How to solve the "Chinese characteristics" blood sugar problem?

*It is only for medical professionals to read and refer to the optimal solution for double insulin, which is difficult to control sugar.

The latest China Type 2 Diabetes (T2DM) Epidemiological Survey[1] data shows that the prevalence of T2DM in China is as high as 12.
8%, and it is increasing year by year.

However, the blood glucose compliance rate of T2DM patients is not ideal.
According to the 2020 China Glycated Hemoglobin Monitoring Network (CNHSS) research data [2], the Chinese T2DM patients' glycated hemoglobin (HbA1c) compliance rate is less than 1/3, and more than 1/ The fasting and postprandial blood glucose levels of 3 patients increased on average, and the proportion of patients with postprandial hyperglycemia was as high as 81.
5% (Figure 1).

 Figure 1.
The proportion of patients with different blood glucose phenotypes in T2DM in China.
This may be due to the relatively weak pancreatic β-cell function in East Asian populations, including China, compared to European and American populations, and their functional decline is more significant after illness [3] .

At the same time, my country's traditional eating habits are mainly refined rice noodles rich in carbohydrates, which will also have a great impact on blood sugar after meals.

Combined with the physiological and pathological characteristics and eating habits, it has caused the "Chinese characteristic" blood sugar problem of high blood sugar on an empty stomach and after a meal.

 Nowadays, diabetic patients are facing the dilemma of "difficult to control sugar, difficult to control sugar", and in the "Chinese Type 2 Diabetes Prevention Guidelines (2017 Edition)" [1] (hereinafter referred to as "Guide") recommended patient treatment path, insulin Treatment is an important means to control hyperglycemia [4], but some patients who use insulin to control blood sugar are worried that "after eating a lot of bitterness from injections, blood sugar can't reach the ideal'degree'".

 How can insulin be more fully effective and help diabetic patients undergoing insulin therapy to solve the "Chinese characteristics" blood sugar problem? To overcome the "Chinese characteristics" blood sugar problem, 4 tips can help.
After taking hypoglycemic drugs, some T2DM patients tend to ignore the impact of lifestyle, mood swings, and drug choices on blood sugar.
In fact, long-term eating irregularities/ Intemperance, lack of exercise, excessive stress, depression and anxiety, or unsatisfactory drug selection, even if insulin is used, the ideal hypoglycemic effect cannot be achieved.

How to do? The following 4 tips should be kept in mind! 1Improve diet structure and control weight The "Guide" clearly states that medical nutrition therapy is the basic treatment for diabetes.
By adjusting the total energy of the diet, diet structure and meal distribution ratio, it is conducive to blood sugar control, maintaining ideal body weight and preventing malnutrition.
[4], it is recommended that diabetic patients adjust their total energy intake under the guidance of professional physicians/nutritionists, and distribute nutrients in a reasonable and balanced manner.

Specifically, you can control the post-meal blood sugar level by controlling the calorie intake of each meal and choosing carbohydrates rich in dietary fiber, such as oats and brown rice as staple foods instead of refined rice noodles.

 2 Appropriate exercise Exercise also occupies an important position in the comprehensive management of T2DM patients [4].

Exercise can improve insulin resistance index, improve insulin sensitivity and glucose and lipid metabolism [5].

The "Guide" points out that regular exercise can help control blood sugar, reduce cardiovascular risk factors, and reduce weight.
It is recommended that adult T2DM patients take at least 150 minutes of moderate-intensity aerobic exercise per week to reduce sitting time (for extremely poor blood sugar control and associated with Patients with acute or severe chronic complications should carefully choose exercise methods under the guidance of professional doctors) [4].

 3 Emotion management In modern society, work and life are fast-paced and stressful, and the causes of T2DM are complicated, and the treatment process is long.
Patients are prone to psychological stress reactions such as depression or anxiety, which will directly negatively affect the patient's glucose metabolism regulation ability [6] .

At the same time, these negative emotions will cause patients to have low compliance during long-term medication and limit the improvement of treatment effects [7], leading to further aggravation of the disease.

 Therefore, during the treatment of T2DM patients, professional medical staff can adopt psychological care methods (such as active education, guide patients' psychological barriers, help patients build confidence in treatment, etc.
), which is conducive to regulating patients' negative emotions and achieving good blood sugar control[5 ].

At the same time, patients and their families must also strengthen their confidence in treatment, better help blood sugar reach the standard, and improve the quality of life.

4 Choose the right insulin dosage form.
T2DM patients who want to ideally control sugar, in addition to lifestyle interventions and mood adjustments, should also receive insulin treatment in time and choose suitable drugs.

The "Guide" emphasizes [4] that, based on the combination of lifestyle and oral hypoglycemic drugs, patients with T2DM should initiate insulin therapy as soon as possible if the blood sugar has not reached the control goal.

 Combined with the blood glucose characteristics of Chinese T2DM patients, the treatment plan should manage fasting and postprandial blood glucose at the same time.

Among the many current insulin preparations, Degu aspartic insulin can meet this demand.

Innovative preparations, two-pronged approach to exert the ability to control sugar.
Degluso insulin is the world's first soluble di-insulin preparation.
It is a combination of 70% insulin degludec (long-acting) and 30% insulin aspart (rapid-acting).
Among them, The half-life of insulin degludec is as long as 25 hours, and the variability of daytime blood sugar is only 1/4 of that of insulin glargine, which can smoothly cover the management of fasting blood sugar 24 hours a day; The variability in the body is small [8, 9].

 In this way, 1 to 2 needles a day can take into account the control of fasting and postprandial blood sugar, providing patients with a more ideal new insulin treatment plan.
In addition, Degu aspart is a soluble preparation, colorless liquid, no turbidity, and injection There is no need to mix, which is convenient for patients to use.

 Studies have shown that according to the pharmacodynamic characteristics of Degu aspart insulin, its single-injection glucose infusion rate curve is biphasic and single-peak, which can not only take into account fasting and postprandial blood sugar, but also avoid similar intermediate-acting insulin injections.
The peak value, reduce the "shoulder effect", better simulate physiological insulin secretion, and avoid hypoglycemia (Figure 2) [10].  Figure 2.
The curve of glucose infusion rate of Degu aspart di-insulin biphasic and single peak From RCT to RWE, double insulin leads the new direction of hypoglycemic.
At present, there has been a multinational consensus on the clinical application of degu-aspart di-insulin, etc.
, which affirmed the drug’s effectiveness Effectiveness and safety [11, 12].

Whether it is used as a once-a-day (QD) or twice-a-day (BID) initial treatment regimen, or as an insulin conversion regimen, degluaspartin can exert its blood sugar lowering effectiveness, and the risk of hypoglycemia is low .

 ★A Japanese Phase 3 clinical trial enrolled 296 T2DM patients for a 26-week study.
The participants were all patients who used oral hypoglycemic drugs and had poor blood sugar control (≥1 fixed-dose oral hypoglycemic drugs, but blood sugar Poor control), the results found that compared with the insulin glargine QD regimen, the degluaspart double insulin QD regimen can significantly reduce the patient's HbA1c (P<0.
01), and the number of confirmed hypoglycemia and confirmed hypoglycemia at night is higher , The value is lower (P=NS).
In addition, the proportion of patients with HbA1c<7% and no confirmed hypoglycemia in the Degu aspartic insulin group is higher (43% vs.
25%; P<0.
01) [13].

★In a 26-week open-label, randomized controlled, double-arm parallel clinical study, for patients whose blood glucose is still poorly controlled by oral hypoglycemic drugs (metformin ± another type of oral hypoglycemic drugs but poor blood glucose control), As the initial insulin regimen, a comparison between degluaspartin BID and insulin aspart 30 BID control group showed that HbA1c of degluaspartin group can be reduced to 6.
6%, which is equivalent to the decrease in the control group, but using The fasting blood glucose decreased better in patients with Degu aspartic insulin (-4.
3mmol/L vs.
-3.
3mmol/L) (Figure 3) [14].

Figure 3.
Degu aspart insulin is more effective in controlling fasting blood glucose.
The overall risk of confirming hypoglycemia in patients taking Degu aspart insulin is reduced by 54% (P <0.
001), and the risk of night hypoglycemia is relatively higher.
Insulin aspart 30 BID was reduced by 75% (P <0.
001) [14], and the risk of hypoglycemia of degluaspartic insulin was lower (Figure 4).  Figure 4.
Comparison of hypoglycemia events between the Degu aspartic insulin group and the control group (a: overall hypoglycemia events, b: nocturnal hypoglycemia events) ★ A real-world study [15] included 10798 T2DM patients in Japan (> 3940 cases of 75-year-old patients) were observed for 12 months to analyze the effectiveness and safety of switching from basal insulin, basal-meal insulin and other insulin treatments to degluaspartin for T2DM patients.

The results showed that the HbA1c of T2DM patients who switched to Degu aspartic insulin therapy decreased by 1.
23%, which was significantly lower than the original regimen (P<0.
001), and whether it was in people over 75 years old or under 75 years old The above trends can be observed.

Figure 5.
The change in HbA1c reduction of T2DM patients treated with double insulin aspart.
In terms of safety, the risk of hypoglycemia in the double insulin treatment group was significantly lower than that of the insulin regimen before switching (P<0.
001).
The above trend can be observed in people over 75 years old (P=0.
041) or people under 75 years old (P=0.
006).
It can be seen that Degu aspart insulin reduces the risk of hypoglycemia while controlling blood sugar [15 ].

 In addition, Degu aspart insulin has been officially included in the national medical insurance reimbursement scope from March 1, 2021 [16], and it is used to treat T2DM patients who are difficult to control with other insulin or oral hypoglycemic drugs, which is more beneficial to the people.

 Summary Based on the physiological and pathological characteristics of the Chinese population and traditional eating habits, the problem of blood sugar with "Chinese characteristics" needs to be resolved urgently.

Lifestyle intervention, positive adjustment of emotions, and selection of appropriate medications for hypoglycemic programs are very important.

Degu Aspart Di-Insulin is the world's first soluble di-insulin preparation, which can balance fasting blood glucose and postprandial blood glucose control, helping Chinese patients to improve blood glucose management.

At the same time, various studies have also confirmed that whether it is used as an initial treatment plan or a conversion treatment plan, Degu aspart insulin can take into account the effectiveness and safety of hypoglycemic.

With the inclusion of Degu aspartic acid double insulin in the medical insurance reimbursement scope, it can also reduce the cost of patient treatment to a certain extent, so that more Chinese patients with T2DM will benefit! References: [1]Li Y, et al.
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[16] "National Basic Medical Insurance, Work Injury Insurance and Maternity Insurance Drug Catalog (2020)".
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