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*Only for medical professionals to read and reference.
In 1957, Merck's Gwazhi was first used in clinical practice as the original drug of metformin.
It has been more than 60 years since it has good evidence of efficacy and safety, evidence of health and economic benefits, Clear clinical evidence such as the prevention of cardiovascular complications has become the basic drug for the prevention and control of type 2 diabetes worldwide, which makes metformin known as the "magic drug" for lowering blood sugar in the folk.
Recently, Professor Zhu Dalong of the Endocrinology Department of Nanjing Gulou Hospital, Professor Mu Yiming of the Endocrinology Department of the Chinese People's Liberation Army General Hospital and other well-known experts in the endocrinology circle jointly wrote "Metformin and Diabetes Treatment-Hundred Questions and Answers" and held a new book release conference.
.
After Professor Zhu Dalong and Professor Mu Yiming attended the press conference of "Metformin and Diabetes Treatment-Hundred Questions and Answers", the "medical community" invited the editor-in-chief of the book, the chairman of the Diabetes Branch of the Chinese Medical Association, and the endocrinology department of Nanjing Gulou Hospital.
The professor shared the original intention of publishing this book and the characteristics of this book.
"Hundred Questions and One Hundred Answers" answers questions and “adds bricks” to diabetes management.
Professor Zhu Dalong said that although metformin is recommended as a first-line drug in the global diabetes guidelines due to its good efficacy and safety, among the majority of primary-level doctors in my country, The prescription rate of metformin is still unsatisfactory.
At the same time, some grassroots doctors and patients still have misunderstandings about metformin.
As a result, patients cannot get the correct treatment, and it also brings challenges to the prevention and treatment of diabetes.
The book is mainly aimed at clinicians, especially primary medical workers, who can be a good helper for them to prescribe metformin, and it can also help diabetics answer their questions.
Professor Zhu Dalong expects that this book can "make contributions" to my country's diabetes management.
New drugs have emerged one after another.
Metformin is still the cornerstone drug for the prevention and treatment of diabetes.
Metformin should be the first-line first choice as an important drug for the prevention and treatment of diabetes.
For patients with type 2 diabetes (T2DM), if lifestyle intervention fails to make their blood glucose reach the target, metformin therapy should be initiated.
If there are no contraindications and intolerances, metformin is the first choice and the whole course of treatment for T2DM, and it should always be kept in the diabetes treatment plan.
Whether it is the 2021 American Diabetes Association (ADA) "Diagnosis and Treatment Standards for Diabetes" or the 2019 European Society of Diabetes (ASD) guidelines for the management of hyperglycemia in T2DM patients, or the 2020 "China Type 2 Diabetes Prevention Guidelines" to be published in April ", have made the above suggestions.
Professor Zhu Dalong emphasized that no matter how the guidelines are updated and changed, the status of metformin as a first-line treatment is still unshakable.
Professor Zhu Dalong believes that due to my country's large area and large number of diabetic patients, patients, the media, and grassroots doctors will inevitably have misunderstandings in their understanding and application of metformin, such as thinking that metformin hurts the liver and kidneys, and that old drugs are inferior to new drugs.
Therefore, the publication of "Metformin and Diabetes Treatment-Hundred Questions and Answers" can build a bridge of communication and help us get out of the "misunderstanding" of metformin.
Use a good dose, use a good dosage form, and use a good brand of metformin.
The main adverse reaction is gastrointestinal reactions.
With the extension of treatment time, most patients can gradually tolerate or the symptoms disappear.
Starting with a small dose and gradually increasing the dose is the principle of dose adjustment for metformin.
Metformin is recommended to start with 500mg, 2 times/d, if there is no obvious gastrointestinal adverse reaction, then it can be gradually increased to 1000mg, 2 times/d.
In terms of dosage forms, currently domestic and foreign metformin mainly includes ordinary tablets, enteric-coated tablets and sustained-release tablets.
Compared with ordinary tablets, sustained-release tablets dissolve and release slowly in the gastrointestinal tract, have better gastrointestinal tolerance, and once a day can bring the same curative effect and improve the patient's medication compliance.
Professor Zhu Dalong pointed out that there are many metformin options available in clinical practice.
Evidence-based evidence is an important basis for choosing drugs.
The original research (Gehuazhi) has a large amount of clinical evidence-based evidence.
Domestic metformin needs to be compared with the original research (Gehuazhi).
) It can be used after consistency evaluation, so the clinic can make a reasonable choice according to the actual situation when choosing specific drugs. Even without the CVOT study, 60 years of evidence for metformin is sufficient to prove that it has a "heart" benefit.
Cardiovascular disease is a common complication of diabetes patients.
Compared with patients without diabetes, the risk of cardiovascular disease in diabetic patients is increased by 2-4 times [1].
Good blood sugar control helps reduce the risk of diabetic microvascular complications and macrovascular complications.
Studies have shown that for every 1% reduction in glycosylated hemoglobin (HbA1c), the risk of microvascular endpoint events is reduced by 37%, the risk of myocardial infarction is reduced by 14%, the risk of stroke is reduced by 12%, and the risk of heart failure is reduced by 16% [2].
Metformin has reliable short-term and long-term hypoglycemic effects.
It can effectively reduce the fasting blood glucose and postprandial blood glucose of T2DM patients when used alone, and can reduce HbA1c by 1.
0%-2.
0% (after removing the placebo effect), which can enable newly diagnosed T2DM patients in China HbA1c is reduced by 1.
8% (including placebo effect) and is not affected by body weight [3].
Therefore, metformin can effectively improve insulin resistance, reduce HbA1c, and improve cardiovascular risk factors (lipid regulation, weight loss, anticoagulation, etc.
), and play a direct or indirect cardiovascular protective effect [3].
The UK Prospective Diabetes Study (UKPDS) showed that the risk of all-cause death in obese T2DM patients using metformin was relatively reduced by 35%, and the risk of myocardial infarction was reduced by 39% [4]; the UKPDS 10-year follow-up study showed that the use of metformin treatment brought great The benefit of vascular complications and the risk of death has a continuation effect, and its effect on reducing death and myocardial infarction is significantly better than sulfonylureas and insulin [5].
In 2008, the U.
S.
Food and Drug Administration (FDA) required a new type of hypoglycemic drug to carry out a cardiovascular outcome trial (CVOT) to prove its cardiovascular safety before it could be marketed.
Among these CVOTs, metformin is usually used as a background combination therapy.
When combined with dipeptidyl peptidase-4 inhibitor (DPP-4i) or sodium-glucose cotransporter 2 inhibitor (SGLT-2i), patients on metformin showed cardiovascular outcomes compared with patients who did not use metformin The improvement trend [6, 7].
As an old blood sugar lowering drug that has been used for more than 60 years, metformin has not undergone CVOT.
Professor Zhu believes that the above evidence has proved its cardiovascular benefits.
Summary Metformin is the cornerstone of the prevention and treatment of T2DM, and its first-line cornerstone status is unshakable.
Starting with a small dose and choosing an appropriate dosage form (such as a sustained-release dosage form) can reduce the gastrointestinal reaction of metformin and improve patient compliance.
In terms of cardiovascular effects, UKPDS and other studies have shown that metformin has cardiovascular protective effects.
This time, "Metformin and Diabetes Treatment-Hundred Questions and Answers" collected common clinical questions, with simple and clear answers, which will better assist the reasonable clinical application of metformin, especially at the grassroots level.
(Leave a comment below to share your story about the clinical prescription of metformin, the top 10 with the most likes, we will give this book!) Expert profile Professor Zhu Dalong Nanjing University, Peking Union Medical College, Nanjing Medical University PhD supervisor, postdoctoral supervisor Director of the Department of Endocrinology, Nanjing Gulou Hospital, Chairman of the Diabetes Branch of the Chinese Medical Association, Vice President of the Endocrinology and Metabolism Physicians Branch of the Chinese Medical Doctor Association J Diabetes, Deputy Editor-in-Chief, Editor-in-Chief of Endocrine Reviews Chinese Edition and Diabetes Care Chinese Edition, Diabetes Chinese Edition, Deputy Editor-in-Chief of Chinese Diabetes Journal References: [1] Diabetes Branch of Chinese Medical Association.
Guidelines for Prevention and Treatment of Type 2 Diabetes in China (2017 Edition)[J].
Chinese Journal of Diabetes.
2018;10(1): 4-67.
[2]Stefano Del Prato.
Diabetes Exploration of normal blood glucose: control postprandial blood glucose[J].
Foreign Medicine: Endocrinology Section, 2003, 23(3):155-156.
[3] Mu Yiming, Ji Linong, Li Chunlin, et al.
Expert consensus on the clinical application of metformin ( 2018 edition)[J].
Chinese Journal of Diabetes, 2019, 027(003):161-173.
[4]UK Prospective Diabetes Study (UKPDS) Group.
Effect of intensive blood-glucose control with metformin on complications in overweightpatients with type 2 diabetes (UKPDS 34).
Lancet, 1998, 352: 854-865.
[5] Holman RR, Paul SK, Bethel MA, etal.
10-year follow-up of intensive glucose control in type 2 diabetes.
N Engl J Med, 2008 , 359:1577-1589.
[6]Crowley MJ, Williams JW Jr, Kosinski AS, et al.
Metformin Use May Moderate the Effect of DPP-4 Inhibitors on CardiovascularOutcomes[J].
Diabetes Care, 2017, 40(12):1787-1789.
[7]Neuen, et al.
2019; Abstractpresented at AACE 2019.
Submitted/Reproduced/ For business cooperation, please contact: pengsanmei@yxj.
org.
cn
In 1957, Merck's Gwazhi was first used in clinical practice as the original drug of metformin.
It has been more than 60 years since it has good evidence of efficacy and safety, evidence of health and economic benefits, Clear clinical evidence such as the prevention of cardiovascular complications has become the basic drug for the prevention and control of type 2 diabetes worldwide, which makes metformin known as the "magic drug" for lowering blood sugar in the folk.
Recently, Professor Zhu Dalong of the Endocrinology Department of Nanjing Gulou Hospital, Professor Mu Yiming of the Endocrinology Department of the Chinese People's Liberation Army General Hospital and other well-known experts in the endocrinology circle jointly wrote "Metformin and Diabetes Treatment-Hundred Questions and Answers" and held a new book release conference.
.
After Professor Zhu Dalong and Professor Mu Yiming attended the press conference of "Metformin and Diabetes Treatment-Hundred Questions and Answers", the "medical community" invited the editor-in-chief of the book, the chairman of the Diabetes Branch of the Chinese Medical Association, and the endocrinology department of Nanjing Gulou Hospital.
The professor shared the original intention of publishing this book and the characteristics of this book.
"Hundred Questions and One Hundred Answers" answers questions and “adds bricks” to diabetes management.
Professor Zhu Dalong said that although metformin is recommended as a first-line drug in the global diabetes guidelines due to its good efficacy and safety, among the majority of primary-level doctors in my country, The prescription rate of metformin is still unsatisfactory.
At the same time, some grassroots doctors and patients still have misunderstandings about metformin.
As a result, patients cannot get the correct treatment, and it also brings challenges to the prevention and treatment of diabetes.
The book is mainly aimed at clinicians, especially primary medical workers, who can be a good helper for them to prescribe metformin, and it can also help diabetics answer their questions.
Professor Zhu Dalong expects that this book can "make contributions" to my country's diabetes management.
New drugs have emerged one after another.
Metformin is still the cornerstone drug for the prevention and treatment of diabetes.
Metformin should be the first-line first choice as an important drug for the prevention and treatment of diabetes.
For patients with type 2 diabetes (T2DM), if lifestyle intervention fails to make their blood glucose reach the target, metformin therapy should be initiated.
If there are no contraindications and intolerances, metformin is the first choice and the whole course of treatment for T2DM, and it should always be kept in the diabetes treatment plan.
Whether it is the 2021 American Diabetes Association (ADA) "Diagnosis and Treatment Standards for Diabetes" or the 2019 European Society of Diabetes (ASD) guidelines for the management of hyperglycemia in T2DM patients, or the 2020 "China Type 2 Diabetes Prevention Guidelines" to be published in April ", have made the above suggestions.
Professor Zhu Dalong emphasized that no matter how the guidelines are updated and changed, the status of metformin as a first-line treatment is still unshakable.
Professor Zhu Dalong believes that due to my country's large area and large number of diabetic patients, patients, the media, and grassroots doctors will inevitably have misunderstandings in their understanding and application of metformin, such as thinking that metformin hurts the liver and kidneys, and that old drugs are inferior to new drugs.
Therefore, the publication of "Metformin and Diabetes Treatment-Hundred Questions and Answers" can build a bridge of communication and help us get out of the "misunderstanding" of metformin.
Use a good dose, use a good dosage form, and use a good brand of metformin.
The main adverse reaction is gastrointestinal reactions.
With the extension of treatment time, most patients can gradually tolerate or the symptoms disappear.
Starting with a small dose and gradually increasing the dose is the principle of dose adjustment for metformin.
Metformin is recommended to start with 500mg, 2 times/d, if there is no obvious gastrointestinal adverse reaction, then it can be gradually increased to 1000mg, 2 times/d.
In terms of dosage forms, currently domestic and foreign metformin mainly includes ordinary tablets, enteric-coated tablets and sustained-release tablets.
Compared with ordinary tablets, sustained-release tablets dissolve and release slowly in the gastrointestinal tract, have better gastrointestinal tolerance, and once a day can bring the same curative effect and improve the patient's medication compliance.
Professor Zhu Dalong pointed out that there are many metformin options available in clinical practice.
Evidence-based evidence is an important basis for choosing drugs.
The original research (Gehuazhi) has a large amount of clinical evidence-based evidence.
Domestic metformin needs to be compared with the original research (Gehuazhi).
) It can be used after consistency evaluation, so the clinic can make a reasonable choice according to the actual situation when choosing specific drugs. Even without the CVOT study, 60 years of evidence for metformin is sufficient to prove that it has a "heart" benefit.
Cardiovascular disease is a common complication of diabetes patients.
Compared with patients without diabetes, the risk of cardiovascular disease in diabetic patients is increased by 2-4 times [1].
Good blood sugar control helps reduce the risk of diabetic microvascular complications and macrovascular complications.
Studies have shown that for every 1% reduction in glycosylated hemoglobin (HbA1c), the risk of microvascular endpoint events is reduced by 37%, the risk of myocardial infarction is reduced by 14%, the risk of stroke is reduced by 12%, and the risk of heart failure is reduced by 16% [2].
Metformin has reliable short-term and long-term hypoglycemic effects.
It can effectively reduce the fasting blood glucose and postprandial blood glucose of T2DM patients when used alone, and can reduce HbA1c by 1.
0%-2.
0% (after removing the placebo effect), which can enable newly diagnosed T2DM patients in China HbA1c is reduced by 1.
8% (including placebo effect) and is not affected by body weight [3].
Therefore, metformin can effectively improve insulin resistance, reduce HbA1c, and improve cardiovascular risk factors (lipid regulation, weight loss, anticoagulation, etc.
), and play a direct or indirect cardiovascular protective effect [3].
The UK Prospective Diabetes Study (UKPDS) showed that the risk of all-cause death in obese T2DM patients using metformin was relatively reduced by 35%, and the risk of myocardial infarction was reduced by 39% [4]; the UKPDS 10-year follow-up study showed that the use of metformin treatment brought great The benefit of vascular complications and the risk of death has a continuation effect, and its effect on reducing death and myocardial infarction is significantly better than sulfonylureas and insulin [5].
In 2008, the U.
S.
Food and Drug Administration (FDA) required a new type of hypoglycemic drug to carry out a cardiovascular outcome trial (CVOT) to prove its cardiovascular safety before it could be marketed.
Among these CVOTs, metformin is usually used as a background combination therapy.
When combined with dipeptidyl peptidase-4 inhibitor (DPP-4i) or sodium-glucose cotransporter 2 inhibitor (SGLT-2i), patients on metformin showed cardiovascular outcomes compared with patients who did not use metformin The improvement trend [6, 7].
As an old blood sugar lowering drug that has been used for more than 60 years, metformin has not undergone CVOT.
Professor Zhu believes that the above evidence has proved its cardiovascular benefits.
Summary Metformin is the cornerstone of the prevention and treatment of T2DM, and its first-line cornerstone status is unshakable.
Starting with a small dose and choosing an appropriate dosage form (such as a sustained-release dosage form) can reduce the gastrointestinal reaction of metformin and improve patient compliance.
In terms of cardiovascular effects, UKPDS and other studies have shown that metformin has cardiovascular protective effects.
This time, "Metformin and Diabetes Treatment-Hundred Questions and Answers" collected common clinical questions, with simple and clear answers, which will better assist the reasonable clinical application of metformin, especially at the grassroots level.
(Leave a comment below to share your story about the clinical prescription of metformin, the top 10 with the most likes, we will give this book!) Expert profile Professor Zhu Dalong Nanjing University, Peking Union Medical College, Nanjing Medical University PhD supervisor, postdoctoral supervisor Director of the Department of Endocrinology, Nanjing Gulou Hospital, Chairman of the Diabetes Branch of the Chinese Medical Association, Vice President of the Endocrinology and Metabolism Physicians Branch of the Chinese Medical Doctor Association J Diabetes, Deputy Editor-in-Chief, Editor-in-Chief of Endocrine Reviews Chinese Edition and Diabetes Care Chinese Edition, Diabetes Chinese Edition, Deputy Editor-in-Chief of Chinese Diabetes Journal References: [1] Diabetes Branch of Chinese Medical Association.
Guidelines for Prevention and Treatment of Type 2 Diabetes in China (2017 Edition)[J].
Chinese Journal of Diabetes.
2018;10(1): 4-67.
[2]Stefano Del Prato.
Diabetes Exploration of normal blood glucose: control postprandial blood glucose[J].
Foreign Medicine: Endocrinology Section, 2003, 23(3):155-156.
[3] Mu Yiming, Ji Linong, Li Chunlin, et al.
Expert consensus on the clinical application of metformin ( 2018 edition)[J].
Chinese Journal of Diabetes, 2019, 027(003):161-173.
[4]UK Prospective Diabetes Study (UKPDS) Group.
Effect of intensive blood-glucose control with metformin on complications in overweightpatients with type 2 diabetes (UKPDS 34).
Lancet, 1998, 352: 854-865.
[5] Holman RR, Paul SK, Bethel MA, etal.
10-year follow-up of intensive glucose control in type 2 diabetes.
N Engl J Med, 2008 , 359:1577-1589.
[6]Crowley MJ, Williams JW Jr, Kosinski AS, et al.
Metformin Use May Moderate the Effect of DPP-4 Inhibitors on CardiovascularOutcomes[J].
Diabetes Care, 2017, 40(12):1787-1789.
[7]Neuen, et al.
2019; Abstractpresented at AACE 2019.
Submitted/Reproduced/ For business cooperation, please contact: pengsanmei@yxj.
org.
cn
