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*Only for medical professionals to read for reference.
Promote early screening and early diagnosis, and establish a diabetes prevention and control system.
"We" are in action! The number of diabetic patients in China is as high as 130 million, ranking first in the world [1].
Chronic kidney disease (CKD) is an important comorbidity of diabetes, which directly affects the prognosis and quality of life of diabetic patients.
Recently, the "Healthy China-Early Nephropathy Screening Program for Diabetic Patients (UACR)" sponsored by the Beijing Great Medical Public Welfare Foundation and participated by many authoritative experts in the field of endocrinology was officially launched.
The project aims to popularize science education on diabetic nephropathy nationwide, increase patients' attention to early diabetic nephropathy, and at the same time strengthen doctors' attention to early diabetic nephropathy, comprehensively improve early screening, early intervention, and early prevention awareness, thereby promoting diabetic nephropathy (DKD) Early screening and early diagnosis, perfecting the standardized diagnosis and treatment system, and realizing more extensive benefits for doctors and patients.
Professor Hong Tianpei, director of the Endocrinology Department of Peking University Third Hospital, said that to achieve such a goal, the joint efforts of the whole society are needed.
UACR helps standardize DKD screening and standardizing DKD screening indicators is the focus of the early screening program.
Professor Hong Tianpei pointed out that the current domestic and foreign guidelines emphasize the importance of DKD screening.
As far as the screening method is concerned, the urine albumin/creatinine ratio (UACR) [2] is recommended, mainly because the test is simple and convenient.
Professor Hong further explained that, firstly, a single urine can meet the needs of screening for diabetic nephropathy when using UACR, and the subject does not need to keep urine for a period of time; secondly, the detection method is less expensive and more accurate , So it is a recommended indicator for the detection of early kidney damage.
Patients can use UACR for rapid screening at the first diagnosis of diabetes, early diagnosis, and prevent and delay the occurrence and development of DKD, and prevent the progression to end-stage renal disease.
Picture: Professor Hong Tianpei standardizes the diagnosis and treatment path at the meeting site, and promotes the advancement of DKD management.
Authoritative guidelines related to diabetes in the United States and China are recommended.
Type 1 diabetes (T1DM) patients with a course of ≥ 5 years and type 2 diabetes after diagnosis (T2DM) patients, check UACR and estimate glomerular filtration rate (eGFR) at least once a year [2].
T1DM is usually diagnosed and the course of the disease is relatively clear, but because the symptoms of T2DM patients are not obvious, the diagnosis is not timely, and the course of kidney disease cannot be confirmed after the diagnosis of diabetes.
Therefore, Professor Hong emphasized that at the same time as the diagnosis of T2DM, patients need to be screened for diabetic nephropathy.
In addition, Professor Hong also mentioned that there is a huge gap between clinical practice and guideline recommendations, and the proportion of standardized screening in clinical practice is relatively low.
The public's awareness of chronic kidney disease and the rate of reasonable treatment is low, causing a large number of patients to miss the best time for diagnosis and treatment.
On the one hand, disease-related education and education are mainly concentrated in cities, while grassroots hospitals in more remote areas, especially in remote areas and rural areas, still lack disease education and education for doctors and patients; on the other hand, because the current patient medical care is concentrated in tertiary hospitals , Specialist doctors are under great pressure for diagnosis and treatment, and they may miss the other and fail to educate and help patients in early disease screening in a timely and comprehensive manner.
Therefore, strengthening the training of grassroots doctors and general practitioners and improving the hierarchical diagnosis and treatment system are important measures to promote the advancement of DKD management.
Renal disease is diagnosed clearly and comprehensively managed by multiple methods.
Regarding renal function screening, Professor Hong said that doctors need to test patients for proteinuria and eGFR at the same time.
If the two test results deviate, such as proteinuria but normal eGFR, then Other kidney problems need to be considered, because in addition to DKD, diabetic patients may also have non-diabetic nephropathy (NDKD), or the coexistence of DKD and NDKD, which should be diagnosed by renal biopsy.
In addition, it can also be combined with other factors such as diabetic retinopathy to make a comprehensive judgment [3].
Professor Hong also pointed out that for diabetes patients with kidney disease, they will not only face the multiple burdens of dialysis and kidney transplantation required for end-stage renal disease, but also have a high risk of cardiovascular and cerebrovascular complications.
The risk factors of AIDS need to be comprehensively managed, such as controlling blood sugar, blood pressure, blood lipids, etc.
, as well as life>
In hypoglycemic therapy, it is necessary to choose a renal protective sodium-glucose cotransporter-2 inhibitor (SGLT-2i) and a glucagon-like peptide-1 receptor agonist (GLP-1 RA).
For patients with diabetes and hypertension, angiotensin-converting enzyme inhibitor (ACEI) and angiotensin II receptor antagonist (ARB) can also be used to delay the progression of chronic nephropathy [4].
Professor Hong said that this will help improve the quality of life of patients and reduce the economic burden, which is of great significance to patients and society.
Improve patients’ awareness of early screening and “prevent” disease first.
In our country, early screening of complications of chronic diseases such as diabetes is insufficient.
A large part of the reason is that patients are not aware of early screening and the general public is concerned about disease prevention.
Poor awareness of importance.
In this regard, Professor Hong said that while strengthening relevant training for junior doctors and grassroots medical workers, it is also necessary to strengthen patient self-education.
For diabetic patients, we should learn how to comprehensively manage various metabolic indicators and actively screen some common chronic complications of diabetes.
It is hoped that through patient education, patients' awareness of the disease can be comprehensively improved.
Emphasizing the importance of prevention will help raise public health management awareness, especially the awareness of early screening and early diagnosis of potential patients.
Professor Hong also pointed out that the cost of disease prevention is far lower than that of disease treatment, but the current public’s concept has not been reversed.
Even my country’s public health resources are mainly invested in disease treatment, and for disease education and prevention.
Investment is insufficient.
It is hoped that the UACR project can help strengthen primary medical institutions and the entire society's attention to DKD screening, thereby improving the medical status quo.
To sum up, my country’s diabetic nephropathy has a low clinical, especially grassroots level, awareness and screening rate.
There are also gaps in screening equipment and relevant training and education received by medical staff.
Patients are not sufficiently aware of the hazards of diabetic nephropathy and are aware of early screening.
weak.
UACR is an important early indicator for clinical detection of diabetic kidney injury.
It is convenient and low-cost.
It will help the nationwide early screening of diabetes and help the public improve disease awareness and screening awareness, early detection of diseases, prevention of major diseases, and avoidance Heavy economic burden.
Expert profile Professor Hong Tianpei, Director of the Endocrinology Department, Peking University Third Hospital, second-level professor, chief physician, and doctoral tutor, current director of the Diabetes Branch of the Beijing Medical Association, deputy director of the Endocrinology Branch of the Chinese Medical Association and leader of the Diabetes Group China Associate editor of 6 journals including Chinese Journal of Diabetes, Chinese Journal of Endocrinology and Metabolism, International Journal of Endocrinology and Metabolism, Vice President of Endocrinology and Metabolism Physician Branch of the Association of Physicians, and reviewers of SCI journals such as BMJ and Diabetes Care.
References: [ 1].
Yongze Li, et al.
BMJ.
2020;369.
[2].
American Diabetes Association.
Diabetes Care.
2020;43(Suppl1):S135-S151.
[3].
Consensus expert on multidisciplinary diagnosis, treatment and management of diabetic nephropathy Group.
Chinese Journal of Clinicians.
2020;48(5):522-527.
[4].
National Kidney Foundation.
Kidney Int Suppl.
2013;3(1):1-150.
This material is provided by AstraZeneca, only For medical and health professionals to refer to Approval Number: CN-77173 Valid until: 2023-4-18 For submission/reprint/business cooperation, please contact: pengsanmei@yxj.
org.
cn
Promote early screening and early diagnosis, and establish a diabetes prevention and control system.
"We" are in action! The number of diabetic patients in China is as high as 130 million, ranking first in the world [1].
Chronic kidney disease (CKD) is an important comorbidity of diabetes, which directly affects the prognosis and quality of life of diabetic patients.
Recently, the "Healthy China-Early Nephropathy Screening Program for Diabetic Patients (UACR)" sponsored by the Beijing Great Medical Public Welfare Foundation and participated by many authoritative experts in the field of endocrinology was officially launched.
The project aims to popularize science education on diabetic nephropathy nationwide, increase patients' attention to early diabetic nephropathy, and at the same time strengthen doctors' attention to early diabetic nephropathy, comprehensively improve early screening, early intervention, and early prevention awareness, thereby promoting diabetic nephropathy (DKD) Early screening and early diagnosis, perfecting the standardized diagnosis and treatment system, and realizing more extensive benefits for doctors and patients.
Professor Hong Tianpei, director of the Endocrinology Department of Peking University Third Hospital, said that to achieve such a goal, the joint efforts of the whole society are needed.
UACR helps standardize DKD screening and standardizing DKD screening indicators is the focus of the early screening program.
Professor Hong Tianpei pointed out that the current domestic and foreign guidelines emphasize the importance of DKD screening.
As far as the screening method is concerned, the urine albumin/creatinine ratio (UACR) [2] is recommended, mainly because the test is simple and convenient.
Professor Hong further explained that, firstly, a single urine can meet the needs of screening for diabetic nephropathy when using UACR, and the subject does not need to keep urine for a period of time; secondly, the detection method is less expensive and more accurate , So it is a recommended indicator for the detection of early kidney damage.
Patients can use UACR for rapid screening at the first diagnosis of diabetes, early diagnosis, and prevent and delay the occurrence and development of DKD, and prevent the progression to end-stage renal disease.
Picture: Professor Hong Tianpei standardizes the diagnosis and treatment path at the meeting site, and promotes the advancement of DKD management.
Authoritative guidelines related to diabetes in the United States and China are recommended.
Type 1 diabetes (T1DM) patients with a course of ≥ 5 years and type 2 diabetes after diagnosis (T2DM) patients, check UACR and estimate glomerular filtration rate (eGFR) at least once a year [2].
T1DM is usually diagnosed and the course of the disease is relatively clear, but because the symptoms of T2DM patients are not obvious, the diagnosis is not timely, and the course of kidney disease cannot be confirmed after the diagnosis of diabetes.
Therefore, Professor Hong emphasized that at the same time as the diagnosis of T2DM, patients need to be screened for diabetic nephropathy.
In addition, Professor Hong also mentioned that there is a huge gap between clinical practice and guideline recommendations, and the proportion of standardized screening in clinical practice is relatively low.
The public's awareness of chronic kidney disease and the rate of reasonable treatment is low, causing a large number of patients to miss the best time for diagnosis and treatment.
On the one hand, disease-related education and education are mainly concentrated in cities, while grassroots hospitals in more remote areas, especially in remote areas and rural areas, still lack disease education and education for doctors and patients; on the other hand, because the current patient medical care is concentrated in tertiary hospitals , Specialist doctors are under great pressure for diagnosis and treatment, and they may miss the other and fail to educate and help patients in early disease screening in a timely and comprehensive manner.
Therefore, strengthening the training of grassroots doctors and general practitioners and improving the hierarchical diagnosis and treatment system are important measures to promote the advancement of DKD management.
Renal disease is diagnosed clearly and comprehensively managed by multiple methods.
Regarding renal function screening, Professor Hong said that doctors need to test patients for proteinuria and eGFR at the same time.
If the two test results deviate, such as proteinuria but normal eGFR, then Other kidney problems need to be considered, because in addition to DKD, diabetic patients may also have non-diabetic nephropathy (NDKD), or the coexistence of DKD and NDKD, which should be diagnosed by renal biopsy.
In addition, it can also be combined with other factors such as diabetic retinopathy to make a comprehensive judgment [3].
Professor Hong also pointed out that for diabetes patients with kidney disease, they will not only face the multiple burdens of dialysis and kidney transplantation required for end-stage renal disease, but also have a high risk of cardiovascular and cerebrovascular complications.
The risk factors of AIDS need to be comprehensively managed, such as controlling blood sugar, blood pressure, blood lipids, etc.
, as well as life>
In hypoglycemic therapy, it is necessary to choose a renal protective sodium-glucose cotransporter-2 inhibitor (SGLT-2i) and a glucagon-like peptide-1 receptor agonist (GLP-1 RA).
For patients with diabetes and hypertension, angiotensin-converting enzyme inhibitor (ACEI) and angiotensin II receptor antagonist (ARB) can also be used to delay the progression of chronic nephropathy [4].
Professor Hong said that this will help improve the quality of life of patients and reduce the economic burden, which is of great significance to patients and society.
Improve patients’ awareness of early screening and “prevent” disease first.
In our country, early screening of complications of chronic diseases such as diabetes is insufficient.
A large part of the reason is that patients are not aware of early screening and the general public is concerned about disease prevention.
Poor awareness of importance.
In this regard, Professor Hong said that while strengthening relevant training for junior doctors and grassroots medical workers, it is also necessary to strengthen patient self-education.
For diabetic patients, we should learn how to comprehensively manage various metabolic indicators and actively screen some common chronic complications of diabetes.
It is hoped that through patient education, patients' awareness of the disease can be comprehensively improved.
Emphasizing the importance of prevention will help raise public health management awareness, especially the awareness of early screening and early diagnosis of potential patients.
Professor Hong also pointed out that the cost of disease prevention is far lower than that of disease treatment, but the current public’s concept has not been reversed.
Even my country’s public health resources are mainly invested in disease treatment, and for disease education and prevention.
Investment is insufficient.
It is hoped that the UACR project can help strengthen primary medical institutions and the entire society's attention to DKD screening, thereby improving the medical status quo.
To sum up, my country’s diabetic nephropathy has a low clinical, especially grassroots level, awareness and screening rate.
There are also gaps in screening equipment and relevant training and education received by medical staff.
Patients are not sufficiently aware of the hazards of diabetic nephropathy and are aware of early screening.
weak.
UACR is an important early indicator for clinical detection of diabetic kidney injury.
It is convenient and low-cost.
It will help the nationwide early screening of diabetes and help the public improve disease awareness and screening awareness, early detection of diseases, prevention of major diseases, and avoidance Heavy economic burden.
Expert profile Professor Hong Tianpei, Director of the Endocrinology Department, Peking University Third Hospital, second-level professor, chief physician, and doctoral tutor, current director of the Diabetes Branch of the Beijing Medical Association, deputy director of the Endocrinology Branch of the Chinese Medical Association and leader of the Diabetes Group China Associate editor of 6 journals including Chinese Journal of Diabetes, Chinese Journal of Endocrinology and Metabolism, International Journal of Endocrinology and Metabolism, Vice President of Endocrinology and Metabolism Physician Branch of the Association of Physicians, and reviewers of SCI journals such as BMJ and Diabetes Care.
References: [ 1].
Yongze Li, et al.
BMJ.
2020;369.
[2].
American Diabetes Association.
Diabetes Care.
2020;43(Suppl1):S135-S151.
[3].
Consensus expert on multidisciplinary diagnosis, treatment and management of diabetic nephropathy Group.
Chinese Journal of Clinicians.
2020;48(5):522-527.
[4].
National Kidney Foundation.
Kidney Int Suppl.
2013;3(1):1-150.
This material is provided by AstraZeneca, only For medical and health professionals to refer to Approval Number: CN-77173 Valid until: 2023-4-18 For submission/reprint/business cooperation, please contact: pengsanmei@yxj.
org.
cn
