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*Only for medical professionals to read and refer to ten years of evidence-based clinical evidence, leading a new era of hypoglycemic and heart protection! With the continuous deepening of related research, people are paying more and more attention to cardiovascular complications in diabetic patients.
Endocrinologists are also making continuous efforts to solve this problem.
Diabetes mellitus (DM) is the main risk factor for cardiovascular disease (CVD), and cardiovascular complications are the leading cause of death in patients with type 2 diabetes (T2DM) [1].
In recent years, the glucagon-like peptide-1 receptor agonist (GLP-1RA), which has attracted more and more attention in recent years, is a new type of hypoglycemic agent, which can not only reduce blood sugar safely and efficiently, but also exert cardiovascular protection through related mechanisms[2] .
Among them, liraglutide is the first GLP-1RA drug that has been proven to have cardiovascular benefits.
On June 13, 2016, the 76th American Diabetes Association (ADA) Scientific Annual Meeting officially announced the LEADER study results, confirming its cardiovascular protective effect.
On May 14, 2020, the cardiovascular indication for liraglutide was officially approved in my country.
In this regard, the medical community invited Professor Ji Linong, director of the Endocrinology Department of Peking University People's Hospital and director of Peking University Diabetes Center, to share.
Medical community: The LEADER study has been announced heavily, providing new directions and new hopes for diabetes management.
Could you please take us to review the main results of the LEADER study? Professor Ji Linong: As one of the researchers, I personally participated in this research, and we are still very excited in retrospect.
The LEADER trial is a randomized, double-blind, placebo-controlled, long-term follow-up trial that included 9,340 patients from 410 research centers in 32 countries, of which 92 patients from 7 research centers in Mainland China participated in the study, with an average follow-up of 3.
8 In 2009, the effect of liraglutide compared with placebo on the cardiovascular outcome of T2DM patients with cardiovascular disease or high risk of cardiovascular disease was evaluated.The study confirmed that on the basis of standard treatment, liraglutide can significantly reduce the risk of major adverse cardiovascular events (MACE) in patients by 13%, and significantly reduce the risk of cardiovascular death by 22% and the risk of all-cause death by 15%.
It is a guideline for follow-up development And clinical practice has laid a solid foundation [3].
Medical profession: Do you remember how you felt when you learned the results of the study? What were your expectations for the clinical application of liraglutide in China at that time? Now it seems that the help of liraglutide to Chinese diabetic patients and the current status of its clinical application are in line with your expectations? Professor Ji Linong: The LEADER research is the research result announced at the 2016 ADA conference, and it can be called the most dazzling "star" at the 2016 ADA conference.
At that time, as a researcher, I had the honor to witness this moment at the ADA conference: liraglutide is not only cardiovascular safety, but also has a clear cardiovascular protective effect.
The announcement of this result made the participants very excited and happy.
This research makes GLP-1RA drugs become the second type of hypoglycemic drugs that have been confirmed by randomized clinical trials after sodium-glucose cotransporter-2 inhibitors (SGLT-2i) to bring cardiovascular benefits; Laglutide became the first GLP-1RA drug to be confirmed by the cardiovascular outcome study (CVOT) to have a cardiovascular hard end point benefit.
With the promotion of evidence-based evidence, the 2018 ADA guidelines recommend that for T2DM patients with atherosclerotic cardiovascular disease (ASCVD), GLP-1RA or SGLT-2i, which has proven cardiovascular benefits, are recommended as part of blood glucose management [1].
However, in clinical practice, the use rate of GLP-1RA drugs in T2DM patients with cardiovascular risk is still low.
The CAPTURE study, a large-scale investigation of cardiovascular disease in diabetic patients, shows that 32.
2% of Chinese T2DM patients have ASCVD, and only less than 10% of these patients have used GLP-1RA recommended by the guidelines for treatment [4]. This result shows that there is still a long way to go from the guideline recommendation to clinical practice.
It also reminds us that after clinical evidence is generated, it is more important to transform clinical evidence into clinical practice, which also requires the efforts of all our medical workers.
Medical community: On May 14, 2020, the National Medical Products Administration (NMPA) approved the expansion of the indications for liraglutide.
After that, liraglutide can be used to reduce the main cardiovascular disease in T2DM adult patients with cardiovascular disease.
The risk of adverse events (cardiovascular death, non-fatal myocardial infarction or non-fatal stroke), how do you think this will affect the future clinical application of liraglutide? What are the effects on the clinical application of GLP-1RA drugs in my country? Professor Ji Linong: First of all, based on the 2016 landmark LEADER study, liraglutide has obtained indications for cardiovascular protection in the United States and the European Union.
That is, in clinical applications, liraglutide can not only be used as a hypoglycemic agent, It can also be used as a cardiovascular protective drug.
As more evidence of cardiovascular benefits of GLP-1RA drugs emerge, their status in major guidelines has improved.
Both the "Chinese Type 2 Diabetes Prevention Guidelines (2020 Edition)" and the 2021 ADA guidelines recommend that for T2DM patients with high-risk ASCVD or ASCVD, regardless of whether the glycosylated hemoglobin (HbA1c) meets the standard, it is recommended to give priority to those with evidence of cardiovascular benefit Drugs, such as GLP-1RA [5-6].
Compared with non-diabetic patients, the risk of death in diabetic patients is significantly increased, the average life span is shortened by 9 years, and the life span of patients with cardiovascular disease is expected to be shortened by 12 years [7-8].
Therefore, for diabetic patients, it is necessary to reduce blood sugar while avoiding or reducing the risk of vascular complications.
At present, the management concept of T2DM has changed from simply controlling glucose to comprehensive management to control a variety of metabolic abnormalities, prevent and delay diabetes complications.
Cardiovascular risk assessment is an important part of T2DM management, and it has cardiovascular benefits to reduce blood sugar.
The drug has also been recommended by a number of domestic and foreign relevant guidelines for the primary prevention and secondary prevention of cardiovascular disease in patients with T2DM.
Liraglutide is the first and only hypoglycemic drug approved by NMPA with indications to reduce the risk of major adverse cardiovascular events in China.
The update of this manual provides the majority of T2DM patients with cardiovascular disease with drugs that take into account blood glucose management and cardiovascular benefits, avoiding or delaying the occurrence and deterioration of vascular complications in later patients, and providing long-term comprehensive benefits for Chinese diabetic patients.
Provides the possibility.
Summary The end-stage cardiovascular adverse events caused by ASCVD are the most important disease burden faced by T2DM patients.
Liraglutide in GLP-1RA is a drug that has been confirmed by clinical studies to have cardiovascular benefits.
With the update of the guideline and the expansion of the indications for liraglutide, patients in my country with ASCVD or high-risk ASCVD should promptly use hypoglycemic drugs with clear cardiovascular benefits, and thus obtain comprehensive benefits while reducing blood sugar.
beneficial.
References: [1]American Diabetes Association.
Diabetes Care.
2018;41(suppl 1):S1-S159.
[2]Zhu Yuqin, Guo Kai.
Journal of Practical Clinical Medicine.
2021;25(03):107-110.
[3]Marso SP, et al.
N Engl J Med.
2016;375(4):311-22.
[4]Hong Tianpei, et al.
GW-ICC.
2020 Poster: GW31-e1199.
[5]American Diabetes Association.
Diabetes Care.
2021;44(Suppl 1):S111-S124.
[6]Cosentino F, et al.
Eur Heart J.
2020;41(2):255-323.
[7]Fiona B, et al.
JAMA.
2017;317(3)280-289.
[8]Schmidt A M.
Arteriosclerosis Thrombosis & Vascular Biology.
2019;39(4).
Endocrinologists are also making continuous efforts to solve this problem.
Diabetes mellitus (DM) is the main risk factor for cardiovascular disease (CVD), and cardiovascular complications are the leading cause of death in patients with type 2 diabetes (T2DM) [1].
In recent years, the glucagon-like peptide-1 receptor agonist (GLP-1RA), which has attracted more and more attention in recent years, is a new type of hypoglycemic agent, which can not only reduce blood sugar safely and efficiently, but also exert cardiovascular protection through related mechanisms[2] .
Among them, liraglutide is the first GLP-1RA drug that has been proven to have cardiovascular benefits.
On June 13, 2016, the 76th American Diabetes Association (ADA) Scientific Annual Meeting officially announced the LEADER study results, confirming its cardiovascular protective effect.
On May 14, 2020, the cardiovascular indication for liraglutide was officially approved in my country.
In this regard, the medical community invited Professor Ji Linong, director of the Endocrinology Department of Peking University People's Hospital and director of Peking University Diabetes Center, to share.
Medical community: The LEADER study has been announced heavily, providing new directions and new hopes for diabetes management.
Could you please take us to review the main results of the LEADER study? Professor Ji Linong: As one of the researchers, I personally participated in this research, and we are still very excited in retrospect.
The LEADER trial is a randomized, double-blind, placebo-controlled, long-term follow-up trial that included 9,340 patients from 410 research centers in 32 countries, of which 92 patients from 7 research centers in Mainland China participated in the study, with an average follow-up of 3.
8 In 2009, the effect of liraglutide compared with placebo on the cardiovascular outcome of T2DM patients with cardiovascular disease or high risk of cardiovascular disease was evaluated.The study confirmed that on the basis of standard treatment, liraglutide can significantly reduce the risk of major adverse cardiovascular events (MACE) in patients by 13%, and significantly reduce the risk of cardiovascular death by 22% and the risk of all-cause death by 15%.
It is a guideline for follow-up development And clinical practice has laid a solid foundation [3].
Medical profession: Do you remember how you felt when you learned the results of the study? What were your expectations for the clinical application of liraglutide in China at that time? Now it seems that the help of liraglutide to Chinese diabetic patients and the current status of its clinical application are in line with your expectations? Professor Ji Linong: The LEADER research is the research result announced at the 2016 ADA conference, and it can be called the most dazzling "star" at the 2016 ADA conference.
At that time, as a researcher, I had the honor to witness this moment at the ADA conference: liraglutide is not only cardiovascular safety, but also has a clear cardiovascular protective effect.
The announcement of this result made the participants very excited and happy.
This research makes GLP-1RA drugs become the second type of hypoglycemic drugs that have been confirmed by randomized clinical trials after sodium-glucose cotransporter-2 inhibitors (SGLT-2i) to bring cardiovascular benefits; Laglutide became the first GLP-1RA drug to be confirmed by the cardiovascular outcome study (CVOT) to have a cardiovascular hard end point benefit.
With the promotion of evidence-based evidence, the 2018 ADA guidelines recommend that for T2DM patients with atherosclerotic cardiovascular disease (ASCVD), GLP-1RA or SGLT-2i, which has proven cardiovascular benefits, are recommended as part of blood glucose management [1].
However, in clinical practice, the use rate of GLP-1RA drugs in T2DM patients with cardiovascular risk is still low.
The CAPTURE study, a large-scale investigation of cardiovascular disease in diabetic patients, shows that 32.
2% of Chinese T2DM patients have ASCVD, and only less than 10% of these patients have used GLP-1RA recommended by the guidelines for treatment [4]. This result shows that there is still a long way to go from the guideline recommendation to clinical practice.
It also reminds us that after clinical evidence is generated, it is more important to transform clinical evidence into clinical practice, which also requires the efforts of all our medical workers.
Medical community: On May 14, 2020, the National Medical Products Administration (NMPA) approved the expansion of the indications for liraglutide.
After that, liraglutide can be used to reduce the main cardiovascular disease in T2DM adult patients with cardiovascular disease.
The risk of adverse events (cardiovascular death, non-fatal myocardial infarction or non-fatal stroke), how do you think this will affect the future clinical application of liraglutide? What are the effects on the clinical application of GLP-1RA drugs in my country? Professor Ji Linong: First of all, based on the 2016 landmark LEADER study, liraglutide has obtained indications for cardiovascular protection in the United States and the European Union.
That is, in clinical applications, liraglutide can not only be used as a hypoglycemic agent, It can also be used as a cardiovascular protective drug.
As more evidence of cardiovascular benefits of GLP-1RA drugs emerge, their status in major guidelines has improved.
Both the "Chinese Type 2 Diabetes Prevention Guidelines (2020 Edition)" and the 2021 ADA guidelines recommend that for T2DM patients with high-risk ASCVD or ASCVD, regardless of whether the glycosylated hemoglobin (HbA1c) meets the standard, it is recommended to give priority to those with evidence of cardiovascular benefit Drugs, such as GLP-1RA [5-6].
Compared with non-diabetic patients, the risk of death in diabetic patients is significantly increased, the average life span is shortened by 9 years, and the life span of patients with cardiovascular disease is expected to be shortened by 12 years [7-8].
Therefore, for diabetic patients, it is necessary to reduce blood sugar while avoiding or reducing the risk of vascular complications.
At present, the management concept of T2DM has changed from simply controlling glucose to comprehensive management to control a variety of metabolic abnormalities, prevent and delay diabetes complications.
Cardiovascular risk assessment is an important part of T2DM management, and it has cardiovascular benefits to reduce blood sugar.
The drug has also been recommended by a number of domestic and foreign relevant guidelines for the primary prevention and secondary prevention of cardiovascular disease in patients with T2DM.
Liraglutide is the first and only hypoglycemic drug approved by NMPA with indications to reduce the risk of major adverse cardiovascular events in China.
The update of this manual provides the majority of T2DM patients with cardiovascular disease with drugs that take into account blood glucose management and cardiovascular benefits, avoiding or delaying the occurrence and deterioration of vascular complications in later patients, and providing long-term comprehensive benefits for Chinese diabetic patients.
Provides the possibility.
Summary The end-stage cardiovascular adverse events caused by ASCVD are the most important disease burden faced by T2DM patients.
Liraglutide in GLP-1RA is a drug that has been confirmed by clinical studies to have cardiovascular benefits.
With the update of the guideline and the expansion of the indications for liraglutide, patients in my country with ASCVD or high-risk ASCVD should promptly use hypoglycemic drugs with clear cardiovascular benefits, and thus obtain comprehensive benefits while reducing blood sugar.
beneficial.
References: [1]American Diabetes Association.
Diabetes Care.
2018;41(suppl 1):S1-S159.
[2]Zhu Yuqin, Guo Kai.
Journal of Practical Clinical Medicine.
2021;25(03):107-110.
[3]Marso SP, et al.
N Engl J Med.
2016;375(4):311-22.
[4]Hong Tianpei, et al.
GW-ICC.
2020 Poster: GW31-e1199.
[5]American Diabetes Association.
Diabetes Care.
2021;44(Suppl 1):S111-S124.
[6]Cosentino F, et al.
Eur Heart J.
2020;41(2):255-323.
[7]Fiona B, et al.
JAMA.
2017;317(3)280-289.
[8]Schmidt A M.
Arteriosclerosis Thrombosis & Vascular Biology.
2019;39(4).
