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*Only for medical professionals to read for reference.
The latest research shows that diabetic nephropathy (DKD) has replaced primary glomerular disease as the leading cause of chronic kidney disease (CKD) in my country.
Last time, Xiaojie invited Professor Sun Lin from the Institute of Nephrology, Central South University/Department of Nephrology, Xiangya Second Hospital, to share with us the first part of the "Chinese Guidelines for Clinical Diagnosis and Treatment of Diabetic Kidney Disease" formulated by the Nephrology Professional Committee of the Chinese Medical Association.
.
Interpretation of the guide, poke here>> Interpretation of the Chinese Guide to Diabetic Nephropathy (Part 1), full of dry goods! This time, we still ask Professor Sun to continue to explain to everyone ~ Delay the progression of DKD: Controlling blood sugar is the most effective Controlling blood sugar is the most effective treatment to prevent the occurrence and progression of DKD.
It is recommended that all patients with DKD reduce blood sugar reasonably, control blood sugar levels strictly and reasonably, and delay the occurrence and progression of DKD.
Although blood sugar needs to be controlled well and controlled to reach the standard, the control goal of each patient should be different from person to person.
It should be suggested that the target value of HbA1c should be managed by stratification and individualized treatment to avoid the occurrence of hypoglycemia.
The following table is derived from relatively widely recognized internationally recognized hierarchical management recommendations.
Table 1: Hierarchical management of the target value of HbA1c and the choice of hypoglycemic agents.
In the choice of hypoglycemic agents, the guidelines also make recommendations.
Figure 1: The choice of antihypertensive drugs The choice of antihypertensive drugs The choice of drugs for DKD to control blood pressure has been controversial in the past.
According to a number of RCT studies, the guidelines recommend the following: Figure 2: The choice of antihypertensive drugs to reduce proteinuria Proteinuria levels can also reduce the risk of T2DM-CKD progression.
I believe that in the near future it will be listed on the domestic market to benefit diabetic patients.
SGLT2 inhibitors have the effect of reducing proteinuria in T2DKD with massive albuminuria.
A randomized, double-blind, placebo-controlled, multi-center clinical trial enrolled 4401 T2DM-CKD patients, divided into canagliflozin group and placebo group.
After a follow-up of 2.
62 years, the results showed that canagliflozin not only lowered blood sugar but also reduced urine protein levels in T2DKD patients.
Figure 3: How the choice to control proteinuria regulates blood lipids Lowering LDL-c levels can reduce the risk of cardiovascular events in patients with DKD.
Studies have shown that after statin treatment, for every 1mmol/L (38.
7 mg/dl) decrease in LDL-c level, the RR for major vascular events is 0.
77 (95% CI, 0.
71-0.
84, P<0.
001).
At the same time, studies have shown that atorvastatin can effectively reduce proteinuria in diabetic patients and protect kidney function.
Lipid-lowering treatment is a decision that kills two birds with one stone.
Figure 4: Recommendations recommended by the guidelines to regulate blood lipids How to deal with anemia Research has shown that rosastat has a good effect on improving anemia in CKD/DKD 3-5 non-dialysis patients and improving anemia in CKD/DKD dialysis patients.
The guideline updated the recommendation for rosastat: Figure 5: Treatment of anemia How to use insulin Insulin is listed as a separate section in this guideline for discussion.
The current status of controversy and insufficient attention to the application of insulin in nephrology.
Figure 6: Recommendations for insulin use Regarding the insulin use and dosage adjustment process of DKD G1-2 patients, please refer to the flow chart below.
Figure 7: Insulin use and dosage adjustment process for patients with DKD G1-2 Research has shown that the gradual addition of mealtime insulin can reduce the risk of hypoglycemia more than full-dose addition.
This means that when using insulin, it is recommended to add one meal one meal at a time.
Do not get insulin in one step with three meals.
This way, although the standard is reached faster, the risk of hypoglycemia is increased. Summary This guide takes into account the national conditions and the characteristics of nephrology, and refers to evidence-based medicine and collective wisdom.
It is the result of innovation under the collective efforts and experience of several generations.
These innovations need to be tested by history and practice.
The clinical practice guided by theory will provide fresh blood for the further development and improvement of the guidelines.
Log in to the "Doctor Station" to search for Professor Sun's "Interpretation of the Chinese Guidelines for Diabetic Nephropathy", and listen to Professor Sun's personal interpretation! Course viewing 1.
Log in to the medical doctor station (If the medical doctor station is not installed, click the QR code or read the original download) 2.
Find the "Courses" page 3.
Enter the name of the course you want to see in the search box 4.
Enter "Diabetic Kidney Disease" Interpretation of the Chinese Guide" to watch Scan the QR code to download the Doctor Station App Famous Doctor Class for you to watch for free to read the original text, watch it now↓↓↓↓
The latest research shows that diabetic nephropathy (DKD) has replaced primary glomerular disease as the leading cause of chronic kidney disease (CKD) in my country.
Last time, Xiaojie invited Professor Sun Lin from the Institute of Nephrology, Central South University/Department of Nephrology, Xiangya Second Hospital, to share with us the first part of the "Chinese Guidelines for Clinical Diagnosis and Treatment of Diabetic Kidney Disease" formulated by the Nephrology Professional Committee of the Chinese Medical Association.
.
Interpretation of the guide, poke here>> Interpretation of the Chinese Guide to Diabetic Nephropathy (Part 1), full of dry goods! This time, we still ask Professor Sun to continue to explain to everyone ~ Delay the progression of DKD: Controlling blood sugar is the most effective Controlling blood sugar is the most effective treatment to prevent the occurrence and progression of DKD.
It is recommended that all patients with DKD reduce blood sugar reasonably, control blood sugar levels strictly and reasonably, and delay the occurrence and progression of DKD.
Although blood sugar needs to be controlled well and controlled to reach the standard, the control goal of each patient should be different from person to person.
It should be suggested that the target value of HbA1c should be managed by stratification and individualized treatment to avoid the occurrence of hypoglycemia.
The following table is derived from relatively widely recognized internationally recognized hierarchical management recommendations.
Table 1: Hierarchical management of the target value of HbA1c and the choice of hypoglycemic agents.
In the choice of hypoglycemic agents, the guidelines also make recommendations.
Figure 1: The choice of antihypertensive drugs The choice of antihypertensive drugs The choice of drugs for DKD to control blood pressure has been controversial in the past.
According to a number of RCT studies, the guidelines recommend the following: Figure 2: The choice of antihypertensive drugs to reduce proteinuria Proteinuria levels can also reduce the risk of T2DM-CKD progression.
I believe that in the near future it will be listed on the domestic market to benefit diabetic patients.
SGLT2 inhibitors have the effect of reducing proteinuria in T2DKD with massive albuminuria.
A randomized, double-blind, placebo-controlled, multi-center clinical trial enrolled 4401 T2DM-CKD patients, divided into canagliflozin group and placebo group.
After a follow-up of 2.
62 years, the results showed that canagliflozin not only lowered blood sugar but also reduced urine protein levels in T2DKD patients.
Figure 3: How the choice to control proteinuria regulates blood lipids Lowering LDL-c levels can reduce the risk of cardiovascular events in patients with DKD.
Studies have shown that after statin treatment, for every 1mmol/L (38.
7 mg/dl) decrease in LDL-c level, the RR for major vascular events is 0.
77 (95% CI, 0.
71-0.
84, P<0.
001).
At the same time, studies have shown that atorvastatin can effectively reduce proteinuria in diabetic patients and protect kidney function.
Lipid-lowering treatment is a decision that kills two birds with one stone.
Figure 4: Recommendations recommended by the guidelines to regulate blood lipids How to deal with anemia Research has shown that rosastat has a good effect on improving anemia in CKD/DKD 3-5 non-dialysis patients and improving anemia in CKD/DKD dialysis patients.
The guideline updated the recommendation for rosastat: Figure 5: Treatment of anemia How to use insulin Insulin is listed as a separate section in this guideline for discussion.
The current status of controversy and insufficient attention to the application of insulin in nephrology.
Figure 6: Recommendations for insulin use Regarding the insulin use and dosage adjustment process of DKD G1-2 patients, please refer to the flow chart below.
Figure 7: Insulin use and dosage adjustment process for patients with DKD G1-2 Research has shown that the gradual addition of mealtime insulin can reduce the risk of hypoglycemia more than full-dose addition.
This means that when using insulin, it is recommended to add one meal one meal at a time.
Do not get insulin in one step with three meals.
This way, although the standard is reached faster, the risk of hypoglycemia is increased. Summary This guide takes into account the national conditions and the characteristics of nephrology, and refers to evidence-based medicine and collective wisdom.
It is the result of innovation under the collective efforts and experience of several generations.
These innovations need to be tested by history and practice.
The clinical practice guided by theory will provide fresh blood for the further development and improvement of the guidelines.
Log in to the "Doctor Station" to search for Professor Sun's "Interpretation of the Chinese Guidelines for Diabetic Nephropathy", and listen to Professor Sun's personal interpretation! Course viewing 1.
Log in to the medical doctor station (If the medical doctor station is not installed, click the QR code or read the original download) 2.
Find the "Courses" page 3.
Enter the name of the course you want to see in the search box 4.
Enter "Diabetic Kidney Disease" Interpretation of the Chinese Guide" to watch Scan the QR code to download the Doctor Station App Famous Doctor Class for you to watch for free to read the original text, watch it now↓↓↓↓
