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*Only for medical professionals to read for reference.
From the EASD annual meeting to the new journey of insulin therapy in China, to find the most suitable plan for the Chinese population
.
The 57th European Association for the Study of Diabetes (EASD) Annual Meeting in 2021 was successfully held from September 28 to October 1, 2021
.
In the "Hundred Years of Insulin Therapy" forum on the afternoon of September 29, Professor Cees Tack from the Netherlands and Professor Tina Vilsbøll from Denmark discussed the current situation and challenges of insulin therapy.
The two wonderful speeches also brought us a lesson in insulin therapy in China.
Many revelations came
.
Starting from the characteristics of Chinese patients and clarifying the needs of individualized treatment, Professor Cees Tack’s speech focused on "Insulin Therapy Forms in 2021: Individualized Approaches" and pointed out the importance of individualized treatment based on the characteristics of patients [1]
.
So what are the characteristics of Chinese type 2 diabetes (T2DM) patients? How should individualized treatment for the Chinese population be carried out? Regarding the characteristics of T2DM patients in China, a study of 405 newly diagnosed T2DM patients found that the insulin secretion defects and insulin resistance of Chinese T2DM patients exist at the same time, and the insulin secretion defects are more serious [2]
.
Another study comparing the postprandial blood glucose (PPG) of Caucasians and Asians showed that after eating the same amount of grains, the area under the curve of postprandial blood glucose increase in Asians was 63% higher than that of Caucasians [3]
.
iAUC: The area under the curve of blood glucose increase (mmol/L/min) Figure 1 The blood glucose increase of Asians and Caucasians after eating As can be seen from the above evidence, Chinese T2DM patients have the characteristics of poor insulin secretion, high PPG and large increase.
Therefore, the individualized treatment of Chinese patients should pay attention to PPG control while controlling fasting blood glucose (FPG), and pay attention to patients with different blood glucose characteristics, such as patients with high FPG and PPG, and patients with normal FPG after treatment but still high PPG.
Patients implement different management programs
.
While carrying out individualized management according to the patient's condition, the improvement of patient compliance through the optimization of treatment plans should also be paid attention to, in order to allow patients to get more benefits
.
Pre-mixed insulin analogues have advantages, but the proportion of development and innovation in the past century has been dedicated to making insulin better meet the needs of patients
.
Nowadays, pre-mixed insulin analogues have become an important force in the treatment of diabetes by virtue of their advantages in both basic blood glucose and PPG control
.
However, low-proportion premixed and medium-proportioned premixed insulins are suitable for different patients.
For example, insulin lispro 25 and insulin lispro 50 are suitable for different populations.
Therefore, individualized selection must be made when clinical medication
.
In this regard, the "Practical Guidelines for the Application of Premixed Insulin Analogue Initiation, Intensification, and Conversion Programs for Patients with Type 2 Diabetes"[4] pointed out that when patients have severe postprandial hyperglycemia or hypoglycemia, they can consider using it Pre-mixed insulin analogues in medium proportions
.
CLASSIFY China subgroup analysis showed that in T2DM patients with baseline PPG increase ≥4.
4mmol/L and PPG level ≥13.
5mmol/L, compared with insulin lispro 25 treatment, insulin lispro 50 treatment of glycosylated hemoglobin (HbA1c) The level of decline is more obvious [5]
.
It can be seen that in patients with higher PPG levels and greater increases in PPG, insulin lispro 50 is more effective
.
Figure 2 In the population with a greater increase in PPG, insulin lispro 50 is significantly better than insulin lispro 25.
Insulin treatment is still challenging.
How to break through the new schemes one by one? Professor Tina Vilsbøll is presenting "New Insulin: What Can We Get, Real Value or Vague Promise?" "The speech on the topic stated that despite 100 years of development, insulin therapy still faces challenges such as hypoglycemia, complicated operations, and poor treatment compliance [6]
.
Faced with these challenges, there are many clinical attempts, such as improving injection and blood glucose monitoring equipment, using mobile phone APP intervention, strengthening diabetes self-management education, and nurse participation, etc.
, in order to improve clinical inertia in diabetes management
.
In addition, choosing suitable hypoglycemic drugs or programs can also be of great help
.
For example, in insulin therapy, compared with the basal-meal regimen, the pre-mixed insulin regimen is easier to treat.
It has the advantages of fewer injections, fewer blood glucose monitoring times, and lower requirements for the patient's injection ability, so patient compliance is more Good [7]
.
In the premixed insulin regimen, the "Clinical Guidance and Recommendations for the Conversion of Insulin after the Initiation of Type 2 Diabetes"[8] further pointed out that the efficacy of premixed human insulin 2 times a day is not good, or the patient has difficulty complying with the needs of insulin injections.
When waiting for 30 minutes to eat, consider adjusting to premixed insulin analog 2 times/d
.
In addition, premixed insulin analogs can effectively control sugar without increasing the risk of hypoglycemia, and the incidence of hypoglycemia with different proportions of premixed insulin analogs is similar [5,9,10]
.
Studies have shown that when patients with type 2 diabetes are treated with meals + basal insulin (4 times/d) or 3 times a day premixed insulin analogues, the two have a significant effect on the reduction of HbA1c, the incidence of hypoglycemia, the total insulin dose, and the There is no significant difference in the effect of weight [9]
.
Another Chinese study found that the incidence of hypoglycemia of insulin lispro 50 is similar to that of insulin lispro 25 [10]
.
CLASSIFY China subgroup analysis results also showed that the incidence of hypoglycemia and weight gain were similar in the two groups treated with insulin lispro 50 and insulin lispro 25 [5]
.
Summary Professors Cees Tack and Tina Vilsbøll pointed out the importance of individualized treatment and the challenges facing insulin after a century of development at the EASD meeting
.
According to the disease characteristics of Chinese patients, PPG control is especially emphasized in treatment
.
Premixed insulin analogues have clinical advantages in the treatment of diabetes because they control PPG while taking into account the characteristics of overall blood sugar.
Clinically, the proportion of premixed insulin can be individualized according to the patient's condition
.
In addition, the premixed insulin regimen is more convenient than the basic mealtime regimen
.
For patients with poor efficacy of premixed human insulin, you can consider adjusting to premixed insulin analogues
.
The advantages of premixed insulin analogues also include improving blood sugar without increasing the risk of hypoglycemia
.
Insulin therapy has ushered in the era of individualization.
It is expected that the clinical application experience of various individualized treatment plans can form a "Chinese-specific treatment plan" tailored to the characteristics of Chinese patients and benefit more Chinese patients
.
References: [1] Cees Tack.
Forms of insulin treatment in 2021 an individualised approach.
2021 EASD short oral presentation.
[2] An Yali, et al.
Chinese Journal of Endocrinology and Metabolism.
2008;24(3):256-260.
[3 ]Venn BS, Williams SM, Mann JI.
Diabet Med.
2010 Oct;27(10):1205-8.
[4]Wu T, et al.
Diabetes Ther.
2015;6(3):273-87.
[5 ]Su Q, et al.
J Diabetes.
2017 Jun;9(6):575-585.
[6]Tina Vilsbøll.
New insulins: What could we get, true value or vague promise.
2021EASD short oral presentation.
[7] Wei Yanhong, et al.
Chinese Journal of Practical Diagnosis and Therapy.
2016;30(4):407-408.
[8] Chinese Endocrine Related Expert Group (collectively).
Chinese Journal of Diabetes.
2018;10(2):97-102.
[ 9] Diabetes Branch of Chinese Medical Association.
Chinese Journal of Diabetes.
2021;13(04):315-409.
[10]Wu Yang, et al.
Journal of Practical Diabetes.
2012;8(5):24-25.
- End- Approval code: PP-HI-CN-5426 "This article is only used to provide scientific information to medical and health professionals, and does not represent the position of the platform.
" For submission/reprint/business cooperation, please contact: pengsanmei@yxj.
org.
cn
From the EASD annual meeting to the new journey of insulin therapy in China, to find the most suitable plan for the Chinese population
.
The 57th European Association for the Study of Diabetes (EASD) Annual Meeting in 2021 was successfully held from September 28 to October 1, 2021
.
In the "Hundred Years of Insulin Therapy" forum on the afternoon of September 29, Professor Cees Tack from the Netherlands and Professor Tina Vilsbøll from Denmark discussed the current situation and challenges of insulin therapy.
The two wonderful speeches also brought us a lesson in insulin therapy in China.
Many revelations came
.
Starting from the characteristics of Chinese patients and clarifying the needs of individualized treatment, Professor Cees Tack’s speech focused on "Insulin Therapy Forms in 2021: Individualized Approaches" and pointed out the importance of individualized treatment based on the characteristics of patients [1]
.
So what are the characteristics of Chinese type 2 diabetes (T2DM) patients? How should individualized treatment for the Chinese population be carried out? Regarding the characteristics of T2DM patients in China, a study of 405 newly diagnosed T2DM patients found that the insulin secretion defects and insulin resistance of Chinese T2DM patients exist at the same time, and the insulin secretion defects are more serious [2]
.
Another study comparing the postprandial blood glucose (PPG) of Caucasians and Asians showed that after eating the same amount of grains, the area under the curve of postprandial blood glucose increase in Asians was 63% higher than that of Caucasians [3]
.
iAUC: The area under the curve of blood glucose increase (mmol/L/min) Figure 1 The blood glucose increase of Asians and Caucasians after eating As can be seen from the above evidence, Chinese T2DM patients have the characteristics of poor insulin secretion, high PPG and large increase.
Therefore, the individualized treatment of Chinese patients should pay attention to PPG control while controlling fasting blood glucose (FPG), and pay attention to patients with different blood glucose characteristics, such as patients with high FPG and PPG, and patients with normal FPG after treatment but still high PPG.
Patients implement different management programs
.
While carrying out individualized management according to the patient's condition, the improvement of patient compliance through the optimization of treatment plans should also be paid attention to, in order to allow patients to get more benefits
.
Pre-mixed insulin analogues have advantages, but the proportion of development and innovation in the past century has been dedicated to making insulin better meet the needs of patients
.
Nowadays, pre-mixed insulin analogues have become an important force in the treatment of diabetes by virtue of their advantages in both basic blood glucose and PPG control
.
However, low-proportion premixed and medium-proportioned premixed insulins are suitable for different patients.
For example, insulin lispro 25 and insulin lispro 50 are suitable for different populations.
Therefore, individualized selection must be made when clinical medication
.
In this regard, the "Practical Guidelines for the Application of Premixed Insulin Analogue Initiation, Intensification, and Conversion Programs for Patients with Type 2 Diabetes"[4] pointed out that when patients have severe postprandial hyperglycemia or hypoglycemia, they can consider using it Pre-mixed insulin analogues in medium proportions
.
CLASSIFY China subgroup analysis showed that in T2DM patients with baseline PPG increase ≥4.
4mmol/L and PPG level ≥13.
5mmol/L, compared with insulin lispro 25 treatment, insulin lispro 50 treatment of glycosylated hemoglobin (HbA1c) The level of decline is more obvious [5]
.
It can be seen that in patients with higher PPG levels and greater increases in PPG, insulin lispro 50 is more effective
.
Figure 2 In the population with a greater increase in PPG, insulin lispro 50 is significantly better than insulin lispro 25.
Insulin treatment is still challenging.
How to break through the new schemes one by one? Professor Tina Vilsbøll is presenting "New Insulin: What Can We Get, Real Value or Vague Promise?" "The speech on the topic stated that despite 100 years of development, insulin therapy still faces challenges such as hypoglycemia, complicated operations, and poor treatment compliance [6]
.
Faced with these challenges, there are many clinical attempts, such as improving injection and blood glucose monitoring equipment, using mobile phone APP intervention, strengthening diabetes self-management education, and nurse participation, etc.
, in order to improve clinical inertia in diabetes management
.
In addition, choosing suitable hypoglycemic drugs or programs can also be of great help
.
For example, in insulin therapy, compared with the basal-meal regimen, the pre-mixed insulin regimen is easier to treat.
It has the advantages of fewer injections, fewer blood glucose monitoring times, and lower requirements for the patient's injection ability, so patient compliance is more Good [7]
.
In the premixed insulin regimen, the "Clinical Guidance and Recommendations for the Conversion of Insulin after the Initiation of Type 2 Diabetes"[8] further pointed out that the efficacy of premixed human insulin 2 times a day is not good, or the patient has difficulty complying with the needs of insulin injections.
When waiting for 30 minutes to eat, consider adjusting to premixed insulin analog 2 times/d
.
In addition, premixed insulin analogs can effectively control sugar without increasing the risk of hypoglycemia, and the incidence of hypoglycemia with different proportions of premixed insulin analogs is similar [5,9,10]
.
Studies have shown that when patients with type 2 diabetes are treated with meals + basal insulin (4 times/d) or 3 times a day premixed insulin analogues, the two have a significant effect on the reduction of HbA1c, the incidence of hypoglycemia, the total insulin dose, and the There is no significant difference in the effect of weight [9]
.
Another Chinese study found that the incidence of hypoglycemia of insulin lispro 50 is similar to that of insulin lispro 25 [10]
.
CLASSIFY China subgroup analysis results also showed that the incidence of hypoglycemia and weight gain were similar in the two groups treated with insulin lispro 50 and insulin lispro 25 [5]
.
Summary Professors Cees Tack and Tina Vilsbøll pointed out the importance of individualized treatment and the challenges facing insulin after a century of development at the EASD meeting
.
According to the disease characteristics of Chinese patients, PPG control is especially emphasized in treatment
.
Premixed insulin analogues have clinical advantages in the treatment of diabetes because they control PPG while taking into account the characteristics of overall blood sugar.
Clinically, the proportion of premixed insulin can be individualized according to the patient's condition
.
In addition, the premixed insulin regimen is more convenient than the basic mealtime regimen
.
For patients with poor efficacy of premixed human insulin, you can consider adjusting to premixed insulin analogues
.
The advantages of premixed insulin analogues also include improving blood sugar without increasing the risk of hypoglycemia
.
Insulin therapy has ushered in the era of individualization.
It is expected that the clinical application experience of various individualized treatment plans can form a "Chinese-specific treatment plan" tailored to the characteristics of Chinese patients and benefit more Chinese patients
.
References: [1] Cees Tack.
Forms of insulin treatment in 2021 an individualised approach.
2021 EASD short oral presentation.
[2] An Yali, et al.
Chinese Journal of Endocrinology and Metabolism.
2008;24(3):256-260.
[3 ]Venn BS, Williams SM, Mann JI.
Diabet Med.
2010 Oct;27(10):1205-8.
[4]Wu T, et al.
Diabetes Ther.
2015;6(3):273-87.
[5 ]Su Q, et al.
J Diabetes.
2017 Jun;9(6):575-585.
[6]Tina Vilsbøll.
New insulins: What could we get, true value or vague promise.
2021EASD short oral presentation.
[7] Wei Yanhong, et al.
Chinese Journal of Practical Diagnosis and Therapy.
2016;30(4):407-408.
[8] Chinese Endocrine Related Expert Group (collectively).
Chinese Journal of Diabetes.
2018;10(2):97-102.
[ 9] Diabetes Branch of Chinese Medical Association.
Chinese Journal of Diabetes.
2021;13(04):315-409.
[10]Wu Yang, et al.
Journal of Practical Diabetes.
2012;8(5):24-25.
- End- Approval code: PP-HI-CN-5426 "This article is only used to provide scientific information to medical and health professionals, and does not represent the position of the platform.
" For submission/reprint/business cooperation, please contact: pengsanmei@yxj.
org.
cn
