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*It is only for medical professionals to read and refer to the rich Chinese data, optimize the prevention and treatment path, and benefit more patients! Currently, diabetes mellitus (DM) has become one of the public health problems that seriously affect the health of Chinese people.
The harm caused by diabetic complications is not only related to the prognosis and quality of life of diabetic patients, but also affects the quality of my country's labor force.
At the National Two Sessions this year, many representatives called for clear policy guidance as soon as possible, raise awareness and screening rate of diabetic nephropathy screening in the whole society, improve the quality of life of patients, and realize the established diabetes in the "Healthy China Action (2019-2030)" as soon as possible The standardized management rate reaches the target of 70% and above.
Recently, the "Healthy China-Early Diabetic Nephropathy Screening Program (UACR)" focused on early screening and early diagnosis of diabetic nephropathy (DKD).
Many authoritative experts from the field of endocrinology actively participated to jointly promote the full implementation of DKD early screening and the optimization of the diagnosis and treatment path.
.
At the meeting, Professor Li Xiaoying, director of the Department of Endocrinology, Zhongshan Hospital, Fudan University, made a speech on the current status of DKD in my country and its solutions.
Picture: Professor Li Xiaoying giving a speech at the meeting 01 High prevalence rate, low awareness rate, and huge disease burden Professor Li introduced to us in his speech that the current prevalence of DM in China is 12.
8%, while the prevalence of chronic kidney disease (CKD) The rate is also 11% [1-2].
DM is closely related to CKD.
The risk of CKD in diabetic patients is 2.
6 times higher than that in non-diabetic patients [3], and about 20%-40% of diabetic patients have CKD.
The risk of event and all-cause mortality increases exponentially, and life expectancy is significantly reduced [4].
In my country, the combination of diabetes and CKD cannot be underestimated.
According to statistics, more than half of hospitalized diabetic patients in my country have renal complications.
For example, in Shanghai, the prevalence of CKD in patients with type 2 diabetes (T2DM) over 30 years old in the urban area is as high as 63.
9% [5].Professor Li also pointed out that although there are many patients with chronic diseases in my country, problems such as low awareness of the disease, low screening rate and reasonable treatment rate are very common.
According to the latest data, the awareness rate, treatment rate, and control rate of diabetes in my country are only 43.
3%, 49.
0%, and 49.
4%, respectively [6], while the awareness rate of patients with CKD is lower, only 12.
5%, and the reasonable treatment rate is only 7.
5%.
[7] Early screening is even more of a weak link.
Among T2DM patients, the early diagnosis rate of CKD is less than 20%.
Professor Li said that DM has now become an important cause of end-stage renal disease (ESRD).
Compared with 10 years ago, the proportion of DM patients in dialysis patients nowadays is very large, and the prevalence of DKD has increased significantly with the prevalence of DM.
It also grows proportionally.
Kidney disease can also increase the risk of cardiovascular disease and mortality of patients, directly affect the prognosis and quality of life of patients, increase a lot of medical expenditures, and bring a great burden to society, families and individuals.
02 Early Screening and Early Diagnosis, Standardizing Disease Management In response to the current severe situation in the management of diabetic patients in my country, Professor Li said that the main reason for the high prevalence of diabetes complications is insufficient attention.
In the early stage of proteinuria in patients with DKD, if it can be detected and treated early, the condition can be well controlled and even reversed.
Therefore, it is a key time window for intervention in the progression of nephropathy in diabetic patients.
Professor Li emphasized that after diagnosis of T2DM patients, relevant screening should be carried out immediately, including urine routine, serum creatinine, urine albumin/creatinine ratio (UACR), and T2DM patients and patients with type 1 diabetes who have been diagnosed for more than 5 years should be at least annually Carry out a kidney disease screening, and the frequency of screening should increase with the progression of the disease [9], so as to intervene as soon as possible and maximize benefits.
For people at high risk of CKD, such as family history of kidney disease, diabetes, hypertension, etc.
, UACR and estimating glomerular filtration rate (eGFR) should be tested at least once a year [8].
Once the patient is diagnosed with DKD, a comprehensive assessment of diabetes-related complications should be carried out first, and corresponding individualized treatment strategies should be formulated.
Sodium-glucose cotransporter-2 inhibitors (SGLT-2i) with clear evidence of renal benefit should be applied promptly afterwards to help diabetic patients benefit earlier.
"China Type 2 Diabetes Prevention Guidelines 2020 Edition" also pointed out that for diabetes patients with CKD or heart failure, regardless of whether the glycosylated hemoglobin meets the standard, SGLT-2i is the first choice[10].
Diabetes patients are a high-risk group of CKD, but lack of awareness of early screening makes many patients miss the time for the best diagnosis and treatment of the disease.
Therefore, Professor Li said that in order to achieve the goal of Healthy China 2030, promote the standardization of primary diabetes screening for emergency complications, standardize chronic kidney disease and chronic diabetes management throughout the course, it is of great significance to strengthen disease science and early diagnosis and standardized management of diseases.
03 A total of nationwide screening to comprehensively improve the early diagnosis and treatment of DKD.
Under the guidance of the Health Commission, the UACR plan came into being to promote the realization of the goals of screening and management of diabetes complications.
Professor Li pointed out that the UACR program covers a wide range and includes a large number of people.
The project is expected to involve more than 3,000 hospitals across the country and screen more than 8 million patients.
It aims to promote early screening and standardized management of proteinuria in diabetic patients to prevent, delay, and It can even reverse kidney disease in diabetic patients.
In addition to ensuring the benefits of directly participating patients, the UACR plan is more important to guide more high-risk patients with DKD to pay attention to and actively participate in screening, promote the standardization of screening for DM and its complications at the grassroots level, and improve the medical staff’s awareness of DM and its complications.
Early detection, standardized diagnosis and treatment capabilities have established a benign early screening and early diagnosis and standardized treatment mechanism to benefit more diabetes patients with CKD.
Professor Li said that the UACR program is expected to help enrich China's data and grasp the awareness, incidence, and standardized treatment rates of DKD among the Chinese population.
I look forward to more Chinese data in the future to enrich the clinical treatment of diabetes and CKD.
Summary DKD is one of the main microvascular complications of diabetes.
Early screening, early diagnosis, and early treatment can effectively delay and prevent the occurrence and development of the disease, and improve the patient's recovery and quality of life. After the launch of the UACR program, early screening of DKD will be carried out nationwide, effectively increasing the importance of patients and medical staff for early kidney disease; at the same time, it has enriched the data of the national DKD epidemiological survey, helping to establish a population-based DKD screening and management plan.
Expert profileProfessor Li Xiaoying Director, Chief Physician, and Professor, Department of Endocrinology, Zhongshan Hospital Affiliated to Fudan University, Deputy Director, Chinese Medical Association Diabetes Branch, Chairman, Shanghai Medical Association Diabetes Branch, Deputy Director, Key Laboratory of Metabolic Molecular Medicine, Ministry of Education, China Biochemistry and Director of the Cell Biology Society "Endocrine Reviews", Deputy Editor-in-Chief of "Journal of Diabetes", "Diabetes", "Chinese Journal of Endocrinology and Metabolism", "Chinese Journal of Diabetes", "Chinese Journal of Diabetes" Editorial Board Reference: [1] Yongze Li , et al.
BMJ.
2020;369:m997.
[2]GBD Chronic Kidney Disease Collaboration.
Lancet.
2020;395(10225):709-733.
[3]Fox CS, et al.
JAMA.
2004;291(7 ):844-850.
[4]Wen CP, et al.
Kidney Int.
2017;92(2):388-396.
[5] Chinese Medical Doctor Association Endocrinology and Metabolism Physician Branch.
Chinese Journal of Endocrinology and Metabolism.
2016;32( 6): 455-460.
[6]Wang L, et al.
Jama.
2017;317(24):2515-2523.
[7]Zhang L, et al.
Lancet.
2012;379(9818):815-822 .
[8]Shanghai Expert Group on Early Detection and Standardized Diagnosis, Treatment and Demonstration Project of Chronic Kidney Disease.
Chinese Journal of Practical Internal Medicine.
2017;37(1):28-34.
[9] Expert Group on Multidisciplinary Diagnosis, Treatment and Management of Diabetic Nephropathy.
China Journal of Clinicians.
2020;48(5):522-527.
[10] Diabetes Branch of Chinese Medical Association.
Chinese Journal of Diabetes.
2021;13(4):315-409.
This material is provided by AstraZeneca for only Medical and health professionals refer to the approval number: CN-77407 Valid until: 2021-12-31 Submission/reprint/business cooperation, please contact: pengsanmei@yxj.
org.
cn
The harm caused by diabetic complications is not only related to the prognosis and quality of life of diabetic patients, but also affects the quality of my country's labor force.
At the National Two Sessions this year, many representatives called for clear policy guidance as soon as possible, raise awareness and screening rate of diabetic nephropathy screening in the whole society, improve the quality of life of patients, and realize the established diabetes in the "Healthy China Action (2019-2030)" as soon as possible The standardized management rate reaches the target of 70% and above.
Recently, the "Healthy China-Early Diabetic Nephropathy Screening Program (UACR)" focused on early screening and early diagnosis of diabetic nephropathy (DKD).
Many authoritative experts from the field of endocrinology actively participated to jointly promote the full implementation of DKD early screening and the optimization of the diagnosis and treatment path.
.
At the meeting, Professor Li Xiaoying, director of the Department of Endocrinology, Zhongshan Hospital, Fudan University, made a speech on the current status of DKD in my country and its solutions.
Picture: Professor Li Xiaoying giving a speech at the meeting 01 High prevalence rate, low awareness rate, and huge disease burden Professor Li introduced to us in his speech that the current prevalence of DM in China is 12.
8%, while the prevalence of chronic kidney disease (CKD) The rate is also 11% [1-2].
DM is closely related to CKD.
The risk of CKD in diabetic patients is 2.
6 times higher than that in non-diabetic patients [3], and about 20%-40% of diabetic patients have CKD.
The risk of event and all-cause mortality increases exponentially, and life expectancy is significantly reduced [4].
In my country, the combination of diabetes and CKD cannot be underestimated.
According to statistics, more than half of hospitalized diabetic patients in my country have renal complications.
For example, in Shanghai, the prevalence of CKD in patients with type 2 diabetes (T2DM) over 30 years old in the urban area is as high as 63.
9% [5].Professor Li also pointed out that although there are many patients with chronic diseases in my country, problems such as low awareness of the disease, low screening rate and reasonable treatment rate are very common.
According to the latest data, the awareness rate, treatment rate, and control rate of diabetes in my country are only 43.
3%, 49.
0%, and 49.
4%, respectively [6], while the awareness rate of patients with CKD is lower, only 12.
5%, and the reasonable treatment rate is only 7.
5%.
[7] Early screening is even more of a weak link.
Among T2DM patients, the early diagnosis rate of CKD is less than 20%.
Professor Li said that DM has now become an important cause of end-stage renal disease (ESRD).
Compared with 10 years ago, the proportion of DM patients in dialysis patients nowadays is very large, and the prevalence of DKD has increased significantly with the prevalence of DM.
It also grows proportionally.
Kidney disease can also increase the risk of cardiovascular disease and mortality of patients, directly affect the prognosis and quality of life of patients, increase a lot of medical expenditures, and bring a great burden to society, families and individuals.
02 Early Screening and Early Diagnosis, Standardizing Disease Management In response to the current severe situation in the management of diabetic patients in my country, Professor Li said that the main reason for the high prevalence of diabetes complications is insufficient attention.
In the early stage of proteinuria in patients with DKD, if it can be detected and treated early, the condition can be well controlled and even reversed.
Therefore, it is a key time window for intervention in the progression of nephropathy in diabetic patients.
Professor Li emphasized that after diagnosis of T2DM patients, relevant screening should be carried out immediately, including urine routine, serum creatinine, urine albumin/creatinine ratio (UACR), and T2DM patients and patients with type 1 diabetes who have been diagnosed for more than 5 years should be at least annually Carry out a kidney disease screening, and the frequency of screening should increase with the progression of the disease [9], so as to intervene as soon as possible and maximize benefits.
For people at high risk of CKD, such as family history of kidney disease, diabetes, hypertension, etc.
, UACR and estimating glomerular filtration rate (eGFR) should be tested at least once a year [8].
Once the patient is diagnosed with DKD, a comprehensive assessment of diabetes-related complications should be carried out first, and corresponding individualized treatment strategies should be formulated.
Sodium-glucose cotransporter-2 inhibitors (SGLT-2i) with clear evidence of renal benefit should be applied promptly afterwards to help diabetic patients benefit earlier.
"China Type 2 Diabetes Prevention Guidelines 2020 Edition" also pointed out that for diabetes patients with CKD or heart failure, regardless of whether the glycosylated hemoglobin meets the standard, SGLT-2i is the first choice[10].
Diabetes patients are a high-risk group of CKD, but lack of awareness of early screening makes many patients miss the time for the best diagnosis and treatment of the disease.
Therefore, Professor Li said that in order to achieve the goal of Healthy China 2030, promote the standardization of primary diabetes screening for emergency complications, standardize chronic kidney disease and chronic diabetes management throughout the course, it is of great significance to strengthen disease science and early diagnosis and standardized management of diseases.
03 A total of nationwide screening to comprehensively improve the early diagnosis and treatment of DKD.
Under the guidance of the Health Commission, the UACR plan came into being to promote the realization of the goals of screening and management of diabetes complications.
Professor Li pointed out that the UACR program covers a wide range and includes a large number of people.
The project is expected to involve more than 3,000 hospitals across the country and screen more than 8 million patients.
It aims to promote early screening and standardized management of proteinuria in diabetic patients to prevent, delay, and It can even reverse kidney disease in diabetic patients.
In addition to ensuring the benefits of directly participating patients, the UACR plan is more important to guide more high-risk patients with DKD to pay attention to and actively participate in screening, promote the standardization of screening for DM and its complications at the grassroots level, and improve the medical staff’s awareness of DM and its complications.
Early detection, standardized diagnosis and treatment capabilities have established a benign early screening and early diagnosis and standardized treatment mechanism to benefit more diabetes patients with CKD.
Professor Li said that the UACR program is expected to help enrich China's data and grasp the awareness, incidence, and standardized treatment rates of DKD among the Chinese population.
I look forward to more Chinese data in the future to enrich the clinical treatment of diabetes and CKD.
Summary DKD is one of the main microvascular complications of diabetes.
Early screening, early diagnosis, and early treatment can effectively delay and prevent the occurrence and development of the disease, and improve the patient's recovery and quality of life. After the launch of the UACR program, early screening of DKD will be carried out nationwide, effectively increasing the importance of patients and medical staff for early kidney disease; at the same time, it has enriched the data of the national DKD epidemiological survey, helping to establish a population-based DKD screening and management plan.
Expert profileProfessor Li Xiaoying Director, Chief Physician, and Professor, Department of Endocrinology, Zhongshan Hospital Affiliated to Fudan University, Deputy Director, Chinese Medical Association Diabetes Branch, Chairman, Shanghai Medical Association Diabetes Branch, Deputy Director, Key Laboratory of Metabolic Molecular Medicine, Ministry of Education, China Biochemistry and Director of the Cell Biology Society "Endocrine Reviews", Deputy Editor-in-Chief of "Journal of Diabetes", "Diabetes", "Chinese Journal of Endocrinology and Metabolism", "Chinese Journal of Diabetes", "Chinese Journal of Diabetes" Editorial Board Reference: [1] Yongze Li , et al.
BMJ.
2020;369:m997.
[2]GBD Chronic Kidney Disease Collaboration.
Lancet.
2020;395(10225):709-733.
[3]Fox CS, et al.
JAMA.
2004;291(7 ):844-850.
[4]Wen CP, et al.
Kidney Int.
2017;92(2):388-396.
[5] Chinese Medical Doctor Association Endocrinology and Metabolism Physician Branch.
Chinese Journal of Endocrinology and Metabolism.
2016;32( 6): 455-460.
[6]Wang L, et al.
Jama.
2017;317(24):2515-2523.
[7]Zhang L, et al.
Lancet.
2012;379(9818):815-822 .
[8]Shanghai Expert Group on Early Detection and Standardized Diagnosis, Treatment and Demonstration Project of Chronic Kidney Disease.
Chinese Journal of Practical Internal Medicine.
2017;37(1):28-34.
[9] Expert Group on Multidisciplinary Diagnosis, Treatment and Management of Diabetic Nephropathy.
China Journal of Clinicians.
2020;48(5):522-527.
[10] Diabetes Branch of Chinese Medical Association.
Chinese Journal of Diabetes.
2021;13(4):315-409.
This material is provided by AstraZeneca for only Medical and health professionals refer to the approval number: CN-77407 Valid until: 2021-12-31 Submission/reprint/business cooperation, please contact: pengsanmei@yxj.
org.
cn
