Lectures in 2021∣Gathering of big names to talk about the "new" journey of diabetes management

2021 "Let's talk" is divided into three themes, which lasted for five sessions.
Among them, the "New' Path of Diabetes Management" theme conference has just come to an end, and several experts have brought wonderful academic speeches to everyone
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The "New" Path of Diabetes Management (Phase 1) This conference invited Professor Chen Lulu and Professor Xu Chun as the chairmen of the conference, and Professor Jiang Sheng, Professor Pan Qi, Professor Li Guangwei and Professor Xiao Xinhua as speakers
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Gwazhi promotes the process of China's exploration of metformin.
Professor Jiang Sheng, Professor Jiang Sheng from the First Affiliated Hospital of Xinjiang Medical University, first briefly explained the evidence-based accumulation of metformin in the past 60 years, and then gave some questions about the concerns of clinicians Detailed answer (Figure 1): Figure 1 Common problems encountered by clinicians in the process of using metformin ① Chinese type 2 diabetes (T2DM) patients who use metformin, the blood sugar lowering effect is not affected by body weight
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②T2DM patients using insulin combined with metformin therapy can get more benefits without increasing the risk of hypoglycemia
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③If patients with T2DM develop gastrointestinal intolerance after using metformin, they can be improved by the following methods: (1) Start with a small dose and gradually reach the optimal dose; (2) Replace ordinary metformin tablets with sustained-release tablets (Grid Huazhi®XR), Gwazhi®XR can significantly reduce gastrointestinal adverse events and improve gastrointestinal tolerance
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④Metformin has clear cardiovascular benefits.
Previous studies have confirmed that all-cause mortality and risk of heart failure in patients receiving metformin treatment are significantly reduced
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Diabetes and tumors are right and wrong Professor Pan Qi Professor Pan Qi from Beijing Hospital believes that diseases such as insulin resistance, obesity, and T2DM are related to tumor risk; hyperinsulinemia, abnormal glucose and lipids, inflammatory factors, and adipokines may all promote tumor cell proliferation
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Various hypoglycemic drugs have different effects on the risk of tumor occurrence, but it is clear that metformin can reduce the overall cancer incidence and mortality.
Its anti-tumor mechanism mainly has two aspects.
On the one hand, it activates AMPK to make mTOR signal.
Decrease directly inhibits tumor cell proliferation; on the other hand, by reducing insulin levels and reducing insulin receptor activity, it further affects the PI3K/Akt signaling pathway, thereby inhibiting cell proliferation (Figure 2)
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Figure 2 Metformin's anti-tumor mechanism Metformin and the prevention of diabetes and cardiovascular disease Professor Li Guangwei Professor Li Guangwei, Fuwai Hospital, Chinese Academy of Medical Sciences, first emphasized the importance of diabetes management focusing on long-term outcomes, and then pointed out that metformin can significantly reduce all-cause deaths in diabetic patients The risk of cardiovascular death and heart failure (Figure 3).
If there are no contraindications or intolerances, initiating metformin in the early stage of T2DM can help reduce the patient’s long-term cardiovascular risk and death risk
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It is well known that insulin resistance not only induces T2DM, but is also associated with cardiovascular and cerebrovascular diseases.
Metformin improves insulin sensitivity and fundamentally improves the cardiovascular outcome of T2DM patients
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Figure 3 Metformin can reduce the risk of all-cause death, cardiovascular death and heart failure in diabetic patients.
Key points and difficulties in the diagnosis and treatment of hypoglycemia.
Professor Xiao Xinhua, Peking Union Medical College Hospital.
Key points and difficulties: Insulinoma cannot be ruled out for patients with postprandial hypoglycemia, and imaging examinations should be performed in time for suspicious patients; congenital hyperinsulinemic hypoglycemia (CHI) does not have tumor problems, and most patients are right Responsive to diazoxide treatment; Insulin autoimmune syndrome (IAS) is characterized by high insulin levels and low C-peptide levels during hypoglycemia; non-islet cell neoplastic hypoglycemia (NICTH) is manifested by low insulin levels but elevated IGF-2 High, often associated with tumors
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Q&A and Discussion Q1.
The incidence of diabetes has increased sharply, and new therapeutic drugs continue to be marketed in the clinic.
Is metformin still the main force for lowering blood sugar? Professor Li Guangwei believes that the new hypoglycemic drugs have indeed demonstrated their excellent efficacy, but the control of the basic etiology and pathogenesis of diabetes has yet to be confirmed
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The current status of metformin is still irreplaceable
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Professor Pan Qi further added that in the RCT study of the new drug, about 60% of the subjects used metformin at the same time; in addition, the new hypoglycemic drugs have been used in clinical applications for a short period of time, and the experience of using metformin has been more than 60 years.
, Clinicians will be more confident that metformin will be used to maximize its efficacy, and many studies have found that metformin has benefits for multiple organs
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Q2.
From the current stage, what does the China Diabetes Prevention Study (CDPP) bring to the clinic? Professor Jiang Sheng said that for the prevention of diabetes, apart from life>
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The results of future CDPP studies may provide strong evidence that metformin can be used in diabetes prevention
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Q3.
For primary doctors, how to prevent hypoglycemia during the treatment of diabetic patients? Professor Xiao Xinhua pointed out that primary-level doctors should first pay attention to the collection of medical history; secondly, in terms of oral medicine, they should try to choose hypoglycemic drugs with less risk of hypoglycemia, such as metformin; in terms of insulin treatment, the insulin regimen should be selected based on the specific conditions of the patient
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Summary: Gehuazhi® has entered the clinic as a classic drug for decades.
As Professor Jiang said, Chinese studies have given Gehuazhi® some Chinese experience, such as avoiding gastrointestinal reactions and adjusting drug dosages
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It is hoped that in the future, clinicians can use Gehuazhi® to achieve better results
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In addition, type 2 diabetes is a high-risk disease for tumors.
Certain hypoglycemic drugs may increase the risk of tumors in diabetic patients, and the view that metformin can reduce the risk of tumors has been confirmed
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Professor Pan’s speech provided an extremely favorable direction for optimizing diabetes treatment plans in the future
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In the earliest UKPDS study, it was confirmed that metformin has cardiovascular benefits
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As we all know, insulin resistance not only induces T2DM, but is also closely related to cardiovascular and cerebrovascular diseases.
Metformin can improve insulin sensitivity and fundamentally improve the cardiovascular outcome of patients with T2DM
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With regard to the prevention and treatment of hypoglycemia, Professor Xiao Xinhua explained the key points and difficulties in the diagnosis and treatment of hypoglycemia in a simple and simple way.
From this we learned the identification of various types of hypoglycemia, including the method of locating islet cell tumors and congenital hypoglycemia.
treatment of blood sugar
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The "New" Course of Diabetes Management (Phase 2) This conference invited Professor Guo Lixin and Professor Kuang Hongyu as chairmen of the conference, and Professor Liao Lin, Professor Xu Chun, Professor Zhang Haohao and Professor Xiao Xinhua to give wonderful speeches
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In order to standardize the diagnosis and treatment of diabetes and cardiovascular diseases, this "Lecture" academic exchange activity adopts the form of online lectures, combined with wonderful academic interactions, systematic theoretical learning and practical discussions, to help doctors improve their scientific research skills and promote information exchanges And talent training
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From another perspective, look at the reasons why metformin is the first-line first-line choice.
Professor Lin Liao, from the First Affiliated Hospital of Shandong First Medical University, mentioned that many authoritative guidelines recommend metformin as the first-line hypoglycemic agent for diabetic patients.
The main reasons are as follows: Reasons: ①Metformin alone can achieve a strong hypoglycemic effect without the risk of hypoglycemia; ②Insulin resistance is the common pathophysiological basis of T2DM and cardiovascular diseases, and metformin can activate AMPK, thereby improving insulin resistance (Figure 4); ③Metformin is the first hypoglycemic drug to prove cardiovascular benefits, and more and more evidence-based evidence proves that metformin can improve cardiovascular outcomes
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Figure 4 Metformin improves the pathophysiological mechanism of insulin resistance.
Multiple advantages of metformin besides hypoglycemic.
Prof.
Xu Chun Professor Xu Chun from the Third Medical Center of PLA General Hospital pointed out that besides hypoglycemic, metformin has many benefits in other fields: (1) Metformin has many benefits for T2DM The patient’s cardiovascular system has a protective effect, and is recommended by the guidelines as one of the hypoglycemic agents with cardiovascular protection; ②Metformin can treat polycystic ovary syndrome and non-alcoholic fatty liver disease caused by insulin resistance; ③Metformin It has anti-aging effects and can reduce the risk of tumors by directly activating AMPK and improving insulin resistance; ④Metformin can improve glucose tolerance by regulating the T2DM intestinal flora
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The mechanism of metformin improving insulin sensitivity through hypothalamic MC4R Professor Zhang Haohao Professor Zhang Haohao from the First Affiliated Hospital of Zhengzhou University pointed out that MC4R gene can increase peripheral energy expenditure and insulin sensitivity, and metformin intervention can significantly up-regulate the expression of hypothalamic MC4R (Figure 5) ), increase the expression of skeletal muscle AMPK, SIRT1 and the number of mitochondria, thereby improving skeletal muscle insulin resistance
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 Figure 5 Metformin can up-regulate the expression of MC4R in the hypothalamus.
Chinese expert consensus on the triple optimization of oral hypoglycemic drugs in adult type 2 diabetes The benefits of medication are far greater than the traditional step-by-step diagnosis and treatment
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The triple regimen represented by metformin+DPP-4i+SGLT2i is suitable for most T2DM patients.
At the same time, the triple regimen can achieve synergy and complementarity, optimize blood sugar control, and comprehensively improve metabolic indicators.
It has good safety and the incidence of adverse reactions is not high.
For single-drug or double-dose therapy (Figure 6)
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 Figure 6 Recommended content of the triple optimization plan of oral hypoglycemic drugs for T2DM patients Q1.
For patients with cardiovascular disease and diabetes, SGLT2i is directly used for hypoglycemia because it has antihypertensive and cardiovascular prognostic effects
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There are also many successful cases of control
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No first-line metformin
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Do you have any suggestions for this? Is it recommended to follow the guidelines recommended by metformin that also has cardiovascular benefits, and then it depends on the patient's condition? Professor Zhang Haohao believes that when prescribing drugs, doctors must not only consider the factors of blood sugar and comorbidities, but also evaluate the risks of other diseases that affect the life safety of patients.
It may not be necessary for patients with cardiovascular disease and diabetes to use SGLT2i
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Q2.
The optimal dose of metformin is 2000mg/day, but the most commonly used clinically are 1000 and 1500mg/day.
Should the patient continue to increase the dose or directly add other hypoglycemic drugs if the patient can tolerate it? Professor Xu Chun believes that if the patient's oral metformin 1000 or 1500 mg/day blood sugar control is not satisfactory, it is recommended to increase the dose to 2000 mg/day; if the patient really cannot tolerate the optimal dose of metformin, the original 1000 or 1500 mg/day basis can be maintained Add other hypoglycemic drugs
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Q3.
In patients with T2DM treated with the consensus triple regimen in clinical practice, if there is a significant weight loss, high sensitivity to drugs, or low blood sugar, and the patient wants to withdraw the drug, is it Is there a fallback plan? Professor Xiao Xinhua pointed out that drug regression needs to be analyzed according to the specific conditions of the patient, and the drug to be discontinued should be selected according to the patient's most obvious symptoms (weight loss, gastrointestinal reaction, etc.
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Concluding remarks Through detailed explanations of metformin from various angles by experts, we have a deeper understanding of metformin
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At present, there are many kinds of drugs on the market.
How to apply the drugs to maximize the efficacy of the drugs in clinical application and make patients have greater benefits has become a topic of common discussion.
I hope this event can provide you with the use of metformin in clinical work.
More help
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With the advancement of science, people's exploration of diabetes has never stopped.
The authoritative guide is constantly updated, which promotes the continuous improvement of diabetes treatment.
Metformin is still the first-line hypoglycemic drug unanimously recommended by the authoritative guide.
We look forward to future explorations.
, Metformin will also bring us new surprises
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In the next second meeting, every big coffee will bring you the "Internet Era of Chronic Disease Management", so stay tuned!