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*Only for medical professionals to read and refer to the five-party assessment, the four early principles, and the timely and reasonable initiation of basal insulin therapy to help the management of diabetes in the elderly in China
.
The seventh national census shows that in 2020, the elderly population (≥60 years old) in China will account for 18.
7% of the total population, of which about 30% of the elderly are diabetic patients, and elderly patients have gradually become the mainstream population of diabetes [1]
.
Complications caused by poorly controlled diabetes pose serious challenges to the healthy survival of the elderly
.
In order to further optimize the concept of prevention and treatment of diabetes in the elderly, promote the implementation of standardized prevention, diagnosis and treatment clinical measures, and continuously improve the overall management level of diabetes in the elderly, the "China Clinical Guidelines for the Prevention and Treatment of Type 2 Diabetes in the Elderly (2022 Edition)" (hereinafter referred to as the "Guidelines") was recently released.
Let's take a look at what new strategies the "Guide" brings to the treatment of elderly diabetes in China
.
Strategy 1: "Five-party" evaluation and development of individualized treatment plans There is great heterogeneity in elderly patients, which is generally not conducive to subsequent blood sugar management
.
The "Guide" recommends that a comprehensive assessment of the patient's condition be carried out before the formulation of a personalized treatment plan for elderly diabetes mellitus, and the following five aspects should be evaluated for newly diagnosed/first-time patients [1] (Figure 1)
.
According to the evaluation results, a highly targeted and personalized plan is adopted to effectively control the diabetes while reducing the disability and death rate of cardiovascular and cerebrovascular diseases, laying the foundation for the long-term management of diabetes
.
Figure 1 "Five prescriptions" evaluation strategy for elderly type 2 diabetes II: "Four early" principles to help elderly diabetes management The basic conditions of the program, "early prevention, early diagnosis, early treatment, and early compliance" are the basic principles for optimizing treatment outcomes (Figure 2)
.
The two parties complement each other, breaking the traditional model of "salvation" of diabetes management only when it is in danger, so as to maximize the benefits and minimize the risks of elderly patients with type 2 diabetes (T2DM)
.
Figure 2 The "four early" principles for the prevention and treatment of T2DM in the elderly Strategy 3: Individualize blood sugar control goals and pay attention to hypoglycemia In the management of elderly patients with T2DM, the "Guide" points out that blood sugar control goals should be established as soon as possible after comprehensive evaluation
.
Due to the large differences in the physical condition, organ function, cognitive function and life expectancy of elderly diabetic patients, the setting of goals cannot be too strict or too loose
.
The ideal goal of glycemic control should be to prevent and reduce the vascular complications of diabetes, and to avoid the risk of hypoglycemia, so as to maximize the benefit of patients
.
According to different patient conditions, stratify and formulate individualized blood glucose control goals
.
Table 1.
Standard strategy for blood sugar control in elderly T2DM.
IV: Basal insulin is the first choice, and a personalized plan should be formulated reasonably.
When oral hypoglycemic drug therapy cannot meet the needs of patients, insulin therapy should be initiated to strengthen blood sugar control
.
The "Guide" points out that insulin, as the most powerful hypoglycemic drug, has saved the lives of many patients with severe hyperglycemia, but its side effects of hypoglycemia and long-term overuse of weight gain must be paid attention to in hypoglycemic therapy, especially for the elderly The risk of hypoglycemia should be carefully considered before use [1]
.
Regarding the choice of insulin, the "Guidelines" clearly pointed out that basal insulin is the first choice in the insulin treatment plan, and the simplified insulin treatment mode (single long-acting) can reduce the risk of hypoglycemia in elderly patients
.
It can be seen that an effective, long-acting basal insulin treatment regimen that does not increase the risk of hypoglycemia is the first choice for elderly diabetic patients
.
As an ultra-long-acting insulin analog, insulin glargine U300 benefits from a unique subcutaneous depot micro-precipitation technology.
Its duration of action is as long as 36 hours, with no peaks, and it only needs to be injected once a day [3] (Figure 3 ), which can be an ideal choice for elderly Chinese patients with diabetes
.
Figure 3 Insulin glargine U300 uses a unique subcutaneous reservoir micro-precipitation technology, and the real world study (RWS) found that insulin glargine U300 can effectively lower blood sugar whether compared with premixed insulin or other basal insulins and reduce the risk of hypoglycemia
.
A network meta-analysis of 41 randomized controlled trials of basal insulin therapy showed that insulin glargine U300 was associated with a significantly lower event rate of nocturnal hypoglycemia compared with premixed insulin (RR = 0.
361; 95% CI: 0.
135-0.
944) [ 4] (Fig.
4)
.
Figure 4 Insulin glargine U300 significantly reduces the rate of nocturnal hypoglycemic events.
The first randomized controlled study of insulin glargine U300 and insulin degludec BRIGHT After 24 weeks, the decrease in HbA1c in the insulin glargine U300 group was 0.
34% greater than that in the insulin degludec group [5] (Figure 5)
.
Figure 5.
Subgroup analysis results of the BRIGHT study.
In patients with renal insufficiency, insulin glargine U300 also has a significant advantage.
After 24 weeks of treatment, the HbA1c reduction in the insulin glargine U300 group was 0.
43% greater than that in the insulin degludec group [6] (Fig.
6)
.
Figure 6 In patients with renal insufficiency, the subgroup analysis results of the BRIGHT study shows that insulin glargine U300 can help patients achieve stable glucose control and meet safety standards
.
Summary According to the International Diabetes Federation (IDF) data, more than 2 million elderly patients (60-79 years old) died of diabetes worldwide [7].
The overall blood sugar control of elderly diabetes is not ideal, and the awareness rate and treatment rate of diabetes are less than 50%.
The management level is urgently needed.
Improve [8]
.
Faced with this situation, timely application of insulin therapy and rational selection of insulin regimens are very important
.
Insulin glargine U300 effectively controls glucose without increasing the risk of hypoglycemia, and is the preferred hypoglycemic regimen for elderly diabetic patients in China
.
References: [1].
China Clinical Guidelines for the Prevention and Treatment of Type 2 Diabetes in the Elderly, et al.
Chinese Journal of Endocrinology.
2022;61(1):12-50.
[2].
Lu Zuqian, Ding Wei.
Pharmacy and Clinical Research.
2012 ;05:385-390.
[3].
Ran Xingwu, et al.
Chinese Journal of Diabetes.
2020;28(10):721-728.
[4].
Freemantle N, et al.
BMJ Open.
2016;6(2 ):e009421.
[5].
Bernard Charbonnel, et al.
Presented at: American Diabetes Association Scientific Sessions.
2019;131-LB.
[6].
Haluzík M, et al.
Diabetes Obes Metab.
2020;22(8): 1369-1377.
[7].
L Wang, W Peng, et al.
JAMA.
2021 Dec 28;326(24):2498-2506.
[8].
X Bao, et al.
Cardiovasc Diabetol.
2018 Jun 8;17 (1):83.
-End-This information is for medical and scientific reference only, Sanofi does not recommend the use of this product in any manner inconsistent with the prescribing information approved in your country,
.
The seventh national census shows that in 2020, the elderly population (≥60 years old) in China will account for 18.
7% of the total population, of which about 30% of the elderly are diabetic patients, and elderly patients have gradually become the mainstream population of diabetes [1]
.
Complications caused by poorly controlled diabetes pose serious challenges to the healthy survival of the elderly
.
In order to further optimize the concept of prevention and treatment of diabetes in the elderly, promote the implementation of standardized prevention, diagnosis and treatment clinical measures, and continuously improve the overall management level of diabetes in the elderly, the "China Clinical Guidelines for the Prevention and Treatment of Type 2 Diabetes in the Elderly (2022 Edition)" (hereinafter referred to as the "Guidelines") was recently released.
Let's take a look at what new strategies the "Guide" brings to the treatment of elderly diabetes in China
.
Strategy 1: "Five-party" evaluation and development of individualized treatment plans There is great heterogeneity in elderly patients, which is generally not conducive to subsequent blood sugar management
.
The "Guide" recommends that a comprehensive assessment of the patient's condition be carried out before the formulation of a personalized treatment plan for elderly diabetes mellitus, and the following five aspects should be evaluated for newly diagnosed/first-time patients [1] (Figure 1)
.
According to the evaluation results, a highly targeted and personalized plan is adopted to effectively control the diabetes while reducing the disability and death rate of cardiovascular and cerebrovascular diseases, laying the foundation for the long-term management of diabetes
.
Figure 1 "Five prescriptions" evaluation strategy for elderly type 2 diabetes II: "Four early" principles to help elderly diabetes management The basic conditions of the program, "early prevention, early diagnosis, early treatment, and early compliance" are the basic principles for optimizing treatment outcomes (Figure 2)
.
The two parties complement each other, breaking the traditional model of "salvation" of diabetes management only when it is in danger, so as to maximize the benefits and minimize the risks of elderly patients with type 2 diabetes (T2DM)
.
Figure 2 The "four early" principles for the prevention and treatment of T2DM in the elderly Strategy 3: Individualize blood sugar control goals and pay attention to hypoglycemia In the management of elderly patients with T2DM, the "Guide" points out that blood sugar control goals should be established as soon as possible after comprehensive evaluation
.
Due to the large differences in the physical condition, organ function, cognitive function and life expectancy of elderly diabetic patients, the setting of goals cannot be too strict or too loose
.
The ideal goal of glycemic control should be to prevent and reduce the vascular complications of diabetes, and to avoid the risk of hypoglycemia, so as to maximize the benefit of patients
.
According to different patient conditions, stratify and formulate individualized blood glucose control goals
.
Table 1.
Standard strategy for blood sugar control in elderly T2DM.
IV: Basal insulin is the first choice, and a personalized plan should be formulated reasonably.
When oral hypoglycemic drug therapy cannot meet the needs of patients, insulin therapy should be initiated to strengthen blood sugar control
.
The "Guide" points out that insulin, as the most powerful hypoglycemic drug, has saved the lives of many patients with severe hyperglycemia, but its side effects of hypoglycemia and long-term overuse of weight gain must be paid attention to in hypoglycemic therapy, especially for the elderly The risk of hypoglycemia should be carefully considered before use [1]
.
Regarding the choice of insulin, the "Guidelines" clearly pointed out that basal insulin is the first choice in the insulin treatment plan, and the simplified insulin treatment mode (single long-acting) can reduce the risk of hypoglycemia in elderly patients
.
It can be seen that an effective, long-acting basal insulin treatment regimen that does not increase the risk of hypoglycemia is the first choice for elderly diabetic patients
.
As an ultra-long-acting insulin analog, insulin glargine U300 benefits from a unique subcutaneous depot micro-precipitation technology.
Its duration of action is as long as 36 hours, with no peaks, and it only needs to be injected once a day [3] (Figure 3 ), which can be an ideal choice for elderly Chinese patients with diabetes
.
Figure 3 Insulin glargine U300 uses a unique subcutaneous reservoir micro-precipitation technology, and the real world study (RWS) found that insulin glargine U300 can effectively lower blood sugar whether compared with premixed insulin or other basal insulins and reduce the risk of hypoglycemia
.
A network meta-analysis of 41 randomized controlled trials of basal insulin therapy showed that insulin glargine U300 was associated with a significantly lower event rate of nocturnal hypoglycemia compared with premixed insulin (RR = 0.
361; 95% CI: 0.
135-0.
944) [ 4] (Fig.
4)
.
Figure 4 Insulin glargine U300 significantly reduces the rate of nocturnal hypoglycemic events.
The first randomized controlled study of insulin glargine U300 and insulin degludec BRIGHT After 24 weeks, the decrease in HbA1c in the insulin glargine U300 group was 0.
34% greater than that in the insulin degludec group [5] (Figure 5)
.
Figure 5.
Subgroup analysis results of the BRIGHT study.
In patients with renal insufficiency, insulin glargine U300 also has a significant advantage.
After 24 weeks of treatment, the HbA1c reduction in the insulin glargine U300 group was 0.
43% greater than that in the insulin degludec group [6] (Fig.
6)
.
Figure 6 In patients with renal insufficiency, the subgroup analysis results of the BRIGHT study shows that insulin glargine U300 can help patients achieve stable glucose control and meet safety standards
.
Summary According to the International Diabetes Federation (IDF) data, more than 2 million elderly patients (60-79 years old) died of diabetes worldwide [7].
The overall blood sugar control of elderly diabetes is not ideal, and the awareness rate and treatment rate of diabetes are less than 50%.
The management level is urgently needed.
Improve [8]
.
Faced with this situation, timely application of insulin therapy and rational selection of insulin regimens are very important
.
Insulin glargine U300 effectively controls glucose without increasing the risk of hypoglycemia, and is the preferred hypoglycemic regimen for elderly diabetic patients in China
.
References: [1].
China Clinical Guidelines for the Prevention and Treatment of Type 2 Diabetes in the Elderly, et al.
Chinese Journal of Endocrinology.
2022;61(1):12-50.
[2].
Lu Zuqian, Ding Wei.
Pharmacy and Clinical Research.
2012 ;05:385-390.
[3].
Ran Xingwu, et al.
Chinese Journal of Diabetes.
2020;28(10):721-728.
[4].
Freemantle N, et al.
BMJ Open.
2016;6(2 ):e009421.
[5].
Bernard Charbonnel, et al.
Presented at: American Diabetes Association Scientific Sessions.
2019;131-LB.
[6].
Haluzík M, et al.
Diabetes Obes Metab.
2020;22(8): 1369-1377.
[7].
L Wang, W Peng, et al.
JAMA.
2021 Dec 28;326(24):2498-2506.
[8].
X Bao, et al.
Cardiovasc Diabetol.
2018 Jun 8;17 (1):83.
-End-This information is for medical and scientific reference only, Sanofi does not recommend the use of this product in any manner inconsistent with the prescribing information approved in your country,
