Improve glycolipid metabolism, prevent and treat the threshold forward| and protect in multiple links to make the future of sugar friends healthier

Diabetes mellitus is a group of metabolic disorders syndromes such as carbohydrates, proteins, and fats caused by insufficient absolute or relative insulin secretion and/or reduced sensitivity of target tissue cells, in which hyperglycemia is the main marker
.

In 2020, the survey data released by the British Medical Journal showed that the prevalence of adult diabetes in China reached 12.
8%, and the pre-diabetic population was as high as 35.
2
%.
How to prevent and control diabetes has become a topic
of common concern in society.

Every year on November 14, which is the United Nations Diabetes Day, this newspaper specially invited Professor Shang Juju of Beijing Hospital of Traditional Chinese Medicine Affiliated to Capital Medical University and Professor Lu Hao of Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine to conduct wonderful interviews
on the theme of clinical treatment of glucose and lipid metabolism disorders and impaired glucose tolerance from the perspective of integrated traditional Chinese and Western medicine.

Professor Shang Juju

Professor Lu Hao

Improve disorders of glycolipid metabolism and reduce the risk of cardiovascular events

In addition to elevated blood sugar, diabetic patients often have important risk factors
for cardiovascular diseases such as hypertension, dyslipidemia, and obesity.
The CCMR-3B study surveyed 25,817 outpatients with type 2 diabetes in 104 hospitals across the country and found that 72% of people with type 2 diabetes had hypertension, dyslipidemia, or both
.
For newly diagnosed patients with type 2 diabetes, Professor Shang Juju said that studies have found that nearly 60% of newly diagnosed patients with type 2 diabetes have abnormal lipid metabolism
.

Disorders of lipid metabolism increase the risk of
cardiovascular events in patients with diabetes.
The CCMR-3B study showed that patients with type 2 diabetes complicated by hypertension and dyslipidemia had a 6-fold
history of prior cardiovascular disease compared with patients with single type 2 diabetes.

The Chinese Guidelines for the Prevention and Treatment of Type 2 Diabetes (2020 Edition) pointed out that studies have shown that strict blood sugar control has limited effect on reducing the incidence of cardiovascular and cerebrovascular diseases and the risk of death in patients with type 2 diabetes, especially in
people with a long course of disease, older age, and people who have had cardiovascular and cerebrovascular diseases or have multiple cardiovascular and cerebrovascular risk factors.
Therefore, scientific and reasonable comprehensive treatment strategies for type 2 diabetes, including blood sugar, blood pressure, blood lipid and weight control, etc.
, and antiplatelet therapy
when indicated.
Among them, the control of blood sugar, blood pressure, blood lipids and weight should be based on lifestyle improvement, and reasonable drug treatment
should be given according to the specific situation of the patient.

Professor Shang Juju introduced that the drugs commonly used in clinical treatment of dyslipidemia mainly include statins and fibrates, and in recent years there are also some new lipid-lowering drugs, such as drugs that inhibit cholesterol absorption and drugs
that accelerate metabolism.
At present, commonly used lipid-lowering drugs are well tolerated, but nausea, abdominal pain, diarrhea, headache, insomnia, muscle pain and elevated liver enzymes may also occur
.
Among them, the abnormal liver function caused by statins is mainly manifested as elevated transaminases, and regular follow-up of liver function
is required.
In addition, statins may also cause muscle pain and muscle damage, which are rare, but once they occur, they may lead to more serious consequences and even rhabdomyolysis
.

"If patients with abnormal lipid metabolism are worried about the side effects of lipid-lowering drugs or cannot tolerate the adverse reactions of lipid-lowering drugs, they can choose traditional Chinese medicine for treatment
on the basis of diet and exercise.
" Professor Shang Juju said that the TCM treatment of diabetes pays more attention to the integrity of people, and Chinese medicine has the advantages of multi-component, multi-target and multi-mechanism, which can exert a comprehensive therapeutic effect
on diabetes.

"For some obese patients with abnormal lipid metabolism, Jinlida granules under the guidance of the theory of network disease can be transported by spleen and qi, so that the metabolism of Jinlida infusion can be normalized, thereby regulating blood sugar, blood lipids, reducing weight, and preventing the occurrence and development of diabetic complications
.
" Professor Shang Juju introduced that in recent years, a large number of basic and clinical studies have also confirmed the efficacy
of Jinlida granules.

The results of basic research showed that Jinlida granules could significantly reduce the levels of triglycerides, LDL cholesterol and free fatty acids in serum, and reduce the occurrence of atherosclerosis.
Activates and increases the content of brown fat and beige fat in the body, increases energy consumption, reduces white fat accumulation in the body, and reduces body weight
.

A clinical study sponsored by Academician Tong Xiaolin of the Chinese Academy of Sciences showed that in patients who still do not meet the standard blood glucose at a stable dose of metformin, adding Jinlida granules on the basis of metformin can further reduce the patient's glycated hemoglobin by 0.
92%, reduce fasting blood glucose by 1.
34mmol/L and blood glucose 3.
0mmol/L 2 hours after meals, improve insulin sensitivity and islet β cell function index, improve insulin resistance, and improve patients' symptoms such as thirst, fatigue, and constipation.
There are potential therapeutic advantages
for slowing the occurrence of complications.
Another meta-analysis conducted by Academician Tong Xiaolin analyzed 15 clinical studies in China with a total of 1810 patients
.
The results showed that the addition of Zinlida granules on the basis of conventional hypoglycemia could further reduce glycated hemoglobin (0.
6-0.
72%), improve islet function, and reduce body weight
.

To reduce the burden of diabetic disease, moving the treatment threshold forward is key

Dystolerant glucose refers to a diagnostic diagnosis of diabetes that exceeds the normal level of 7.
8 mmol/L two hours after glucose loading, but does not meet the diagnostic criteria of 11.
1 mmol/L, and is an intermediate state between normal glucose tolerance and diabetes, also known as prediabetes
.

Unlike diabetic patients who have typical "three more and one less" symptoms, the symptoms of pre-diabetic patients are often not obvious, and most patients have almost no obvious symptoms
.
Professor Lu Hao said that this makes it easy for pre-diabetic patients to miss the best opportunity for prevention and intervention, and thus may progress to diabetes
.

Studies have shown that once you develop prediabetes, the probability of developing type 2 diabetes in the next 5 years is 35-50%.

Therefore, for people at high risk of diabetes, it is necessary to regularly test blood glucose and conduct oral glucose tolerance test to detect abnormal glucose tolerance early and intervene
early.

In 2020, survey data released by the British Medical Journal showed that the prevalence of prediabetes in China was as high as 35.
2%.

Prediabetes has become a huge reserve army
of diabetics.

Prediabetes also increases the risk of
cardiovascular and cerebrovascular diseases and microvascular diseases.
Professor Lu Hao introduced in the interview that the formulation of the blood glucose threshold for diagnosing diabetes is based on the results of epidemiological investigation, and if the blood sugar is higher than this threshold, the incidence of diabetes complications will be greatly increased; But this does not mean that blood sugar is below this standard, and there is no harm
to cardiovascular disease.

Studies have shown that the incidence of cardiocerebral macrovascular disease in patients with impaired glucose tolerance is twice that of people with normal blood sugar
.
Therefore, for patients with impaired glucose tolerance, especially those with chronic diseases such as hypertension and hyperlipidemia, active intervention is required to reduce the risk of
cardiovascular disease.

"Shut your mouth and open your legs" is an effective means to
reverse diabetes and prediabetes.
Professor Lu Hao said that especially for overweight or obese patients, weight loss through diet control and reasonable exercise can reverse prediabetes or early diabetes to normal
.

"People who have difficulty in lifestyle intervention and cannot adhere to a healthy lifestyle for a long time need to consider drug intervention
.
" Professor Lu Hao introduced that studies have confirmed that α-glycosidase inhibitors, metformin, and TZD drugs can reduce the incidence
of diabetes.
However, many patients with prediabetes find it difficult to accept the use of Western drugs to prevent diabetes
due to insufficient awareness of the harm of the disease and concerns about the side effects of drugs.

Studies have shown that the representative proprietary Chinese medicine Jinlida granules can not only delay the transformation of prediabetes into diabetes, but also increase the conversion rate of prediabetic patients to normal people, and the side effects are small
.
The clinical study of Jinlida granules in the intervention of glucose tolerance dystolerate led by Professor Yang Shuyu of the First Affiliated Hospital of Xiamen University showed that after 12 weeks of treatment, Jinlida granules could significantly reduce glycated hemoglobin and postprandial blood glucose 2h, reduce HOMA-IR index, improve insulin resistance, and the conversion rate of abnormal glucose tolerance reversal to normal blood glucose was as high as 43.
8%, which was significantly higher than that of the control group of 6.
9% (P=0.
001).

。 Professor Lu Hao said that while using traditional Chinese medicine to improve glucose tolerance, it can also improve clinical symptoms such as dry mouth and thirst, and improve the quality of life of patients, which is also the advantage of traditional Chinese medicine in the intervention of
glucose tolerance.

"In clinical applications, we can decide the use of
traditional Chinese medicine according to the patient's glycated hemoglobin level.
" Professor Lu Hao said that 7.
5% of patients with glycated hemoglobin < can use proprietary Chinese medicines such as Jinlida granules alone on the basis of lifestyle interventions; Patients with glycated hemoglobin between 7.
5% and 9% can use one or two Western medicines in combination with Chinese medicine on the basis of lifestyle interventions, depending on the patient's blood glucose; In >9% of patients with glycated hemoglobin, injectable drugs such as insulin or GLP-1 receptor agonists may be considered, either in combination with Zinlida granules
.

"Traditional Chinese medicine can play its role
in the whole treatment of diabetes.
In people with high blood sugar, traditional Chinese medicine can play a synergistic hypoglycemic effect, and in early diabetes, traditional Chinese medicine can even play a leading role
.
Professor Lu Hao said that paying attention to the intervention of patients with impaired glucose tolerance is actually to reduce the harm of potential diabetic patients and achieve the purpose of
moving the threshold of diabetes treatment forward.

epilogue

The International Diabetes Federation refers to diabetes education and psychological improvement, medication, diet therapy, exercise therapy and blood glucose monitoring as the five carriages
of diabetes treatment.
In Professor Lu Hao's view, it is more appropriate
to use "4 rings and 1 rope" as a metaphor for diabetes treatment.
Diet, exercise, medication and blood glucose monitoring are 4 rings, if there is a lack of adequate and effective education, patients can not eat correctly, exercise, medication, monitor blood sugar, the treatment effect will be greatly reduced
.
Therefore, diabetes education is a rope running through diabetes management and is the most important link
in diabetes management.

The theme of this year's UN Diabetes Day is "Education for Tomorrow"
.
Professor Shang Juju believes that diabetes health education is not only about educating patients, but also about the health education of patients' families and medical staff
.
Proper health education for the patient's family can provide better family support for the patient, and assist the patient with dietary control, blood glucose monitoring, medication, and regular follow-up
.
Since diabetes may have other systemic complications, strengthening the education of medical staff other than endocrinology can improve the overall diagnosis and management level
of diabetes in medical institutions.