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*Only for medical professionals to read and refer to the "new forces" to lower blood sugar, benefiting Chinese diabetic patients! There are nearly 130 million diabetic patients in China, but the management of type 2 diabetes mellitus (T2DM) patients in clinical practice is still unsatisfactory, which restricts the rate of reaching the blood sugar control standard [1].
A large number of patients have cardiovascular complications, which has been hanging over the heads of diabetic patients, even life-threatening
.
Based on the low hypoglycemic compliance rate of Chinese diabetic patients and the high number of cardiovascular diseases, the choice of hypoglycemic regimen should also take into account both strong glucose control and cardiovascular benefits.
The weekly preparation of glucagon-like peptide-1 receptor agonist (GLP-1 RA), semaglutide, can meet the therapeutic needs of these two aspects at the same time
.
The "Medical Community" specially invited Professor Du Jian, Deputy Dean of the Fourth Affiliated Hospital of China Medical University, to introduce the treatment benefits of semaglutide and first-hand experience of clinical medication based on the current situation of diabetes prevention and treatment in China
.
Based on the characteristics of patients and the current status of treatment, China's diabetes management still needs to be comprehensively improved.
Professor Du Jian said that from a series of studies in recent years, the awareness rate, treatment rate and compliance rate of T2DM patients in China are less than 50% [1], In addition, T2DM has the characteristics of a large patient base, a long course of disease, and many complications, all of which have brought great challenges to diabetes management, significantly affected the quality of life of patients, and increased the economic burden caused by medical treatment
.
In the process of diabetes management, clinicians also need to adjust the treatment plan in a timely manner, but previous studies have shown that for Chinese T2DM patients with an average disease duration of about 6 years, the use of oral hypoglycemic drugs to achieve the target [glycated hemoglobin (HbA1c) ≤ 7 %] accounts for only about 40% [2], and the treatment effect is not ideal
.
In addition, about 50% of T2DM patients in China have ≥1 diabetes complication, and about 1/3 of T2DM patients have cardiovascular complications [3].
Therefore, preventing or delaying the occurrence and progression of complications is also the focus of diabetes management
.
Regarding the goal of diabetes management, Professor Du Jian said: "The short-term management goal of diabetes is to achieve the metabolic indicators such as blood sugar, blood lipids, blood pressure, and body weight, while the long-term goal is to delay or reduce diabetes complications
.
On the basis of this management and control concept, our management of diabetes has also shifted from focusing on blood sugar management to focusing on the heart and kidney outcomes of patients.
This concept also allows us to think more deeply about the choice of hypoglycemic drugs.
Drugs can bring cardiovascular and renal benefits on the basis of effective blood sugar lowering, so it will play an important role in the management of T2DM
.
" Follow the guideline recommendations and actively use hypoglycemic drugs with cardiovascular benefits 2020 China The Diabetes Society of the Medical Association recommends in the updated "China Guidelines for the Prevention and Treatment of Type 2 Diabetes" (hereinafter referred to as "CDS Guidelines") [4], that if T2DM patients have developed atherosclerotic cardiovascular disease (ASCVD) or are at high risk of ASCVD Factors, heart failure or chronic kidney disease (CKD), on the basis of life>
.
In addition, the 2020 edition of the "CDS Guidelines" [4] also recommends that even without ASCVD or high risk factors, T2DM patients can be combined with GLP-1RA to further manage blood sugar when life>
.
However, the CAPTURE China subgroup study published at the recent American Diabetes Association (ADA) annual meeting showed that 33.
9% of T2DM patients had cardiovascular disease (34.
8% globally), of which about 95% had ASCVD, but only 1.
5% of the patients had cardiovascular disease.
Received GLP-1RA treatment [5]
.
Therefore, Professor Du Jian said: "At present, it is still necessary to continue to promote the 'docking' of authoritative guidelines and clinical hypoglycemic regimens.
In order to truly benefit patients with GLP-1RA drugs with evidence of cardio-renal benefits, clinicians still have many things to do.
Do.
”
Multiple benefits, highly recognized by the clinic, Professor Du Jian introduced that GLP-1RA drugs have been highly recognized by endocrinologists since their launch, and their status in the authoritative T2DM diagnosis and treatment guidelines has also continued to rise, and as GLP-1RA drugs -1 RA weekly formulation, data from the SUSTAIN-6 study (Semaglutide Cardiovascular Outcomes Study) showed that in T2DM patients with high cardiovascular risk, treatment with semaglutide was associated with major adverse cardiovascular events (MACE) Compared with the placebo group, the risk was significantly reduced by 26%, and the risk of non-fatal stroke was significantly reduced by 39% [6].
These data are very encouraging and provide another powerful tool for the treatment of T2DM
.
In addition, the application of semaglutide treatment can also improve some other metabolic indicators of T2DM patients, such as improving overweight or obesity, hypertension, hyperlipidemia, etc.
Therefore, it is suitable for patients with multiple metabolic abnormalities, and even those who have reached metabolic syndrome.
T2DM patients
.
Professor Du Jian said that these benefits beyond sugar control are also what clinicians in endocrinology are looking forward to
.
"We have many years of experience with GLP-1RA drugs, whether it is data from randomized controlled clinical trials or real-world evidence, we can see the hypoglycemic effect and multiple benefits of GLP-1RA, so we have reason to expect The newly launched semaglutide will bring greater benefits to patients, and I hope to see more real-world drug evidence
.
" Professor Du Jian said
.
Talking about the future development prospects of GLP-1RA drugs, Professor Du Jian said: "When GLP-1RA drugs were launched, their therapeutic benefits in hypoglycemic, weight loss and other aspects made clinicians very happy, and as a multi-target drugs, they are also expected to be used to treat disease polycystic ovary syndrome, sleep apnea syndrome
.
based on these successful experiences, we have reason to believe that GLP-1RA week uS Secretary Turkoglu peptide preparation, It can also bring various therapeutic benefits, and its application other than diabetes has a number of clinical studies in progress, and the future benefits are worth looking forward to
.
” GLP-1RA drugs are also constantly upgrading their dosage forms, from the earliest each The once-daily dosage form, to the currently marketed weekly preparation, has effectively improved patients' medication compliance and provided patients with more medication options.
It is expected that semaglutide can benefit more Chinese T2DM patients in the future
.
References: [1]Li Y, et al.
BMJ.
2020;369:m997.
[2]Ji L, et al.
J Diabetes.
2015;7(2):166-173.
[3]Ma RCW.
Diabetologia 2018;61(6):1249-1260.
[4]Dieuzeide G, et al.
Diabetes.
2021; 70(Supplement 1):990-P.
[6]Marso SP, et al.
N Engl J Med.
2016;375(19):1834-1844.
[7]Zinman B, et al.
Lancet Diabetes Endocrinol.
2019; 7(5):356-367.
- End - "This article is only used to provide scientific information to medical and health professionals, and does not represent the platform's position" Contribution / reprint / business cooperation, please contact: pengsanmei@yxj.
org.
cn
A large number of patients have cardiovascular complications, which has been hanging over the heads of diabetic patients, even life-threatening
.
Based on the low hypoglycemic compliance rate of Chinese diabetic patients and the high number of cardiovascular diseases, the choice of hypoglycemic regimen should also take into account both strong glucose control and cardiovascular benefits.
The weekly preparation of glucagon-like peptide-1 receptor agonist (GLP-1 RA), semaglutide, can meet the therapeutic needs of these two aspects at the same time
.
The "Medical Community" specially invited Professor Du Jian, Deputy Dean of the Fourth Affiliated Hospital of China Medical University, to introduce the treatment benefits of semaglutide and first-hand experience of clinical medication based on the current situation of diabetes prevention and treatment in China
.
Based on the characteristics of patients and the current status of treatment, China's diabetes management still needs to be comprehensively improved.
Professor Du Jian said that from a series of studies in recent years, the awareness rate, treatment rate and compliance rate of T2DM patients in China are less than 50% [1], In addition, T2DM has the characteristics of a large patient base, a long course of disease, and many complications, all of which have brought great challenges to diabetes management, significantly affected the quality of life of patients, and increased the economic burden caused by medical treatment
.
In the process of diabetes management, clinicians also need to adjust the treatment plan in a timely manner, but previous studies have shown that for Chinese T2DM patients with an average disease duration of about 6 years, the use of oral hypoglycemic drugs to achieve the target [glycated hemoglobin (HbA1c) ≤ 7 %] accounts for only about 40% [2], and the treatment effect is not ideal
.
In addition, about 50% of T2DM patients in China have ≥1 diabetes complication, and about 1/3 of T2DM patients have cardiovascular complications [3].
Therefore, preventing or delaying the occurrence and progression of complications is also the focus of diabetes management
.
Regarding the goal of diabetes management, Professor Du Jian said: "The short-term management goal of diabetes is to achieve the metabolic indicators such as blood sugar, blood lipids, blood pressure, and body weight, while the long-term goal is to delay or reduce diabetes complications
.
On the basis of this management and control concept, our management of diabetes has also shifted from focusing on blood sugar management to focusing on the heart and kidney outcomes of patients.
This concept also allows us to think more deeply about the choice of hypoglycemic drugs.
Drugs can bring cardiovascular and renal benefits on the basis of effective blood sugar lowering, so it will play an important role in the management of T2DM
.
" Follow the guideline recommendations and actively use hypoglycemic drugs with cardiovascular benefits 2020 China The Diabetes Society of the Medical Association recommends in the updated "China Guidelines for the Prevention and Treatment of Type 2 Diabetes" (hereinafter referred to as "CDS Guidelines") [4], that if T2DM patients have developed atherosclerotic cardiovascular disease (ASCVD) or are at high risk of ASCVD Factors, heart failure or chronic kidney disease (CKD), on the basis of life>
.
In addition, the 2020 edition of the "CDS Guidelines" [4] also recommends that even without ASCVD or high risk factors, T2DM patients can be combined with GLP-1RA to further manage blood sugar when life>
.
However, the CAPTURE China subgroup study published at the recent American Diabetes Association (ADA) annual meeting showed that 33.
9% of T2DM patients had cardiovascular disease (34.
8% globally), of which about 95% had ASCVD, but only 1.
5% of the patients had cardiovascular disease.
Received GLP-1RA treatment [5]
.
Therefore, Professor Du Jian said: "At present, it is still necessary to continue to promote the 'docking' of authoritative guidelines and clinical hypoglycemic regimens.
In order to truly benefit patients with GLP-1RA drugs with evidence of cardio-renal benefits, clinicians still have many things to do.
Do.
”
Multiple benefits, highly recognized by the clinic, Professor Du Jian introduced that GLP-1RA drugs have been highly recognized by endocrinologists since their launch, and their status in the authoritative T2DM diagnosis and treatment guidelines has also continued to rise, and as GLP-1RA drugs -1 RA weekly formulation, data from the SUSTAIN-6 study (Semaglutide Cardiovascular Outcomes Study) showed that in T2DM patients with high cardiovascular risk, treatment with semaglutide was associated with major adverse cardiovascular events (MACE) Compared with the placebo group, the risk was significantly reduced by 26%, and the risk of non-fatal stroke was significantly reduced by 39% [6].
These data are very encouraging and provide another powerful tool for the treatment of T2DM
.
In addition, the application of semaglutide treatment can also improve some other metabolic indicators of T2DM patients, such as improving overweight or obesity, hypertension, hyperlipidemia, etc.
Therefore, it is suitable for patients with multiple metabolic abnormalities, and even those who have reached metabolic syndrome.
T2DM patients
.
Professor Du Jian said that these benefits beyond sugar control are also what clinicians in endocrinology are looking forward to
.
"We have many years of experience with GLP-1RA drugs, whether it is data from randomized controlled clinical trials or real-world evidence, we can see the hypoglycemic effect and multiple benefits of GLP-1RA, so we have reason to expect The newly launched semaglutide will bring greater benefits to patients, and I hope to see more real-world drug evidence
.
" Professor Du Jian said
.
Talking about the future development prospects of GLP-1RA drugs, Professor Du Jian said: "When GLP-1RA drugs were launched, their therapeutic benefits in hypoglycemic, weight loss and other aspects made clinicians very happy, and as a multi-target drugs, they are also expected to be used to treat disease polycystic ovary syndrome, sleep apnea syndrome
.
based on these successful experiences, we have reason to believe that GLP-1RA week uS Secretary Turkoglu peptide preparation, It can also bring various therapeutic benefits, and its application other than diabetes has a number of clinical studies in progress, and the future benefits are worth looking forward to
.
” GLP-1RA drugs are also constantly upgrading their dosage forms, from the earliest each The once-daily dosage form, to the currently marketed weekly preparation, has effectively improved patients' medication compliance and provided patients with more medication options.
It is expected that semaglutide can benefit more Chinese T2DM patients in the future
.
References: [1]Li Y, et al.
BMJ.
2020;369:m997.
[2]Ji L, et al.
J Diabetes.
2015;7(2):166-173.
[3]Ma RCW.
Diabetologia 2018;61(6):1249-1260.
[4]Dieuzeide G, et al.
Diabetes.
2021; 70(Supplement 1):990-P.
[6]Marso SP, et al.
N Engl J Med.
2016;375(19):1834-1844.
[7]Zinman B, et al.
Lancet Diabetes Endocrinol.
2019; 7(5):356-367.
- End - "This article is only used to provide scientific information to medical and health professionals, and does not represent the platform's position" Contribution / reprint / business cooperation, please contact: pengsanmei@yxj.
org.
cn
