New Era, Shared Future - Glutide Summit Leading the Trend, GLP-1RA Spectrum New Chapter

*For medical professionals to read for reference GLP-1RA opens up a new pattern of hypoglycemia Personal, family and medical resources
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With the rapid economic development, life>
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 On April 23, 2022, the Novo Nordglutide Summit was held in Beijing
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At this meeting, domestic and foreign experts in the field of endocrinology gathered to discuss the current status of diabetes treatment and provide new ideas for improving the status of diabetes treatment
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At the same time, this conference was linked online and offline.
During the conference, all colleagues actively participated in the discussion, and provided new experience for clinical practice through sharing and communication
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At the beginning of the meeting, Mr.
He Ruike, Corporate Vice President of Marketing Department of Novo Nordisk, Professor Chen Liming of Tianjin Medical University Zhu Xianyi Memorial Hospital, and Professor Mu Yiming of Chinese People's Liberation Army General Hospital delivered opening speeches
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Mr.
He Ruike delivered a speech and expressed his welcome to all the experts and scholars who attended the conference.
He looked forward to participating in the grand event in the field of diabetes treatment and discussing the future with everyone through this conference
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Professor Chen Liming said in his speech that in the process of changing diabetes, experts and scholars have jointly opened a new era after another, and witnessed one milestone after another in the field of treatment
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The treatment concept was gradually changed from simple sugar control to sugar control while reducing the incidence of cardiovascular and cerebrovascular complications and mortality
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Glucagon-like peptide-1 receptor agonist (GLP-1RA) drugs have accumulated a large amount of evidence-based medical evidence in recent years, and their status in the guidelines has gradually improved, providing a favorable means for patients to obtain satisfactory treatment.
It is believed that With the accumulation of treatment experience and the support of evidence-based medicine, we can continuously enrich the use of innovative drugs and bring a better future to more Chinese diabetic patients
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Professor Yoshiaki Mu said that this meeting will discuss the latest progress in the field of diabetes
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GLP-1RA is a landmark drug in the field of diabetes treatment.
When GLP-1RA is the first choice drug for diabetic patients, especially those with cardiovascular disease, it can really bring more benefits to patients
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It is hoped that through the exchange of this meeting, more clinicians can learn about the latest progress of GLP-1RA and how to rationally select such drugs for patients, so that more patients can benefit from it
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Finally, I would like to thank the conference for the invitation and wish the conference a complete success
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 Guide pilot, evidence-based The latest epidemiological data show that the number of adults with diabetes in the world is 537 million, and it is expected to increase to 783 million by 2045.
At present, the total number of diabetes patients in China is about 140 million, ranking first in the world [1] ]
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Professor Ji Linong of Peking University People's Hospital stated that type 2 diabetes mellitus (T2DM) is the most common type of diabetes, accounting for more than 90% of all diabetes in the world [2]
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In China, more than one-third of T2DM patients have cardiovascular disease (CVD) [3], and CVD is the leading cause of death in T2DM patients [4]
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Based on this, the American Diabetes Association (ADA) issued the "Standards for Diabetes Care (2022 Edition)" (hereinafter referred to as "ADA Guidelines (2022 Edition)") to update the drug treatment pathway for T2DM hyperglycemia.
For T2DM patients with cardiovascular disease (ASCVD) or high risk factors, heart failure and/or chronic kidney disease, GLP-1RA or sodium-glucose cotransporter-2 inhibitor (SGLT-2i) can be selected as initial treatment options, according to Hypoglycemic needs with or without metformin [5]
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The results of a large number of cardiovascular outcome trials (CVOT) showed that some GLP-1RAs, including semaglutide and liraglutide, can reduce the risk of major adverse cardiovascular events (MACE) in patients with T2DM [5]
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 In addition, the "ADA Guidelines (2022 Edition)" recommends the use of dipeptidyl peptidase IV inhibitors (DPP-4i with no/low hypoglycemia risk) for T2DM patients without ASCVD and who need to minimize the risk of hypoglycemia.
), GLP-1RA, SGLT-2i, thiazolidinedione (TZD) hypoglycemic drugs, if sulfonylurea (SU) or basal insulin is used, categories with lower risk of hypoglycemia should be considered; for those without ASCVD and For T2DM patients who need to minimize the risk of weight gain, it is recommended to use GLP-1RA or SGLT-2i with good weight loss effect[5]
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 With the aging of China's population, the health problems of elderly patients with diabetes cannot be ignored
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Professor Guo Lixin from Beijing Hospital gave a detailed explanation of the "Guidelines for Diabetes in the Elderly in China (2021 Edition)" [6] (hereinafter referred to as the "Guidelines")
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Professor Guo said that the latest data shows that the number of elderly diabetic patients in China is as high as 35.
5 million, the prevalence rate is the highest in the world, and the management of elderly diabetes needs to be standardized
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 Because elderly diabetic patients have the characteristics of many complications and/or concomitant diseases, atypical symptoms, high risk of hypoglycemia, and poor self-management ability of patients, they have their own particularities in the formulation of hypoglycemic goals and the principles of drug selection.

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Reasonable blood glucose control goals should be formulated according to the health status of elderly T2DM patients
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In terms of drug selection, the "Guidelines" clearly point out that the following principles should be followed: (1) Drugs with low risk of hypoglycemia should be selected first; (2) Drugs with simple and high compliance should be selected; (3) The benefit-risk ratio should be weighed to avoid Excessive treatment; (4) Pay attention to factors such as organ function, complications and concomitant diseases
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The combination of life>
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 At the same time, Professor Guo pointed out that other comorbidities should be taken into account in the treatment of elderly diabetic patients.
For the common comorbidities of elderly diabetic patients, we should make timely diagnosis, early intervention and improve prognosis
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Common comorbidities in elderly diabetic patients include obstructive sleep apnea syndrome (OSAS), cognitive impairment, hypotension, and sleep disturbance
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GLP-1RA can improve the metabolic state and ventilatory function in patients with OSAS [7-8], and has the potential to reduce the risk of cognitive decline in T2DM patients [9-10], enabling elderly diabetic patients to obtain ideal curative effects
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 Going back to the source, "resisting" diabetes is a global health problem that affects an increasing number of adults and even younger individuals around the world
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Professor Liu Ming from the General Hospital of Tianjin Medical University said that among the diabetic population, about 90% are T2DM patients with insulin resistance as the core pathogenesis [2]
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Under normal circumstances, the combination of insulin and receptors activates downstream signaling pathways and exerts a variety of physiological effects [11]
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When there is excess energy, adipocyte hypertrophy and tissue fibrosis lead to increased levels of free fatty acids and cytokines.
Free fatty acids and cytokines promote insulin resistance in cells through various pathways [11]
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 At the same time, Professor Liu pointed out the harm of insulin resistance to the human body: when insulin resistance occurs, peripheral tissues are not sensitive to insulin action, causing blood sugar to rise [11].
The more severe the insulin resistance, the worse the control of blood pressure and blood lipids [12].
Insulin resistance also increases the risk of cardiovascular disease [13]
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 GLP-1RA is an important weapon to improve insulin resistance.
GLP-1RA weekly preparation semaglutide can play a role in multiple aspects of insulin resistance, including suppressing appetite [14], suppressing excess energy from the source [15], reducing Fat accumulation [15], up-regulation of adiponectin level [16], reduction of free fatty acid and cytokine levels [17-19], increase of glucose transporter-4 (GLUT-4) expression [20]
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Large-scale clinical studies have shown [17, 18, 21] that liraglutide and semaglutide can significantly improve insulin resistance index homeostasis model assessment of insulin resistance index (HOMA-IR), and solve the problem of blood sugar control from the source
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 Safe sugar control, stable as "Taishan" diabetes treatment emphasizes comprehensive management, of which blood sugar management is particularly important
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Hyperglycemia is closely related to microvascular complications [22] and cardiovascular disease [23], and can cause damage to systemic blood vessels through multiple pathways [24]
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Hypoglycemia increases the risk of microvascular events and cardiovascular death [25, 26], and induces vascular complications through various mechanisms [27]
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At the same time, large blood sugar fluctuations also increase the incidence of microalbuminuria and the risk of cardiovascular disease [28, 29]
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 Are there any good strategies to optimize blood sugar management? Professor Shi Lixin from Guizhou International General Hospital answered this question
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Professor Shi pointed out that semaglutide may help us further manage blood sugar
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In the SUSTAIN series of studies including Chinese population data [17, 18, 30-36], compared with the control group, the glycated hemoglobin (HbA1c), fasting blood glucose, postprandial blood glucose level and mean 7-point blood glucose in the semaglutide group significantly reduced
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Regardless of the course of disease, baseline body mass index (BMI) and background therapy, semaglutide can significantly reduce blood sugar, while semaglutide monotherapy has no serious or confirmed hypoglycemia, and can reduce blood sugar fluctuations, which is significantly better than other control drugs
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It can be seen that semaglutide is an important means of blood sugar management in diabetic patients and a new beneficial "weapon" for diabetes treatment
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 Going forward in multiple dimensions, looking forward to the future, the current situation of diabetes in China is not optimistic, and the proportion of Chinese diabetic patients whose blood sugar meets the standard is less than 50% [37]
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Studies have shown that 75.
7% of T2DM patients in China have hypertension [38], 42% of T2DM patients have dyslipidemia [39], and 58.
3% of T2DM patients have overweight/obesity [39].
ASCVD related [40]
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Based on the above status quo, we urgently need a multi-dimensional and simultaneous control of blood sugar, which can control blood sugar and take into account the complications of diabetes
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Professor Filip Knop from the University of Copenhagen in Denmark pointed out that GLP-1RA can control blood sugar and cardiovascular disease risk through multiple pathways
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GLP-1RA can promote insulin secretion and inhibit glucagon secretion, thereby exerting hypoglycemic effect.
At the same time, GLP-1RA can also reduce body weight, lower blood pressure, improve blood lipid profile, reduce atherosclerotic plaque and reduce systemic inflammatory response.
The "good medicine" for diabetes treatment
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 At the end of the conference, Ms.
Gao Kun, Vice President of Novo Nordisk Emerging Business Division, delivered a closing speech
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Ms.
Gao Kun first expressed her gratitude to all experts, scholars and participants, and then Ms.
Gao Kun said that with the continuous improvement of GLP-1RA in the guidelines, the treatment of diabetes ushered in a new era, and Novo Nordisk looked forward to working with you Experts and scholars join hands to overcome diabetes and help realize the healthy Chinese dream
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 At present, the management concept of diabetes has changed from the original "simple sugar control" to "comprehensively improving the cardio-renal outcomes and taking into account blood sugar control"
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Therefore, for hypoglycemic drugs, it is the current development trend to improve the prognosis of cardiovascular disease while effectively reducing blood sugar
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GLP-1RA can effectively lower blood sugar while having clear cardiovascular benefits, bringing a new beginning for the treatment of T2DM, bringing new hope to patients, and accelerating the development, marketing and clinical application of GLP-1RA hypoglycemic drugs.
As the top priority of diabetes treatment, it is expected that GLP-1RA will open up a new generation for T2DM treatment in the future
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It is full of dry goods, not to be missed! References: [1].
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