Considering writing into an international guide?

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Introduction: Focusing on the upstream of the disease, treating diabetes first and treating obesity-after the "cardiovascular outcome as the core", is the concept of diabetes treatment ushered in and then updated? Recently, four international diabetes experts led by Professor Ildiko Lingvay of the University of Texas Southwestern Medical Center jointly issued a paper: It is recommended that "weight loss ≥ 15%" be the "initial main treatment goal" for some type 2 diabetes patients
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Although obesity and diabetes have always been hot topics discussed in the field of endocrinology, the article published in the regular issue of The Lancet has pushed the popularity of this topic to a new height.
A topic of great concern in the international diabetes field
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In addition, the positive statements of experts from international diabetes organizations such as ADA and EASD all seem to indicate that the concept of diabetes management may usher in an update
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Adjusting forces and focusing on disease "upstream" The article pointed out that in the past ten years, the management of type 2 diabetes has undergone several major conceptual changes.
With the announcement of the results of the landmark CVOT study, the focus of diabetes management has gradually shifted to reduce cardiovascular complications.
(In the CVOT study, new hypoglycemic drugs can further reduce the risk of myocardial infarction, stroke and cardiovascular death, and to a large extent Independent of blood sugar effects)
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But even so, the current treatment framework for type 2 diabetes is mainly focused on preventing or treating the downstream adverse metabolic consequences, and these adverse consequences often occur in the late stages of the disease course
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And adopting a weight-centered management method, focusing on the upstream of diabetes will bring more extensive benefits
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Figure 1 "Upstream weight-centered treatment strategy" has broader benefits than "glycemic-centered management methods".
It is recommended to include "weight loss ≥ 15% as the initial treatment target for some type 2 diabetes" into the guidelines.
The upstream "weight-centered management method" has a wide range of advantages compared to the "blood sugar-centered" approach
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It can largely solve the key pathophysiological driving factors of type 2 diabetes and its related metabolic complications, and continuous weight loss ≥15% has an important impact on the progression of type 2 diabetes, which can induce remission in most patients and significantly improve Other metabolic conditions
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Before 2021, the only intervention that can routinely maintain this level of weight loss is bariatric surgery, but treatment options are limited
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Currently, a variety of effective weight-loss drugs are being developed, some of which can directly reduce blood glucose concentration
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Therefore, it is time to reconsider shifting the treatment goal of type 2 diabetes to "obesity management as the main goal"—that is, substantial weight loss as the main means of treating type 2 diabetes patients and achieving blood glucose goals
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This weight-centered intervention will affect the pathophysiology of type 2 diabetes, achieve reversal or slow down the disease process, and benefit other related cardiovascular risk factors.
In the long term, it can prevent the microvascular and macrovascular complications of type 2 diabetes
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First author Professor Ildiko Lingvay said: "At present, admissions of type 2 diabetes clinicians, only a relatively small part of the people who really know how to treat obesity, it is not enough
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'Treatment of obesity' should be every The necessary skills of relevant clinicians
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The
successful implementation of the recommendations put forward by the expert group will bring about fundamental changes.
It is hoped that this concept can be recognized and implemented internationally.
This will be a major step in the right direction.
Step'
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"Professor Ildiko Lingvay "will give serious consideration, but 15% of the target is yet to be considered"-ADA, EASD and other diabetes organizations have responded positively The main person in charge of the center and other internationally renowned diabetes organizations/centers responded positively.
Although the experts raised some concerns and had different views on the target of "15%", the view of "treatment of sugar and obesity first" was obtained.
broad support
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Vice-Chairman of the medical department of the American diabetes Association to improve professor Nuha a.
El Sayed commented: "nursing ADA guidelines and the recommendations are similar views, is also recommended as a treatment for obesity will target patients with type 2 diabetes
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However, the specific weight loss goal of'weight loss ≥ 15%' is open to discussion.
A moderate weight loss of 5% to 7% can bring benefits, and the 15% weight loss goal may not be achieved for some patients
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"The leadership of the American Diabetes Association and its professional practice committee will seriously consider this new proposal
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"Professor El Sayed added
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Professor
Nuha a.
El Sayed, President of the European Diabetes Research Association, Professor Stefano Del Prato raised similar doubts about the general applicability of weight loss ≥15%
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"For new drugs that promote weight loss, such as hyperglycemia For prime peptide-1 receptor agonists, not everyone’s response is the same, so the ideal approach is to try to "find out patients who respond well to weight loss and lose at least 15% of their body weight
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We need improve response capabilities to better identify patients
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"said Professor Stefano Del Prato
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However, it said in an interview, agreed that "significant weight loss should be considered as a target to treat type 2 diabetes," this view
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Professor Stefano Del Prato, Professor of Biological Psychology, University of Leeds, UK, Professor Jason CG Halford, Chairman of the European Association for Research on Obesity, commented: “For those engaged in the prevention or management of type 2 diabetes, proper obesity management training is essential.

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"" for some patients with type 2 diabetes, decreased by 10% to 15% of body weight may mean that they will enter the diabetes remission, even if a small amount of weight can also reduce the life-changing, to help better manage blood sugar and blood pressure, reduce diabetes The risk of complications
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” commented Professor Lucy Chambers, the relevant director of the British Diabetes Institute
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This article summarizes in recent decades, 2 new diabetes management concepts have experienced "emphasis on disease control-the importance of strengthening hypoglycemic", "patient-centered individualized treatment", "comprehensive management of multiple risk factors", "emphasis At different stages, such as "cardiovascular outcome", the overall situation has evolved from purely "controlling blood sugar" to an "outcome-oriented" treatment strategy
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It is worth looking forward to whether the strategy of "weight loss as the core and upstream disease" will become a new disease management concept
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Yimaitong compiled and compiled from: [1]Lingvay I, Sumithran P, Cohen RV, et al.
Obesity management as a primary treatment goal for type 2 diabetes: time to reframe the conversation[J].
Lancet, 2021[2]Shen.
Looking at the changes in the management concept of type 2 diabetes from the guide update[J].
Chinese Journal of Endocrinology and Metabolism,2020,36(08):723-726.