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*For medical professionals to read and refer to the latest concept of diabetes complications diagnosis and treatment at the grassroots level.
China's 3B study shows that among outpatients with type 2 diabetes (T2DM), 14.
6% of patients have cardiovascular disease, and 10.
1% of patients have included Cerebrovascular diseases including ischemic stroke [1].
At the same time, about 20%-40% of diabetic patients in my country have diabetic nephropathy [2].
Diabetic macrovascular and microvascular complications seriously threaten the health of diabetic patients.
Atherosclerotic cardiovascular disease (ASCVD) is still the main cause of death in diabetic patients[3], and diabetic nephropathy has become the main cause of end-stage renal disease[1] .
Therefore, diabetic patients not only need to control blood sugar scientifically and reasonably, but also actively intervene and prevent their vascular complications and related risks.
In order to promote the achievement of this goal, from March 2020 to May 2021, the "Type 2 Diabetes and Related Vascular Complications Management Education and Training Project" initiated by the Chinese Society for Geriatric Healthcare and Medical Research will be held in Nanjing, Guiyang, Kunming, and Shanghai.
Waiting for the smooth landing in many places across the country, such as the Spark of Liaoyuan, illuminates the management of diabetes complications.
On May 9, 2021, the project summary meeting was held in Nanjing.
Zhu Dalong, Shi Lixin, Shi Yongquan, Xue Yaoming, Professor Su Qing and other domestic endocrinologists attended the meeting to jointly release project results, encourage and commend outstanding students, and outstanding students also participated Sharing of clinical experience.
Combining online and offline to start complications management.
Professor Zhu Dalong pointed out that the original intention of the "Type 2 Diabetes and Related Vascular Complications Management Education and Training Program" was to enable clinicians in my country to have a timely and comprehensive understanding of the latest developments in the long-term comprehensive management of diabetes.
The guideline is updated to share the knowledge of the prevention and clinical management of diabetic heart, brain and kidney disease risks, improve the practical ability of clinical diagnosis, treatment and management of diabetic patients, and reduce the long-term family burden and social and economic burden of patients.The project invites well-known endocrinologists from all over the country to build a cloud platform for medical and health education and training based on the latest developments in the long-term comprehensive management of diabetes and guide updates, relying on the "Internet +" medical education and popular science service model to provide online and offline diversified medicine Education and training courses, multi-disciplinary exchanges and training, and popularization of practical and appropriate technologies.
Professor Lixin Shi introduced that from the Nanjing station on August 6, 2020 to the end of the Shanghai station on March 20, 2021, 11 offline education meetings will comprehensively improve the level of doctors' management of diabetes and complications (Figure 1) .
Each education meeting lasts for half a day, with 4-6 expert committee members attending.
50 trainees from the region will combine the latest developments in the long-term comprehensive management of diabetes and guide updates, and focus on the management and prevention of diabetic heart, brain and kidney complications.
, The form of development includes lectures, case analysis, discussion and Q&A, etc.
Figure 1 The offline education meeting of the project improved the concept of diagnosis and treatment on the spot, and the training was full of results.
In order to understand the effects of the training, a questionnaire survey was conducted for the "Type 2 Diabetes and Related Vascular Complication Management Education Training" project.
The vast majority of the hospitals participating in the survey are Class III and Class II hospitals, accounting for 83.
5%.
99% of the physicians have a college degree or above, and the proportion of attending physicians is the highest (43.
2%).
Professor Shi Lixin believes that the training has been full of rewards and has achieved the expected results.
After training, more than 90% of doctors use guidelines/consensus as an important tool for primary clinicians to prescribe hypoglycemic drugs.
The proportion of doctors who prescribe according to the instructions has dropped from 35.
8% to 20.
6%.
The concept of doctors for regular follow-up of patients has improved.
; The proportion of doctors with comprehensive diabetes management concepts has increased from 93% to 98%.
When prescribing hypoglycemic drugs, clinicians are more concerned about the efficacy of hypoglycemic drugs and the effects of hypoglycemic drugs on body weight, liver and kidney function, and cardiovascular disease (Figure 2).
At the same time, as many as 98% and 97% of doctors are more advanced in cardiovascular risk assessment and kidney disease screening.
In recent years, a number of large-scale clinical studies have confirmed that glucagon-like peptide-1 receptor agonists (GLP-1RA) have cardio-renal protection, and are recommended diseases by domestic and foreign guidelines [2,3], but in clinical use Insufficient implementation.
Training has promoted the use of GLP-1RA in patients with diabetes and cardiorenal complications.
For T2DM patients with ASCVD, the proportion of doctors who choose GLP-1RA as a treatment drug has increased from 63% to 72% (Figure 3); For T2DM patients with chronic kidney disease, the proportion of doctors choosing GLP-1RA as a treatment drug has also increased from 33% to 42%.
In general, the proportion of doctors choosing GLP-1RA to treat diabetic heart and kidney diseases has increased from 88% to 98%.
Figure 2 Comparison of clinicians' attention to hypoglycemic drugs before and after training Figure 3 The proportion of doctors choosing new hypoglycemic drugs to treat patients with T2DM and ASCVD after training has increased.
For patients with good blood sugar control but combined with high cardiovascular risk factors, whether to consider combining GLP -1RA? As many as 91% of doctors have made a positive choice, which is consistent with the guidelines recommended.
Eleven clinicians who participated in the training including Gui Li from the Third People’s Hospital of Yunnan Province were awarded the title of Excellent Speakers.
The cases provided by 10 doctors including Cui Lijuan from the Third People’s Hospital of Huizhou City were rated as excellent cases.
The best case was Sichuan Province People’s Hospital.
Cases provided by Dr.
Yang Yi.
On behalf of the project team, Professor Zhu Dalong expressed congratulations and thanks to the winners.
Figure 4 The winners of the title of outstanding speaker and the winner of outstanding cases and their hospitals improve the status of diabetes management: a single spark can start a prairie fire.
In our country, there are still many problems in the prevention and treatment of diabetes, such as the relative lack of medical resources, unbalanced distribution, The doctor-patient ratio is severely unbalanced and the effective control rate is low.
The level of diagnosis and treatment of metabolic diseases in various regions and hospitals at all levels in my country is uneven.
The endocrinology department and other physicians' mastery of the guidelines and the ability to use diagnosis and treatment knowledge need to be further improved.
The early warning and early prevention and treatment of diabetes and its complications in my country are urgent, and the current status of diabetes management urgently needs to be further improved.
In the past two decades, the United States has made considerable progress in the prevention and control of diabetes.
One of the important reasons is to actively promote the quality improvement of medical and health care [4], which is worthy of domestic use for reference. The "Type 2 Diabetes and Related Vascular Complications Management Education and Training Program" effectively promoted the renewal of clinicians' diabetes management concepts, especially the changes in the management concepts of diabetic vascular complications, thereby effectively improving the standardized management of chronic diseases by front-line doctors And comprehensive management capabilities, and ultimately help patients delay the occurrence and development of diabetic vascular complications.
Professor Zhu Dalong pointed out that this kind of continuing education programs should not only be carried out among doctors in second and third-level hospitals, but also should pay attention to the desire for knowledge of grassroots doctors who lack learning opportunities.
Future training programs will not only be a journey of lowering blood sugar, but also focus on preventing cardiovascular events, improving heart failure and renal insufficiency end-point events, to comprehensively manage patients.
A single spark can start a prairie fire.
I look forward to the normalization and further optimization of the project in the future.
It will continue to be promoted and implemented in hospitals below the third level, covering doctors at all levels, and strengthen their learning and practice of the guidelines, so that the project will become the quality of diabetes management.
As the driving force for improvement, it is also hoped that more companies will participate in a more diversified form to jointly improve the management of diabetes complications in my country and help achieve the goal of "Healthy China 2030".
Summary The vascular complications of diabetes seriously endanger the health of diabetic patients and shorten their lifespan.
Standardized early prevention and treatment of diabetes complications is imminent.
The one-year "Type 2 Diabetes and Related Vascular Complications Management Education and Training Project" gave primary clinicians the latest diabetic complications diagnosis and treatment concepts, and comprehensively improved their diabetes and complications management level.
References [1] Ji L, et al.
Am J Med, 2013, 126(10): 925.
e11-22.
[2] Diabetes Branch of Chinese Medical Association.
Chinese Journal of Diabetes, 2021, 13(4):315 -408.
[3] American Diabetes Association.
Diabetes Care, 2021, 44(Suppl 1):S125-S150.
[4] Marjoua Y, Bozic KJ.
Curr Rev Musculoskelet Med.
2012, 5(4).
China's 3B study shows that among outpatients with type 2 diabetes (T2DM), 14.
6% of patients have cardiovascular disease, and 10.
1% of patients have included Cerebrovascular diseases including ischemic stroke [1].
At the same time, about 20%-40% of diabetic patients in my country have diabetic nephropathy [2].
Diabetic macrovascular and microvascular complications seriously threaten the health of diabetic patients.
Atherosclerotic cardiovascular disease (ASCVD) is still the main cause of death in diabetic patients[3], and diabetic nephropathy has become the main cause of end-stage renal disease[1] .
Therefore, diabetic patients not only need to control blood sugar scientifically and reasonably, but also actively intervene and prevent their vascular complications and related risks.
In order to promote the achievement of this goal, from March 2020 to May 2021, the "Type 2 Diabetes and Related Vascular Complications Management Education and Training Project" initiated by the Chinese Society for Geriatric Healthcare and Medical Research will be held in Nanjing, Guiyang, Kunming, and Shanghai.
Waiting for the smooth landing in many places across the country, such as the Spark of Liaoyuan, illuminates the management of diabetes complications.
On May 9, 2021, the project summary meeting was held in Nanjing.
Zhu Dalong, Shi Lixin, Shi Yongquan, Xue Yaoming, Professor Su Qing and other domestic endocrinologists attended the meeting to jointly release project results, encourage and commend outstanding students, and outstanding students also participated Sharing of clinical experience.
Combining online and offline to start complications management.
Professor Zhu Dalong pointed out that the original intention of the "Type 2 Diabetes and Related Vascular Complications Management Education and Training Program" was to enable clinicians in my country to have a timely and comprehensive understanding of the latest developments in the long-term comprehensive management of diabetes.
The guideline is updated to share the knowledge of the prevention and clinical management of diabetic heart, brain and kidney disease risks, improve the practical ability of clinical diagnosis, treatment and management of diabetic patients, and reduce the long-term family burden and social and economic burden of patients.The project invites well-known endocrinologists from all over the country to build a cloud platform for medical and health education and training based on the latest developments in the long-term comprehensive management of diabetes and guide updates, relying on the "Internet +" medical education and popular science service model to provide online and offline diversified medicine Education and training courses, multi-disciplinary exchanges and training, and popularization of practical and appropriate technologies.
Professor Lixin Shi introduced that from the Nanjing station on August 6, 2020 to the end of the Shanghai station on March 20, 2021, 11 offline education meetings will comprehensively improve the level of doctors' management of diabetes and complications (Figure 1) .
Each education meeting lasts for half a day, with 4-6 expert committee members attending.
50 trainees from the region will combine the latest developments in the long-term comprehensive management of diabetes and guide updates, and focus on the management and prevention of diabetic heart, brain and kidney complications.
, The form of development includes lectures, case analysis, discussion and Q&A, etc.
Figure 1 The offline education meeting of the project improved the concept of diagnosis and treatment on the spot, and the training was full of results.
In order to understand the effects of the training, a questionnaire survey was conducted for the "Type 2 Diabetes and Related Vascular Complication Management Education Training" project.
The vast majority of the hospitals participating in the survey are Class III and Class II hospitals, accounting for 83.
5%.
99% of the physicians have a college degree or above, and the proportion of attending physicians is the highest (43.
2%).
Professor Shi Lixin believes that the training has been full of rewards and has achieved the expected results.
After training, more than 90% of doctors use guidelines/consensus as an important tool for primary clinicians to prescribe hypoglycemic drugs.
The proportion of doctors who prescribe according to the instructions has dropped from 35.
8% to 20.
6%.
The concept of doctors for regular follow-up of patients has improved.
; The proportion of doctors with comprehensive diabetes management concepts has increased from 93% to 98%.
When prescribing hypoglycemic drugs, clinicians are more concerned about the efficacy of hypoglycemic drugs and the effects of hypoglycemic drugs on body weight, liver and kidney function, and cardiovascular disease (Figure 2).
At the same time, as many as 98% and 97% of doctors are more advanced in cardiovascular risk assessment and kidney disease screening.
In recent years, a number of large-scale clinical studies have confirmed that glucagon-like peptide-1 receptor agonists (GLP-1RA) have cardio-renal protection, and are recommended diseases by domestic and foreign guidelines [2,3], but in clinical use Insufficient implementation.
Training has promoted the use of GLP-1RA in patients with diabetes and cardiorenal complications.
For T2DM patients with ASCVD, the proportion of doctors who choose GLP-1RA as a treatment drug has increased from 63% to 72% (Figure 3); For T2DM patients with chronic kidney disease, the proportion of doctors choosing GLP-1RA as a treatment drug has also increased from 33% to 42%.
In general, the proportion of doctors choosing GLP-1RA to treat diabetic heart and kidney diseases has increased from 88% to 98%.
Figure 2 Comparison of clinicians' attention to hypoglycemic drugs before and after training Figure 3 The proportion of doctors choosing new hypoglycemic drugs to treat patients with T2DM and ASCVD after training has increased.
For patients with good blood sugar control but combined with high cardiovascular risk factors, whether to consider combining GLP -1RA? As many as 91% of doctors have made a positive choice, which is consistent with the guidelines recommended.
Eleven clinicians who participated in the training including Gui Li from the Third People’s Hospital of Yunnan Province were awarded the title of Excellent Speakers.
The cases provided by 10 doctors including Cui Lijuan from the Third People’s Hospital of Huizhou City were rated as excellent cases.
The best case was Sichuan Province People’s Hospital.
Cases provided by Dr.
Yang Yi.
On behalf of the project team, Professor Zhu Dalong expressed congratulations and thanks to the winners.
Figure 4 The winners of the title of outstanding speaker and the winner of outstanding cases and their hospitals improve the status of diabetes management: a single spark can start a prairie fire.
In our country, there are still many problems in the prevention and treatment of diabetes, such as the relative lack of medical resources, unbalanced distribution, The doctor-patient ratio is severely unbalanced and the effective control rate is low.
The level of diagnosis and treatment of metabolic diseases in various regions and hospitals at all levels in my country is uneven.
The endocrinology department and other physicians' mastery of the guidelines and the ability to use diagnosis and treatment knowledge need to be further improved.
The early warning and early prevention and treatment of diabetes and its complications in my country are urgent, and the current status of diabetes management urgently needs to be further improved.
In the past two decades, the United States has made considerable progress in the prevention and control of diabetes.
One of the important reasons is to actively promote the quality improvement of medical and health care [4], which is worthy of domestic use for reference. The "Type 2 Diabetes and Related Vascular Complications Management Education and Training Program" effectively promoted the renewal of clinicians' diabetes management concepts, especially the changes in the management concepts of diabetic vascular complications, thereby effectively improving the standardized management of chronic diseases by front-line doctors And comprehensive management capabilities, and ultimately help patients delay the occurrence and development of diabetic vascular complications.
Professor Zhu Dalong pointed out that this kind of continuing education programs should not only be carried out among doctors in second and third-level hospitals, but also should pay attention to the desire for knowledge of grassroots doctors who lack learning opportunities.
Future training programs will not only be a journey of lowering blood sugar, but also focus on preventing cardiovascular events, improving heart failure and renal insufficiency end-point events, to comprehensively manage patients.
A single spark can start a prairie fire.
I look forward to the normalization and further optimization of the project in the future.
It will continue to be promoted and implemented in hospitals below the third level, covering doctors at all levels, and strengthen their learning and practice of the guidelines, so that the project will become the quality of diabetes management.
As the driving force for improvement, it is also hoped that more companies will participate in a more diversified form to jointly improve the management of diabetes complications in my country and help achieve the goal of "Healthy China 2030".
Summary The vascular complications of diabetes seriously endanger the health of diabetic patients and shorten their lifespan.
Standardized early prevention and treatment of diabetes complications is imminent.
The one-year "Type 2 Diabetes and Related Vascular Complications Management Education and Training Project" gave primary clinicians the latest diabetic complications diagnosis and treatment concepts, and comprehensively improved their diabetes and complications management level.
References [1] Ji L, et al.
Am J Med, 2013, 126(10): 925.
e11-22.
[2] Diabetes Branch of Chinese Medical Association.
Chinese Journal of Diabetes, 2021, 13(4):315 -408.
[3] American Diabetes Association.
Diabetes Care, 2021, 44(Suppl 1):S125-S150.
[4] Marjoua Y, Bozic KJ.
Curr Rev Musculoskelet Med.
2012, 5(4).
