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    Home > Active Ingredient News > Endocrine System > Interpretation of the updated key points of "China Type 2 Diabetes Prevention and Control Guidelines (2020 Edition)"

    Interpretation of the updated key points of "China Type 2 Diabetes Prevention and Control Guidelines (2020 Edition)"

    • Last Update: 2021-05-22
    • Source: Internet
    • Author: User
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    Guide: In April 2021, the "Guidelines for the Prevention and Treatment of Type 2 Diabetes in China (2020 Edition)" were published online simultaneously in the Chinese Journal of Diabetes and the Chinese Journal of Endocrinology and Metabolism.

    The new version of the guide includes a total of 19 chapters.
    Compared with the 2017 version of the guide, it has been revised and updated in many aspects.

    Recently, Professor Lu Juming from the Endocrinology Department of the PLA General Hospital gave everyone a comprehensive interpretation of the updated points of the 2020 version of the CDS guidelines.

    Expert introduction: Professor Lu Juming ● Chief physician of the Endocrinology Department of PLA General Hospital ● President of Endocrinology and Metabolism Branch of Chinese Geriatrics Association ● Honorary Chairman of Women and Child Obesity Control Professional Committee of Chinese Society of Maternal and Child Health ● Vice President of Beijing Association for Hypertension Prevention The main points of the epidemiological characteristics of diabetes in China are: ➤The prevalence of diabetes in China is still rising, reaching 11.
    2% in 2015-2017.
    There are large differences among ethnic groups, and there are also differences among regions; ➤Awareness rate of diabetes (36.
    5%) ), treatment rate (32.
    2%) and control rate (49.
    2%) have improved, but still at a low level; ➤T2DM accounts for more than 90% of people with diabetes.

     Figure 1 Diabetes prevalence Chapter 2: Diagnosis and classification of diabetes Tips: ➤Fasting blood glucose, random blood glucose or OGTT 2h blood glucose is the main basis for diagnosing diabetes.
    If there are no typical clinical symptoms of diabetes, the test must be repeated to confirm the diagnosis (A ); ➤In a laboratory with strict quality control, the glycosylated hemoglobin (HbA1c) measured by a standardized detection method can be used as a supplementary diagnostic criterion for diabetes (B); ➤ Diabetes is divided into T1DM, T2DM, special type diabetes and pregnancy according to the cause 4 types of early diabetes (ie WH01999 classification system) (A).Incorporate "glycated hemoglobin" into the diagnostic criteria for diabetes: In medical institutions that adopt standardized testing methods and have strict quality control [US National Glycated Hemoglobin Standardization Program (NGSP), China Glycated Hemoglobin Consistency Research Program (CGSP)], HbA1c ≤6.
    5% is used as a supplementary diagnostic criterion for diabetes.

     In these special cases, HbA1c cannot be used: Diabetes can only be diagnosed based on venous plasma glucose levels in the following cases: sickle cell disease, pregnancy (middle and late), glucose-6-phosphate dehydrogenase deficiency, AIDS, hemodialysis, Recent blood loss or blood transfusion, erythropoietin therapy, etc.

    In addition, HbA1c is not recommended for screening cystic fibrosis-related diabetes.

     Chapter 3: Tertiary Prevention of Type 2 Diabetes Chapter 4: Diabetes Screening and Evaluation Tips: ➤High-risk people with diabetes should be screened for diabetes (A); ➤Diabetes patients should be evaluated in detail at the first diagnosis ( A); ➤Patients with diabetes should conduct regular metabolic control status and complication assessment (A).

    Chapter 6: Type 2 diabetes comprehensive control goals and hyperglycemia treatment pathways 1.
    Comprehensive control goals and tips ➤T2DM treatment strategies should be comprehensive, including blood sugar, blood pressure, blood lipids, weight control, antiplatelet therapy and improvement Life>
    Life>
    If there are no contraindications, metformin should always be kept in the diabetes treatment plan (A); ➤T2DM patients with ASCVD or high cardiovascular risk, regardless of whether their HbA1c is up to the standard, as long as there are no contraindications, they should be added on the basis of metformin GLP-1RA or SGLT2i (A) with evidence of ASCVD benefit; ➤T2DM patients with CKD or heart failure, regardless of whether their HbA1c meets the standard, as long as there is no contraindication, SGLT2i should be added to metformin, and T2DM with CKD For patients with diabetes, if SGLT2i cannot be used, GLP-1RA may be considered (A).

     Figure 2 The main factors influencing the setting of individualized HbA1c control goals for adult patients with type 2 diabetes 2.
    The main points of hyperglycemia drug treatment ➤Life>
    Life>
    If there are no contraindications, metformin should always be kept in the diabetes treatment plan.

    (A) ➤ For those who are treated with a hypoglycemic drug and the blood sugar is not up to the standard, use 2 or even 3 kinds of drugs with different mechanisms of action for combined treatment.

    It can also be treated with insulin.

    (A) ➤Patients with type 2 diabetes with ASCVD or high-risk cardiovascular risk, regardless of whether their HbA1c meets the standard, as long as there is no contraindication, GLP-1RA or SGLT2i with evidence of ASCVD benefit should be added to metformin.

    (A) ➤Patients with type 2 diabetes with CKD or heart failure, regardless of whether their HbA1c meets the standard, as long as there is no contraindication, SGLT2i should be added to metformin.
    Patients with type 2 diabetes with CKD should consider SGLT2i if they cannot use SGLT2i Choose GLP-1RA.

    (A) Note: a, high-risk factors refer to age ≥ 55 years old with at least one of the following: coronary artery or carotid artery or lower extremity artery stenosis ≥ 50%, left ventricular hypertrophy; b, usually choose basal insulin; c, plus ASCVD , GLP-1RA or SGLT2i with evidence of benefit from heart failure or CKD; d, those with heart failure do not need TZD Figure 3 Type 2 Diabetes Diagnosis and Treatment Pathway Chapter 10: Drug Therapy of Hyperglycemia 1.
    New recommendation for basal insulin use ➤Initiation The dose is 0.
    1~0.
    2 U/kg/d; ➤For those with НЬA1c>8.
    0%, 0.
    2-0.
    3 U/kg/d can be considered for starting; ➤For those with body mass index (BMI) ≥25 kg/m^2, start with basal insulin At the time, consider starting at 0.
    3U/kg/d; ➤ Adjust the insulin dosage according to the patient’s fasting blood glucose level, usually once every 3-5 days, and adjust 1-4 U at a time according to the blood sugar level until the fasting blood glucose reaches the target; ➤Basic insulin The maximum dose can be 0.
    5~0.
    6U/kg/d.

     2.
    Two new basal insulin analogues are newly added, insulin deglubber and insulin glargine U3003.
    Double insulin analogues are first written in the "Guidelines for the Prevention and Treatment of Type 2 Diabetes in China" Note: A is HbA1c after 3 months of oral hypoglycemic treatment Insulin treatment path for patients with type 2 diabetes ≥7.
    0%, B is the insulin treatment path for newly diagnosed type 2 diabetes patients with HbA1c≥9.
    0% or FPG≥11.
    1 mmol/L Figure 4 Insulin treatment path for patients with type 2 diabetes Chapter 7: 2 Tips for medical nutrition treatment of type 2 diabetes: ➤T2DM and pre-diabetes patients need to receive individualized medical nutrition treatment, which is guided by a nutritionist (medicine) or a comprehensive management team (including diabetes educators) who are familiar with diabetes medical nutrition treatment ( A); ➤On the basis of assessing the nutritional status of the patient, a reasonable medical nutrition goal and plan should be set, total energy intake should be controlled, various nutrients should be distributed in a reasonable and balanced manner, to achieve the patient's metabolic control goals, and meet as much as possible Individual dietary preferences (B).  Note: The standard weight refers to the calculation method of the World Health Organization (1999): male standard weight = [height (cm)-100] × 0.
    9 (kg); female standard weight = [height (cm)-100] × 0.
    9 (kg) -2.
    5 (kg); According to the standard of my country's body mass index, ≤18.
    5 kg/m^2 means underweight, 18.
    6~23.
    9kg/m^2 means normal weight, 24.
    0~27.
    9kg/m^2 means overweight, ≥ 28.
    0kg/m^2 is obese.

     Chapter 8: Tips for exercise treatment of type 2 diabetes: ➤Adult patients with T2DM should exercise at least 150 minutes of moderate-intensity aerobic exercise per week (B); ➤Adult patients with T2DM should increase their daily physical activities and reduce the time of sitting (B); ➤With Exercise therapy should be exercised with caution in the event of acute or severe chronic complications (B).

     Chapter 9: Tips for quitting smoking: ➤It is recommended that all diabetic patients do not smoke or use other tobacco products and e-cigarettes, and minimize second-hand smoke exposure (A); ➤For diabetic patients who smoke and use e-cigarettes, they should quit smoking Counseling and other forms of treatment are included in routine diabetes diagnosis and care (A).

     Chapter 11: New chapter "Weight Management for Patients with Type 2 Diabetes" Overweight and obesity are important risk factors for the onset of type 2 diabetes (T2DM).

    Patients with T2DM are often accompanied by overweight and obesity.
    Obesity further increases the risk of cardiovascular disease in patients with T2DM.

    Weight management is not only an important part of T2DM treatment, but also helps delay the progression of pre-diabetes to T2DM.

     To this end, the 2020 version of the guidelines adds a new chapter "Weight Management for Patients with Type 2 Diabetes" and gives recommendations: ➤The management goal for overweight and obese adults with type 2 diabetes is to lose 5%-10% of body weight.

    (A) ➤The weight management methods for overweight and obese adults with type 2 diabetes include life>
    (A) ➤ Obese adults with type 2 diabetes should be treated with life>
    (B) Chapter 12: Diabetes-related technologies.
    Key points: The 2020 version of the guidelines recommends that the time within the glucose target range (TIR) ​​should be included in the blood glucose control goal.

    (B) The recommended TIR control target for patients with T1DM and T2DM is >70%, but it should be highly individualized, while paying attention to hypoglycemia and blood glucose fluctuations.

     The new indicator glucose target time within the target range (TIR) ​​or the percentage of glucose reaching target time refers to the time (in min) or percentage of glucose within the target range (usually 3.
    9~10.
    0 mmol/L) within 24 h , Can be calculated from CGM data or SMBG data (at least 7 blood glucose monitoring per day).

    A number of observational studies have shown that TIR is significantly related to diabetic microvascular complications, surrogate markers of cardiovascular disease, and pregnancy outcome.

    In addition, a large cohort study showed that TIR was significantly associated with cardiovascular death and all-cause death in T2DM patients.

     Chapter 13: Acute Complications of Diabetes Chapter 14: Management of Cardiovascular Diseases and Risk Factors Key Points: ➤Diabetic patients are often accompanied by important risk factors for cardiovascular diseases such as hypertension and dyslipidemia.

    (A) ➤Diabetes patients should be assessed for cardiovascular disease risk factors at least annually.

    (B) ➤Comprehensive control of multiple risk factors can significantly improve the risk of cardiovascular and cerebrovascular diseases and death in diabetic patients.

    (A) ➤GLP-1RA and SGLT2i can improve ASCVD.

    (A) Chapter 15: Chronic Complications of Diabetes Chapter 16: Hypoglycemia Update CKD Progress Risk and Frequency of Visits: ➤The number in the table is the recommended number of rechecks per year; ➤The background color represents the risk of CKD progression: green It is low risk, yellow is medium risk, orange is high risk, and red is very high risk.

      Chapter Nineteen: TCM Treatment of Diabetes Tips: TCM treatment of diabetes, following the principle of dialectical treatment, plays an important role in synergistically lowering blood sugar, improving symptoms and signs, preventing and treating complications, improving quality of life and tertiary prevention (B) 
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