Guangdong Medical Education Association, Deputy Director of the Endocrinologist Branch of Guangdong Medical Association Member of the Standing Committee of the Branch, Deputy Director of the Endocrinology and Metabolism Professional Committee of Guangdong Preventive Medicine Association, Vice Chairman of the Diabetes Professional Committee of the Guangdong Women's Physician Association, Member of the Standing Committee of the Fatty Liver Disease Committee of the Guangdong Provincial Health Management Association, Member of the Diabetes Branch of the Chinese Society of Microcirculation, Diabetes and Pregnancy of the Diabetes Branch of the Chinese Medical Association Organizing Committee Member, Adrenal Research Group, Endocrinology Branch, Chinese Medical Association, USA Postdoctoral fellow at the University of Pennsylvania, USA, Visiting Scholar at Texas Medical Center, USA Received more than 20 grants from the American Juvenile Diabetes Association Research Fund, the National Natural Science Foundation of China, and the International and Regional Cooperation Fund, and won the American Juvenile Diabetes Scientific Research Award of the Foundation Committee and Science and Technology Progress Award of the Ministry of Education References: [1]Li Y,Teng D,Shi X,et al.
BMJ,2020,369;m997.
[2]Wang L,Gao P,Zhang M,et al.
JAMA,2017,317(24);2515-2523.
[3]Yang Xue,Chen Guofang,Liu Chao.
Chinese Journal of Diabetes,2021;13(07):666-672.
[4]China Insulin Secretion Research Group .
Chinese Journal of Diabetes.
2021; 13(10): 949-959.
[5] Diabetes Branch of Chinese Medical Association.
Chinese Journal of Diabetes.
2021; 13(4): 315-409.
[6] Li Yanbing, et al.
Drug Evaluation .
2017;14(9):5-12.
-End-"This article is only used to provide scientific information to medical and health professionals, and does not represent the platform's position" Contribution / reprint / business cooperation, please contact: pengsanmei@yxj.
org .
cn
