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*Only for medical professionals to read for reference, there is a new "Consensus" for the diagnosis and treatment of diabetes combined with cardiovascular disease! Diabetes is the most important comorbidity of cardiovascular disease (CVD).
The risk of cardiovascular disease in patients with diabetes is about 2.
5 times that of non-diabetic people [1].
CVD is also the main cause of death and disability in patients with type 2 diabetes (T2DM).
.
In order to strengthen the comprehensive management of patients and improve the prognosis of patients, the National Health Commission’s Capacity Building and Continuing Education Center organized experts from the Department of Cardiology and Endocrinology to compile the Expert Consensus on the Diagnosis and Treatment of Cardiovascular Disease in Diabetic Patients (hereinafter referred to as the Consensus) [ 2].
On June 6, 2021, the "Consensus" conference was held in Beijing
.
Figure 1 The launch ceremony of the press conference.
This interdisciplinary "Consensus" will be of great help to both cardiology and endocrinologists.
What are the key points and highlights of the "Consensus"? The medical community invited one of the corresponding authors of the "Consensus"-Professor Ma Changsheng from the Cardiology Center of Beijing Anzhen Hospital Affiliated to Capital Medical University, and the first author of "Consensus"-Professor Sun Yihong from the Department of Cardiology, China-Japan Friendship Hospital, to share
.
The new concept of "Consensus" of "General Internal Medicine" helps doctors "do something" Professor Ma Changsheng's interview video talked about the role and significance of "Consensus".
Professor Ma Changsheng pointed out that the purpose of "Consensus" is to teach cardiologists to manage diabetes well, and at the same time It also provides assistance to endocrinologists in the management of cardiovascular diseases
.
It is hoped that through the popularization of the "Consensus", it can be achieved: Unless it is a complicated condition, there is no need for patients with diabetes and CVD to travel to different departments for medical treatment.
It can be effectively solved in the cardiology or endocrinology department, thereby greatly improving patient management Quality and efficiency
.
Analyze three bright spots: rational use of drugs to optimize goals and improve patient prognosis Professor Ma Changsheng introduced the three bright spots in the "Consensus"
.
First of all, Professor Ma pointed out that for patients with T2DM combined with CVD, the "Consensus" introduced to cardiologists a new type of hypoglycemic drugs that can effectively reduce blood sugar and improve prognosis, including glucagon-like drugs.
Peptide-1 receptor agonist (GLP-1RA) and sodium-glucose cotransporter-2 inhibitor (SGLT-2i) are two categories, and the use of drugs is introduced in detail and clearly
.
Secondly, the "Consensus" recommends that the blood pressure target be set at 130/80mmHg is also a highlight
.
Professor Ma said that the publication of the results of the SPRINT study in 2015 found that patients with blood pressure control at 130/80mmHg benefited significantly better than 140/90mmHg, which had a huge impact on the field of hypertension prevention and treatment
.
Afterwards, the "Guidelines for the Prevention and Treatment of Hypertension in China" pointed out that the general hypertension patients should be reduced to <140/90 mmHg, and those who can tolerate it and some patients with high risk and above can be further reduced to <130/80 mmHg
.
However, this time the "Consensus" is different.
It proposes that the blood pressure reduction target of diabetes combined with CVD is <130/80mmHg, and if it cannot be tolerated, it can be relaxed to <140/90 mmHg
.
"The different order reflects the different concepts
.
" Professor Ma said, "The emphasis is different
.
" Analysis key points: The condition of comorbid patients is complicated, and treatment needs to be "balanced" Professor Ma Changsheng interview video for patients with T2DM combined with CVD , It is necessary to control glucose, improve cardiovascular risk factors and improve prognosis.
Therefore, the "Consensus" recommends new hypoglycemic drugs.
Professor Ma said: "We recommend new drugs because of sufficient evidence.
It can not only reduce Sugar, if used, can also help patients improve the prognosis, then we will use it
.
"The Consensus" makes clear recommendations for cardiovascular professional doctors, which will help these drugs with clear evidence of cardiovascular benefit (such as GLP-1RA liraglutide) to be rationally used to help patients benefit
.
For T2DM combined The "Consensus" also gives detailed advice on how to use drugs and how to treat CVD and chronic kidney disease (CKD) in a complex condition.
For example, if the patient has diabetes with end-stage renal disease, the blood sugar control goal can be appropriately relaxed
.
Professor Ma said that the treatment process needs to pay attention to "balance", and doctors should try their best to do something, even for patients with end-stage disease, some indicators can also be partially improved to help patients extend their life expectancy and improve their quality of life
.
Two departments Working together to help more patients benefit from new drugs.
Professor Sun Yihong’s interview video talked about the formulation of the “Consensus”.
Professor Sun Yihong pointed out that the comorbidity of diabetes and cardiovascular disease is very common in clinical practice.
Therefore, for the diagnosis and treatment of such patients’ diseases, It is also an issue that both endocrinologists and cardiologists are particularly concerned about
.
Starting from three aspects, the main content of the "Consensus" is introduced by these professors.
In general, the "Consensus" mainly deals with the management of patients with diabetes and CVD from three aspects.
Key explanations and recommendations: The first aspect is the management of cardiovascular risk factors in patients with diabetes mellitus and CVD, such as how to control blood pressure, how to set blood lipid target values, and how to deal with diseases such as heart failure and coronary heart disease.
Targeted drug treatment is also something that endocrinologists want to know about
.
The second aspect is how to better manage diabetes and improve prognosis for diabetic patients with CVD
.
This part includes life>
.
the last part is particularly concerned about the problem of clinicians - special populations of disease management, including diabetic nephropathy, advanced age (> 75 years), cardiovascular disorders such critically ill patients
.
The evidence is sufficient.
The "Consensus" recommends new drugs for blood glucose management.
Professor Sun Yihong's interview video.
In terms of blood glucose management, the "Consensus" gives recommended drug treatment routes and recommends hypoglycemic drugs with cardiovascular benefits
.
Professor Sun said that this is actually an area that cardiologists have paid special attention to in recent years
.
There are many types of hypoglycemic drugs, and there have been few clinical trials on the effects of hypoglycemic drugs on cardiovascular events
.
After the Avandia incident, the U.
S.
Food and Drug Administration (FDA) mandated that newly marketed hypoglycemic drugs need to pass a cardiovascular outcome study (CVOT) to verify the cardiovascular safety of the drug
.
Such requirements have brought some challenges to hypoglycemic drugs, as well as some opportunities
.
It is against this background that people have discovered that there are two new types of hypoglycemic drugs—GLP-1RA and SGLT-2i, some of which have clear cardiovascular protective effects in people with diabetes
.
Professor Sun further introduced that although metformin also has potential cardiovascular benefits through subgroup analysis, the above two drugs (GLP-1RA and SGLT-2i) have been confirmed by clinical studies with rigorous design and large sample size.
And it has been repeatedly clinically verified to clarify its benefits
.
However, there is a slight difference between the two.
GLP-1RA is more prominent in reducing atherosclerotic events, while SGLT-2i is helpful in reducing heart failure-related events
.
Therefore, in the "Consensus", the writing expert group has been fully discussed and referred to important guidelines in the field of diabetes at home and abroad, and still regards metformin as the first-line recommended drug, while GLP-1RA and SGLT-2i have sufficient evidence.
》It is pointed out that for patients who do not meet the standard of glycosylated hemoglobin (HbA1c) or have contraindications or intolerance to metformin, and are mainly associated with atherosclerotic cardiovascular disease (ASCVD), it is recommended to choose GLP-1RA (such as liraglutide).
) Or SGLT-2i; for patients with congestive heart failure, the combined use of SGLT-2i is preferred.
If SGLT-2i has contraindications, GLP-1RA may be considered
.
Starting from the "Consensus", strengthening cooperation and benefiting patients.
Professor Sun Yihong's interview video hopes that the release of the "Consensus" can help endocrinologists learn more about some cardiovascular-related normative issues that need to be paid attention to in the diagnosis and treatment of patients with diabetes and CVD.
With cutting-edge progress, it is also hoped that cardiologists will learn more about how to manage blood sugar for such patients and how to use medication to bring more benefits to patients.
At the same time, I hope that the cooperation between the two departments can be strengthened
.
For these hypoglycemic drugs with cardiovascular benefits, cardiologists also highly approve.
It is hoped that through the promotion of this "Consensus", combined with the corresponding evidence-based evidence in the cardiovascular field, more patients with diabetes and CVD will be able to The use of such drugs has resulted in benefits and improved prognosis
.
Summary Diabetes is the most important comorbid disease of CVD, and CVD is the main cause of death and disability in patients with T2DM
.
These two diseases span two departments, but often converge in the same patient
.
This "Consensus" brings together the cutting-edge progress and the latest concepts of the two disciplines, and provides references for doctors in the fields of endocrinology and cardiovascular, and even general practitioners
.
Therefore, it is hoped that through the release of the "Consensus", comprehensive prevention and management capabilities such as diabetes and cardiovascular diseases can be improved in multiple dimensions, and ultimately improve the prognosis of patients
.
References: 1.
Franco OH, et al.
Archives of Internal Medicine.
2007;167(11):1145-1151.
2.
National Health Commission Capacity Building and Continuing Education Center, etc.
Chinese Journal of Internal Medicine.
2021;60(5) :421-437.
This article is only used to provide scientific information to medical and health professionals, and does not represent the position of the platform-End-Contribution/reprint/business cooperation, please contact: yxjxxg@yxj.
org.
cn
The risk of cardiovascular disease in patients with diabetes is about 2.
5 times that of non-diabetic people [1].
CVD is also the main cause of death and disability in patients with type 2 diabetes (T2DM).
.
In order to strengthen the comprehensive management of patients and improve the prognosis of patients, the National Health Commission’s Capacity Building and Continuing Education Center organized experts from the Department of Cardiology and Endocrinology to compile the Expert Consensus on the Diagnosis and Treatment of Cardiovascular Disease in Diabetic Patients (hereinafter referred to as the Consensus) [ 2].
On June 6, 2021, the "Consensus" conference was held in Beijing
.
Figure 1 The launch ceremony of the press conference.
This interdisciplinary "Consensus" will be of great help to both cardiology and endocrinologists.
What are the key points and highlights of the "Consensus"? The medical community invited one of the corresponding authors of the "Consensus"-Professor Ma Changsheng from the Cardiology Center of Beijing Anzhen Hospital Affiliated to Capital Medical University, and the first author of "Consensus"-Professor Sun Yihong from the Department of Cardiology, China-Japan Friendship Hospital, to share
.
The new concept of "Consensus" of "General Internal Medicine" helps doctors "do something" Professor Ma Changsheng's interview video talked about the role and significance of "Consensus".
Professor Ma Changsheng pointed out that the purpose of "Consensus" is to teach cardiologists to manage diabetes well, and at the same time It also provides assistance to endocrinologists in the management of cardiovascular diseases
.
It is hoped that through the popularization of the "Consensus", it can be achieved: Unless it is a complicated condition, there is no need for patients with diabetes and CVD to travel to different departments for medical treatment.
It can be effectively solved in the cardiology or endocrinology department, thereby greatly improving patient management Quality and efficiency
.
Analyze three bright spots: rational use of drugs to optimize goals and improve patient prognosis Professor Ma Changsheng introduced the three bright spots in the "Consensus"
.
First of all, Professor Ma pointed out that for patients with T2DM combined with CVD, the "Consensus" introduced to cardiologists a new type of hypoglycemic drugs that can effectively reduce blood sugar and improve prognosis, including glucagon-like drugs.
Peptide-1 receptor agonist (GLP-1RA) and sodium-glucose cotransporter-2 inhibitor (SGLT-2i) are two categories, and the use of drugs is introduced in detail and clearly
.
Secondly, the "Consensus" recommends that the blood pressure target be set at 130/80mmHg is also a highlight
.
Professor Ma said that the publication of the results of the SPRINT study in 2015 found that patients with blood pressure control at 130/80mmHg benefited significantly better than 140/90mmHg, which had a huge impact on the field of hypertension prevention and treatment
.
Afterwards, the "Guidelines for the Prevention and Treatment of Hypertension in China" pointed out that the general hypertension patients should be reduced to <140/90 mmHg, and those who can tolerate it and some patients with high risk and above can be further reduced to <130/80 mmHg
.
However, this time the "Consensus" is different.
It proposes that the blood pressure reduction target of diabetes combined with CVD is <130/80mmHg, and if it cannot be tolerated, it can be relaxed to <140/90 mmHg
.
"The different order reflects the different concepts
.
" Professor Ma said, "The emphasis is different
.
" Analysis key points: The condition of comorbid patients is complicated, and treatment needs to be "balanced" Professor Ma Changsheng interview video for patients with T2DM combined with CVD , It is necessary to control glucose, improve cardiovascular risk factors and improve prognosis.
Therefore, the "Consensus" recommends new hypoglycemic drugs.
Professor Ma said: "We recommend new drugs because of sufficient evidence.
It can not only reduce Sugar, if used, can also help patients improve the prognosis, then we will use it
.
"The Consensus" makes clear recommendations for cardiovascular professional doctors, which will help these drugs with clear evidence of cardiovascular benefit (such as GLP-1RA liraglutide) to be rationally used to help patients benefit
.
For T2DM combined The "Consensus" also gives detailed advice on how to use drugs and how to treat CVD and chronic kidney disease (CKD) in a complex condition.
For example, if the patient has diabetes with end-stage renal disease, the blood sugar control goal can be appropriately relaxed
.
Professor Ma said that the treatment process needs to pay attention to "balance", and doctors should try their best to do something, even for patients with end-stage disease, some indicators can also be partially improved to help patients extend their life expectancy and improve their quality of life
.
Two departments Working together to help more patients benefit from new drugs.
Professor Sun Yihong’s interview video talked about the formulation of the “Consensus”.
Professor Sun Yihong pointed out that the comorbidity of diabetes and cardiovascular disease is very common in clinical practice.
Therefore, for the diagnosis and treatment of such patients’ diseases, It is also an issue that both endocrinologists and cardiologists are particularly concerned about
.
Starting from three aspects, the main content of the "Consensus" is introduced by these professors.
In general, the "Consensus" mainly deals with the management of patients with diabetes and CVD from three aspects.
Key explanations and recommendations: The first aspect is the management of cardiovascular risk factors in patients with diabetes mellitus and CVD, such as how to control blood pressure, how to set blood lipid target values, and how to deal with diseases such as heart failure and coronary heart disease.
Targeted drug treatment is also something that endocrinologists want to know about
.
The second aspect is how to better manage diabetes and improve prognosis for diabetic patients with CVD
.
This part includes life>
.
the last part is particularly concerned about the problem of clinicians - special populations of disease management, including diabetic nephropathy, advanced age (> 75 years), cardiovascular disorders such critically ill patients
.
The evidence is sufficient.
The "Consensus" recommends new drugs for blood glucose management.
Professor Sun Yihong's interview video.
In terms of blood glucose management, the "Consensus" gives recommended drug treatment routes and recommends hypoglycemic drugs with cardiovascular benefits
.
Professor Sun said that this is actually an area that cardiologists have paid special attention to in recent years
.
There are many types of hypoglycemic drugs, and there have been few clinical trials on the effects of hypoglycemic drugs on cardiovascular events
.
After the Avandia incident, the U.
S.
Food and Drug Administration (FDA) mandated that newly marketed hypoglycemic drugs need to pass a cardiovascular outcome study (CVOT) to verify the cardiovascular safety of the drug
.
Such requirements have brought some challenges to hypoglycemic drugs, as well as some opportunities
.
It is against this background that people have discovered that there are two new types of hypoglycemic drugs—GLP-1RA and SGLT-2i, some of which have clear cardiovascular protective effects in people with diabetes
.
Professor Sun further introduced that although metformin also has potential cardiovascular benefits through subgroup analysis, the above two drugs (GLP-1RA and SGLT-2i) have been confirmed by clinical studies with rigorous design and large sample size.
And it has been repeatedly clinically verified to clarify its benefits
.
However, there is a slight difference between the two.
GLP-1RA is more prominent in reducing atherosclerotic events, while SGLT-2i is helpful in reducing heart failure-related events
.
Therefore, in the "Consensus", the writing expert group has been fully discussed and referred to important guidelines in the field of diabetes at home and abroad, and still regards metformin as the first-line recommended drug, while GLP-1RA and SGLT-2i have sufficient evidence.
》It is pointed out that for patients who do not meet the standard of glycosylated hemoglobin (HbA1c) or have contraindications or intolerance to metformin, and are mainly associated with atherosclerotic cardiovascular disease (ASCVD), it is recommended to choose GLP-1RA (such as liraglutide).
) Or SGLT-2i; for patients with congestive heart failure, the combined use of SGLT-2i is preferred.
If SGLT-2i has contraindications, GLP-1RA may be considered
.
Starting from the "Consensus", strengthening cooperation and benefiting patients.
Professor Sun Yihong's interview video hopes that the release of the "Consensus" can help endocrinologists learn more about some cardiovascular-related normative issues that need to be paid attention to in the diagnosis and treatment of patients with diabetes and CVD.
With cutting-edge progress, it is also hoped that cardiologists will learn more about how to manage blood sugar for such patients and how to use medication to bring more benefits to patients.
At the same time, I hope that the cooperation between the two departments can be strengthened
.
For these hypoglycemic drugs with cardiovascular benefits, cardiologists also highly approve.
It is hoped that through the promotion of this "Consensus", combined with the corresponding evidence-based evidence in the cardiovascular field, more patients with diabetes and CVD will be able to The use of such drugs has resulted in benefits and improved prognosis
.
Summary Diabetes is the most important comorbid disease of CVD, and CVD is the main cause of death and disability in patients with T2DM
.
These two diseases span two departments, but often converge in the same patient
.
This "Consensus" brings together the cutting-edge progress and the latest concepts of the two disciplines, and provides references for doctors in the fields of endocrinology and cardiovascular, and even general practitioners
.
Therefore, it is hoped that through the release of the "Consensus", comprehensive prevention and management capabilities such as diabetes and cardiovascular diseases can be improved in multiple dimensions, and ultimately improve the prognosis of patients
.
References: 1.
Franco OH, et al.
Archives of Internal Medicine.
2007;167(11):1145-1151.
2.
National Health Commission Capacity Building and Continuing Education Center, etc.
Chinese Journal of Internal Medicine.
2021;60(5) :421-437.
This article is only used to provide scientific information to medical and health professionals, and does not represent the position of the platform-End-Contribution/reprint/business cooperation, please contact: yxjxxg@yxj.
org.
cn
