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    Home > Active Ingredient News > Endocrine System > Individualized management helps diabetic patients benefit in multiple ways

    Individualized management helps diabetic patients benefit in multiple ways

    • Last Update: 2022-01-09
    • Source: Internet
    • Author: User
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    *Only for medical professionals to read for reference, "on-demand" hypoglycemia, "on-demand" weight loss, to achieve cardiovascular benefits, suitable for people with mild to moderately severe liver and kidney impairment-tailored to individual conditions, so that diabetics can benefit in many ways Benefit
    .

     Since 1990, the global burden of diabetes has increased significantly
    .

    Among them, type 2 diabetes (T2DM) accounts for 90% of the total number of diabetes [1]
    .

    According to the recently released International Diabetes Federation (IDF) Global Diabetes Map (Tenth Edition 2021) data [2], the number of patients with diabetes in the world is currently as high as 537 million, and in mainland China, there are more than 140 million T2DM patients
    .

    In addition, the mortality rate of T2DM is also increasing year by year [3] (Figure 1), and it is imperative to optimize T2DM management
    .

    Figure 1 The global prevalence and mortality of diabetes from 1990 to 2025 is well known.
    The pathogenesis of T2DM is complex, and its core pathological mechanism is the decrease in insulin secretion and insulin resistance caused by various reasons
    .

    However, due to the different individual characteristics of patients, different T2DM patients have different treatment needs [4]: ​​Different baseline glycosylated hemoglobin (HbA1c) patients have different blood sugar lowering needs; different weight patients have different weight control needs; T2DM patients, especially with atherosclerosis Patients with ASCVD or high-risk factors* have additional requirements for the cardiovascular benefits of drugs; in addition, patients with impaired liver and kidney function have strict requirements on the scope of drug use
    .

    Therefore, diabetes management programs are constantly changing, and individualized diabetes treatment has gradually become the focus of attention.
    The "Diabetes Medical Diagnosis and Treatment Standards" issued by the American Diabetes Association (ADA) also always emphasizes the individualized management of diabetes patients [4]
    .

     So, what is the individualized management of diabetes? Professor Mu Yiming of the First Medical Center of the PLA General Hospital gave us the answer
    .

     The purpose of individualized diabetes management is to prevent complications and improve the quality of life according to individual conditions and needs of different diabetic patients-by evaluating the main characteristics of the patient, including age, weight, HbA1c, etc.
    , as well as comorbidities such as ASCVD, chronic kidney disease Disease (CKD), heart failure (HF); at the same time, consider specific factors that affect treatment options, such as the impact on weight and hypoglycemia, the complexity of the treatment plan, and patient compliance, etc.
    , so as to develop an appropriate diabetes management plan , And strictly implement and monitor blood sugar [5]
    .

     According to the current guidelines, most patients with T2DM have a hypoglycemic goal of HbA1c<7%[1,4,6,7]
    .

    The Chinese epidemiological survey [8] showed that the HbA1c levels of T2DM patients are different, and therefore the demand for lowering blood sugar is also different (Figure 2)
    .

     Figure 2 The HbA1c distribution of T2DM patients in the 2012 Chinese Epidemiological Survey has different weight loss needs.
    Because overweight/obesity can increase the risk of adverse event outcomes in diabetic patients, major guidelines recommend such patients to carry out weight control [1, 4, 9- 11]
    .

    Among them, the "China Type 2 Diabetes Prevention Guidelines" issued by the Diabetes Branch of the Chinese Medical Association (CDS) in 2020 recommends that overweight and obese adults with T2DM should undergo weight management, with the goal of reducing weight by 5% to 10%
    .

    The 3B study [12] showed that about 58.
    3% of Chinese T2DM patients have a body mass index (BMI) ≥24kg/m2 (Figure 3), which meets China's overweight/obesity standards and has weight loss needs.
    The remaining T2DM patients have no weight loss needs, so Different patients have different weight loss needs
    .

    Figure 3 The mass index of Chinese T2DM population taking into account cardiovascular benefits A meta-analysis [13] shows that compared with non-diabetic patients, the cardiovascular risk of diabetic patients is significantly increased
    .

    The latest CAPTURE study [14] shows that about 1/3 of T2DM patients in China have cardiovascular disease, of which ASCVD accounts for about 95%
    .

    For T2DM patients, blood pressure, blood lipids, blood sugar and other cardiovascular risk factors should be controlled.
    At the same time, for people with ASCVD or high-risk factors, drugs with cardiovascular benefits can be used to reduce the risk of cardiovascular events and death [1]
    .

    Pay attention to liver and kidney function limitations Diabetic patients often have liver and kidney dysfunction [15-16], and the use of most hypoglycemic drugs is restricted by liver and kidney function [17]
    .

    Therefore, patients with liver and kidney function impairment need to pay more attention to medication safety
    .

     In summary, diabetic patients need personalized management to meet their diverse clinical needs
    .

     Multi-pronged, individualized management helps multiple benefits.
    GLP-1RA weekly preparation smeglutide "on-demand" reduces blood sugar, weight loss, has both cardiovascular benefits, and in patients with mild to moderate severe liver and kidney dysfunction Unlimited use in T2DM provides a new idea for the individualized glucose control management of T2DM patients
    .

    Its half-life is as long as 7 days, and the medication is administered once a week, which further improves patient compliance
    .

     "On-demand" hypoglycemic, fully up to standard.
    A randomized, double-blind, placebo-controlled clinical trial enrolled 75 T2DM patients and 12 healthy controls.
    T2DM patients were randomly treated with semaglutide or placebo, and graded glucose infusion was performed.
    Note test, the results [18] showed: as the glucose concentration increases, smeglutide significantly promotes insulin secretion; while the glucose concentration is low, the effect of promoting insulin secretion is not significant
    .

    This shows that smeglutide can promote insulin secretion "on demand" (Figure 4)
    .

    Figure 4 Simeglutide promotes insulin secretion "on demand".
    The results of the SUSTAIN series of global phase 3 clinical trials suggest that simeglutide can significantly reduce blood sugar no matter when compared with placebo-controlled or active control drugs (p <0.
    0001), the highest drop rate is 1.
    8%[19-26]
    .

    Further analysis of SUSTAIN 1-5 [27], the higher the baseline HbA1c level, the greater the degree of hypoglycemic reduction of smeglutide (Figure 5)
    .

    Among them, in patients with baseline HbA1c greater than 9%, smeglutide can significantly reduce HbA1c by 2.
    7%
    .

    Figure 5 The higher the baseline HbA1c level, the greater the reduction in HbA1c.
    In addition, the SUSTAIN series of studies [19-26] show that smeglutide makes about 80% of T2DM patients with HbA1c reach the target value (<7%) while serious Or the incidence of confirmatory hypoglycemia is extremely low
    .

     The SUSTAIN China study [28] also showed that simeglutide can also significantly increase the HbA1c compliance rate of Chinese T2DM populations as high as 86.
    1%, suggesting that simeglutide has a significant hypoglycemic effect in China and global studies
    .

     Lose weight on demand and improve metabolic indicators Smeglutide can help patients improve metabolic indicators (such as body weight) and exert cardiovascular protection
    .

    Global SUSTAIN series studies show that [19-26], simeglutide significantly reduces weight by 6.
    5kg
    .

    The post-analysis results showed that smeglutide can lose weight "on demand".
    The greater the BMI, the greater the weight loss; those with BMI<25kg/m2 have a smaller weight loss (Figure 6)
    .

     Figure 6 Simeglutide "on-demand" weight loss Cardiovascular benefits to meet the treatment needs of high-risk patients In animal experiments [30], simeglutide has been proven to play an anti-atherosclerotic effect
    .

     The cardiovascular outcome test SUSTAIN 6 study [29] showed that smeglutide can significantly reduce the risk of patients with major cardiovascular adverse events (MACE) by 26%, and play a cardiovascular protective effect
    .

    And its cardiovascular benefits are not affected by factors such as age, gender, race, race, BMI, course of disease, and history of cardiovascular disease
    .

    Therefore, the latest domestic and foreign guidelines [1, 6, 30] recommend GLP-1RA with clear cardiovascular benefits, such as semaglutide, for patients with ASCVD or T2DM with high-risk factors
    .

     Mild, moderate and severe liver and kidney damage can also be used safely.
    Studies [31, 32] have shown that liver and kidney damage has no significant effect on the pharmacokinetic parameters of semaglutide (Figure 7).
    Therefore, Sime The Chinese manual of Glutide[33] stipulates that Smegaglutide does not need to adjust the dose for T2DM patients with mild, moderate or severe hepatic impairment or renal impairment
    .

     Figure 7 The effect of liver (left) and kidney (right) impairment on the pharmacokinetics of simegliutide is not only that, the results of the SUSTAIN 6 study [29] show that simegliutide can significantly reduce the risk of renal events by 36% , Suggesting that smeglutide can further play a role in kidney protection
    .

     The director commented that there are individual differences in the T2DM group, so individualized management is needed in clinical practice, paying attention to the needs of patients for lowering blood sugar, cardiovascular and other complications, and the peculiarities of special patients' medications
    .

    Smeglutide is a new GLP-1RA weekly preparation, which was launched in China this year, which can achieve HbA1c compliance for up to 86.
    1% of Chinese T2DM patients; significantly reduce the weight of overweight/obese T2DM patients, and the weight of non-overweight/obese patients The decrease is small; there is a clear cardiovascular benefit, and it is recommended by authoritative guidelines at home and abroad for T2DM patients with ASCVD or high-risk factors; mild, moderate, and severe liver and kidney damage can be used, and there is no need to adjust the dose, which meets The treatment needs of different T2DM patients
    .

    It can be said that simeglutide provides a new way for individualized hypoglycemic management and opens up a new situation for hypoglycemic management
    .

     *High risk factors: Refers to age ≥55 years with at least 1 item below: coronary artery or carotid artery or lower extremity artery stenosis ≥50%, left ventricular hypertrophy
    .

    Expert Profile Professor Mu Yiming, Chief Physician, Professor, Doctoral Supervisor of the First Medical Center of PLA General Hospital, Professor and Doctoral Supervisor of Tsinghua University School of Medicine, Professor and Doctoral Supervisor of Nankai University School of Medicine, Current Endocrinology of the First Medical Center of PLA General Hospital Director of the Department, Chairman of the Tenth Committee of the Endocrinology Branch of the Chinese Medical Association, Chairman of the Endocrinology and Metabolism Branch of the Chinese Medical Association, Chairman of the Endocrinology Branch of the Beijing Medical Association, Chairman of the Endocrinology Professional Committee of the PLA Medical Association "Chinese Journal of Internal Medicine", "Chinese Endocrinology Associate editor of Metabolism Journal, Chinese Journal of Medical Frontiers and Journal of Practical Internal Medicine; Chief Editor of "Drug Evaluation" and "International Diabetes"
    .

    Published more than 220 SCI papers, undertook 3 major national scientific and technological research projects and 4 National Natural Science Foundation of China
    .

    In 2008, he won the Army Outstanding Youth Fund
    .

    In 2012 and 2018, he was awarded the Outstanding Contribution Award by the Chinese Medical Association
    .

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