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What are the hot topics in the field of endocrinology recently? "Type 2 Diabetes Relief" must be unsurpassed
.
Recently, the "Expert Consensus on Short-term Intensive Insulin Therapy Reversing Type 2 Diabetes" co-authored by experts from the Chinese Insulin Secretion Research Group was published in the Chinese Journal of Diabetes, aiming to better guide short-term intensive insulin therapy (SIIT) to reverse type 2 diabetes ( T2DM) clinical practice, part of the content of this article is extracted and shared with you (the full version of the guide download link is attached at the end of the article)
.
The core content of the "Consensus" involves the following 9 questions: ➤Question 1: What is the definition of the reversal of T2DM? ➤Question 2: What clinical evidence does SIIT reverse T2DM? ➤Question 3: What is the mechanism for SIIT to reverse T2DM? ➤Question 4: For whom does SIIT reverse T2DM apply? ➤Question 5: During SIIT reversal treatment, how should blood glucose goals be set? ➤Question 6: During SIIT reversal treatment, how should the initial dose, adjustment and treatment course of insulin be set? ➤Question 7: After SIIT treatment, which patients are more likely to get reversal or remission? ➤Question 8: Can the SIIT program be combined with hypoglycemic drugs other than insulin at the same time? ➤Question 9: If diabetes cannot be induced to reverse or alleviate after SIIT, how should the follow-up management plan be selected? Two SIIT reversal flowcharts: applicable to "newly diagnosed" and "existing course of disease" T2DM patients 1.
Flow chart of short-term intensive insulin reversal therapy for newly diagnosed type 2 diabetes patients 2.
Certain course of disease and poor blood sugar control 2 Flow chart of short-term intensive insulin reversal treatment for patients with type 2 diabetes, which people are suitable for/not suitable for SIIT reversal of T2DM? Patients suitable for SIIT treatment ➤ Newly diagnosed T2DM patients, HbA1c ≥ 9.
0% or fasting blood glucose ≥ 11.
1 mmol/L, or when accompanied by obvious symptoms of hyperglycemia, SIIT treatment can be initiated
.
➤For newly diagnosed T2DM patients, HbA1c is 7.
5%~8.
9% or fasting blood glucose is 8.
0~11.
0 mmol/L, SIIT treatment can be implemented cautiously
.
➤T2DM patients with a certain course of disease, combined with oral hypoglycemic agents or initial insulin therapy for more than 3 months, HbA1c≥7.
5%, such as course of disease <15 years, fasting C-peptide ≥0.
4 nmol/L, SIIT can be considered based on the patient's wishes Treatment
.
People who are not suitable for SIIT treatment (1) diagnosed as non-T2DM; (2) age ≥ 70 years or life expectancy <10 years; (3) high risk of hypoglycemia; (4) confirmed coronary atherosclerotic cardiovascular disease; (5) with severe or chronic complications of T2DM patients with systemic diseases and so on
.
How should blood glucose goals be set during SIIT reversal therapy? The mechanism of SIIT reversing T2DM is to minimize the metabolic stress of β cells and promote their recuperation
.
Because mild hyperglycemia can cause damage to β cells, if the goal is to reverse T2DM, blood glucose should be as close to normal as possible during intensive treatment
.
➤It is recommended to target fasting and pre-meal blood glucose <6.
1 mmol/L and 2 h postprandial blood glucose <8.
0 mmol/L during SIIT reversal treatment
.
➤On the basis of ensuring safety, some patients can adopt more stringent hypoglycemic targets (fasting and pre-meal blood glucose 4.
4~5.
6 mmol/L, 2-h postprandial blood glucose 4.
4~7.
6 mmol/L)
.
➤It is recommended to monitor fingertip blood glucose more than 7 times a day during SIIT
.
During SIIT reversal treatment, how should the initial dose, adjustment and treatment course of insulin be set? 1.
The first choice for SIIT The "Consensus" recommends CSII as the first choice for SIIT reversal treatment, and the course of treatment is not less than 2 weeks after blood sugar reaches the target
.
If there is no condition to use CSII, it is feasible and effective to use multiple injections a day
.
Both human insulin and short-acting insulin analogues can be used for SIIT .
Compared with human insulin, the pharmacokinetic characteristics of insulin analogues are more in line with physiological requirements.
In clinical research, it can also make blood sugar strictly up to the standard in a shorter time and help reduce hypoglycemia
.
Therefore, this consensus recommends the use of short-acting insulin analogues for SIIT treatment
.
2.
For the setting and adjustment of insulin dose during SIIT, please refer to "Chinese Insulin Pump Treatment Guidelines (2021 Edition)".
The total amount of daily insulin can be initially set and adjusted according to the patient's weight and blood glucose status at 0.
4 to 1.
0 U/kg.
Distribution
.
➤Initial setting: The total base rate accounts for about 40% of the daily total.
The whole-day base rate does not require complicated segmentation.
It can be considered that the base rate is reduced by 10% compared to the day from 22 to 3, and the average infusion in the rest of the time is the base Rate starting program
.
The total amount of pre-meal infusion accounts for 60% of the total daily dose, and the initial allocation can be based on 1/3, 1/3, and 1/3 of the three meals
.
➤Subsequent daily adjustments: Based on the principles recommended in the "Chinese Insulin Pump Treatment Guidelines (2021 Edition)", the adjustment should be combined with the patient's blood glucose monitoring results, exercise and diet status, and generally need to be adjusted once to several times a day
.
Whether patients with long-term illnesses can apply the above-mentioned principles of initial insulin therapy requires more data to accumulate
.
In addition, if long-acting oral hypoglycemic drugs (such as long-acting sulfonylureas, insulin sensitizers, etc.
) have been used on the day of the initiation of SIIT, it is necessary to consider reducing the basic rate of the day by 10% to 30% as appropriate, and give it the next day Full amount to avoid hypoglycemia
.
The daily decrease of the insulin dose after blood sugar reaches the standard is a sign of recovery.
The rate of reduction is greater than 50%, the chance of remission is higher
.
The insulin dose also needs to be adjusted closely according to the level of blood glucose monitoring to reduce the risk of hypoglycemia
.
Hypoglycemia occurs before meals, so strenuous exercise should be avoided before meals
.
Encourage patients to strictly follow the principles of diabetes medical nutrition therapy and exercise therapy during SIIT treatment, such as calorie control and nutrient ratio adjustment, intake of low glycemic index foods, and appropriate exercise training programs
.
There are significant regional differences in eating habits in China, and clinical measures need to be adapted to local conditions; patients’ diet and exercise interventions need to have a strong regularity, and be closely coordinated with insulin infusion to make blood glucose strictly up to the standard and avoid blood glucose fluctuations
.
In areas where conditions permit, nutritionists and sports therapists can join a multidisciplinary management team for intensive treatment
.
Can the SIIT program be combined with hypoglycemic drugs other than insulin at the same time? The "Consensus" pointed out that in most cases newly diagnosed T2DM patients can be treated with SIIT to achieve blood glucose control goals without the need to use other hypoglycemic drugs
.
Some patients may consider using insulin sensitizers and other hypoglycemic drugs to help blood sugar reach the target, but it is not recommended to use insulin secretagogues during SIIT
.
If diabetes cannot be induced to reverse or relieve after SIIT, how should the follow-up management plan be selected? The "Consensus" recommends continuous life>
.
➤Patients with newly diagnosed T2DM: If it is difficult to relieve after receiving SIIT, or if hyperglycemia recurs during follow-up, the first choice is to start metformin-based monotherapy or combined hypoglycemic therapy, and refer to the "Chinese Type 2 Diabetes Prevention Guidelines (2020 Edition) )" to upgrade the treatment
.
➤T2DM patients with a certain course of disease: Long-term plan formulation after SIIT needs to be individualized, and some patients can try staged downgrade treatment
.
Original Guideline: http://rs.
yiigle.
com/CN115791202110/1340149.
htm Extracted from: China Insulin Secretion Research Group.
Expert consensus on short-term intensive insulin therapy to reverse type 2 diabetes[J].
Chinese Journal of Diabetes, 2021, 13(10) :949-959.
DOI:10.
3760/cma.
j.
cn115791-20210719-00395.
.
Recently, the "Expert Consensus on Short-term Intensive Insulin Therapy Reversing Type 2 Diabetes" co-authored by experts from the Chinese Insulin Secretion Research Group was published in the Chinese Journal of Diabetes, aiming to better guide short-term intensive insulin therapy (SIIT) to reverse type 2 diabetes ( T2DM) clinical practice, part of the content of this article is extracted and shared with you (the full version of the guide download link is attached at the end of the article)
.
The core content of the "Consensus" involves the following 9 questions: ➤Question 1: What is the definition of the reversal of T2DM? ➤Question 2: What clinical evidence does SIIT reverse T2DM? ➤Question 3: What is the mechanism for SIIT to reverse T2DM? ➤Question 4: For whom does SIIT reverse T2DM apply? ➤Question 5: During SIIT reversal treatment, how should blood glucose goals be set? ➤Question 6: During SIIT reversal treatment, how should the initial dose, adjustment and treatment course of insulin be set? ➤Question 7: After SIIT treatment, which patients are more likely to get reversal or remission? ➤Question 8: Can the SIIT program be combined with hypoglycemic drugs other than insulin at the same time? ➤Question 9: If diabetes cannot be induced to reverse or alleviate after SIIT, how should the follow-up management plan be selected? Two SIIT reversal flowcharts: applicable to "newly diagnosed" and "existing course of disease" T2DM patients 1.
Flow chart of short-term intensive insulin reversal therapy for newly diagnosed type 2 diabetes patients 2.
Certain course of disease and poor blood sugar control 2 Flow chart of short-term intensive insulin reversal treatment for patients with type 2 diabetes, which people are suitable for/not suitable for SIIT reversal of T2DM? Patients suitable for SIIT treatment ➤ Newly diagnosed T2DM patients, HbA1c ≥ 9.
0% or fasting blood glucose ≥ 11.
1 mmol/L, or when accompanied by obvious symptoms of hyperglycemia, SIIT treatment can be initiated
.
➤For newly diagnosed T2DM patients, HbA1c is 7.
5%~8.
9% or fasting blood glucose is 8.
0~11.
0 mmol/L, SIIT treatment can be implemented cautiously
.
➤T2DM patients with a certain course of disease, combined with oral hypoglycemic agents or initial insulin therapy for more than 3 months, HbA1c≥7.
5%, such as course of disease <15 years, fasting C-peptide ≥0.
4 nmol/L, SIIT can be considered based on the patient's wishes Treatment
.
People who are not suitable for SIIT treatment (1) diagnosed as non-T2DM; (2) age ≥ 70 years or life expectancy <10 years; (3) high risk of hypoglycemia; (4) confirmed coronary atherosclerotic cardiovascular disease; (5) with severe or chronic complications of T2DM patients with systemic diseases and so on
.
How should blood glucose goals be set during SIIT reversal therapy? The mechanism of SIIT reversing T2DM is to minimize the metabolic stress of β cells and promote their recuperation
.
Because mild hyperglycemia can cause damage to β cells, if the goal is to reverse T2DM, blood glucose should be as close to normal as possible during intensive treatment
.
➤It is recommended to target fasting and pre-meal blood glucose <6.
1 mmol/L and 2 h postprandial blood glucose <8.
0 mmol/L during SIIT reversal treatment
.
➤On the basis of ensuring safety, some patients can adopt more stringent hypoglycemic targets (fasting and pre-meal blood glucose 4.
4~5.
6 mmol/L, 2-h postprandial blood glucose 4.
4~7.
6 mmol/L)
.
➤It is recommended to monitor fingertip blood glucose more than 7 times a day during SIIT
.
During SIIT reversal treatment, how should the initial dose, adjustment and treatment course of insulin be set? 1.
The first choice for SIIT The "Consensus" recommends CSII as the first choice for SIIT reversal treatment, and the course of treatment is not less than 2 weeks after blood sugar reaches the target
.
If there is no condition to use CSII, it is feasible and effective to use multiple injections a day
.
Both human insulin and short-acting insulin analogues can be used for SIIT .
Compared with human insulin, the pharmacokinetic characteristics of insulin analogues are more in line with physiological requirements.
In clinical research, it can also make blood sugar strictly up to the standard in a shorter time and help reduce hypoglycemia
.
Therefore, this consensus recommends the use of short-acting insulin analogues for SIIT treatment
.
2.
For the setting and adjustment of insulin dose during SIIT, please refer to "Chinese Insulin Pump Treatment Guidelines (2021 Edition)".
The total amount of daily insulin can be initially set and adjusted according to the patient's weight and blood glucose status at 0.
4 to 1.
0 U/kg.
Distribution
.
➤Initial setting: The total base rate accounts for about 40% of the daily total.
The whole-day base rate does not require complicated segmentation.
It can be considered that the base rate is reduced by 10% compared to the day from 22 to 3, and the average infusion in the rest of the time is the base Rate starting program
.
The total amount of pre-meal infusion accounts for 60% of the total daily dose, and the initial allocation can be based on 1/3, 1/3, and 1/3 of the three meals
.
➤Subsequent daily adjustments: Based on the principles recommended in the "Chinese Insulin Pump Treatment Guidelines (2021 Edition)", the adjustment should be combined with the patient's blood glucose monitoring results, exercise and diet status, and generally need to be adjusted once to several times a day
.
Whether patients with long-term illnesses can apply the above-mentioned principles of initial insulin therapy requires more data to accumulate
.
In addition, if long-acting oral hypoglycemic drugs (such as long-acting sulfonylureas, insulin sensitizers, etc.
) have been used on the day of the initiation of SIIT, it is necessary to consider reducing the basic rate of the day by 10% to 30% as appropriate, and give it the next day Full amount to avoid hypoglycemia
.
The daily decrease of the insulin dose after blood sugar reaches the standard is a sign of recovery.
The rate of reduction is greater than 50%, the chance of remission is higher
.
The insulin dose also needs to be adjusted closely according to the level of blood glucose monitoring to reduce the risk of hypoglycemia
.
Hypoglycemia occurs before meals, so strenuous exercise should be avoided before meals
.
Encourage patients to strictly follow the principles of diabetes medical nutrition therapy and exercise therapy during SIIT treatment, such as calorie control and nutrient ratio adjustment, intake of low glycemic index foods, and appropriate exercise training programs
.
There are significant regional differences in eating habits in China, and clinical measures need to be adapted to local conditions; patients’ diet and exercise interventions need to have a strong regularity, and be closely coordinated with insulin infusion to make blood glucose strictly up to the standard and avoid blood glucose fluctuations
.
In areas where conditions permit, nutritionists and sports therapists can join a multidisciplinary management team for intensive treatment
.
Can the SIIT program be combined with hypoglycemic drugs other than insulin at the same time? The "Consensus" pointed out that in most cases newly diagnosed T2DM patients can be treated with SIIT to achieve blood glucose control goals without the need to use other hypoglycemic drugs
.
Some patients may consider using insulin sensitizers and other hypoglycemic drugs to help blood sugar reach the target, but it is not recommended to use insulin secretagogues during SIIT
.
If diabetes cannot be induced to reverse or relieve after SIIT, how should the follow-up management plan be selected? The "Consensus" recommends continuous life>
.
➤Patients with newly diagnosed T2DM: If it is difficult to relieve after receiving SIIT, or if hyperglycemia recurs during follow-up, the first choice is to start metformin-based monotherapy or combined hypoglycemic therapy, and refer to the "Chinese Type 2 Diabetes Prevention Guidelines (2020 Edition) )" to upgrade the treatment
.
➤T2DM patients with a certain course of disease: Long-term plan formulation after SIIT needs to be individualized, and some patients can try staged downgrade treatment
.
Original Guideline: http://rs.
yiigle.
com/CN115791202110/1340149.
htm Extracted from: China Insulin Secretion Research Group.
Expert consensus on short-term intensive insulin therapy to reverse type 2 diabetes[J].
Chinese Journal of Diabetes, 2021, 13(10) :949-959.
DOI:10.
3760/cma.
j.
cn115791-20210719-00395.
