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    Home > Active Ingredient News > Endocrine System > Prof. Li Guangwei: The tenacious β-cells are waiting to be awakened, looking at future disease management from the "root" of diabetes

    Prof. Li Guangwei: The tenacious β-cells are waiting to be awakened, looking at future disease management from the "root" of diabetes

    • Last Update: 2022-01-09
    • Source: Internet
    • Author: User
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    This article is published under the authorization of Professor Li Guangwei, please do not reprint without permission
    .

    Introduction: A new leap in the concept of diabetes treatment-with "pursuit of relief" as the first goal, three-level management
    .

    On December 25, 2021, the second "Annual Meeting of the Obesity Professional Committee of the Endocrinology and Diabetes Society of Bethune Spiritual Research Society" was held as scheduled
    .

    Professor Li Guangwei, the leader of the Department of Endocrinology in Fuwai Hospital of the Chinese Academy of Medical Sciences and a well-known scholar in the field of diabetes, gave a wonderful academic lecture on the topic of "Diabetes Management from the Roots of Diabetes"
    .

    Professor Li Guangwei corrected the "previous people's wrong understanding of type 2 diabetes", led everyone to explore the deep-seated causes of the occurrence and development of diabetes, clarified the theoretical basis for promoting the change of treatment concepts, and looked forward to the new management concept of diabetes
    .

    Professor Li Guangwei is the chief endocrinologist of China-Japan Friendship Hospital and the leader of the endocrinology department of Fuwai Hospital, Chinese Academy of Medical Sciences
    .

    Deputy Editor-in-Chief of Chinese Journal of Endocrinology and Metabolism, Member of the Committee of Experts on Disease Control of the Ministry of Health, was elected as the State Council Expert for Outstanding Contributions in 2000
    .

    Served as the vice chairman of the Endocrinology Branch of the Chinese Medical Association for the seventh and eighth sessions
    .

    He is one of the most influential Chinese scholars in the world selected by Elsevier
    .

    The China Daqing Diabetes Prevention Research that he participated in and presided over was hailed as a milestone in the world's diabetes prevention research
    .

     Is "the fate of beta cells" destined to be a tragedy? In 1998, the results of the UKPDS study showed that when type 2 diabetes was diagnosed, only 50% of the β-cell function remained, and thereafter it would decline at a rate of 4.
    5% per year.
    After 12 years, insulin secretion was basically lost
    .

    In clinical practice, this is indeed the case.
    No matter what medicine is used, blood sugar control will gradually deteriorate with the prolongation of the disease, and blood sugar climbing cannot be avoided
    .

    There seems to be nothing we can do to "change the fate of β-cells" and "change diabetes," and the majority of people hold a pessimistic attitude
    .

    Figure 1 UKPDS research results (1998) But is this really the case? Professor Li Guangwei shared a case of a woman, 69 years old, with diabetes for 10 years
    .

    Treated with Humulin 50, 49u 28u for 3 years; fasting blood glucose 12mmol/l, postprandial blood glucose 22mmol/l; in the past two years, he suffered multiple falls due to dizziness, hematoma of the head, two faints and unconsciousness, one in the early morning, one It happened at 10:30 in the morning; his physical condition was getting worse and worse.
    He walked deep and shallow, afraid to land, and had to drive for a few minutes, so he didn't dare to walk
    .

    In the Department of Neurology in the hospital, brain CT found lacunar infarction, ECG showed no abnormalities, and blood sugar occasionally reached 4mmol/l
    .

    Diagnosis and treatment: Considering the hyperglycemia caused by hypoglycemia, two weeks after stopping the drug, the incidence of falls was significantly reduced
    .

     Professor Li Guangwei pointed out that this case reflects the current status of diabetes diagnosis and treatment-for blood sugar lowering drugs, especially insulin therapy, many doctors only do additions, not subtractions-resulting in patients with hunger, high blood sugar, and frequent low blood sugar.
    "Strange Phenomenon"
    .

    Can not help but raise a thought-provoking question: Is the deteriorating blood sugar control the cause of the disease itself? Or is the treatment strategy (medicine) a mistake? "Diabetes can be alleviated.
    Is the previous understanding of type 2 diabetes wrong?" In the past, we believe that the root of diabetes is the loss of β cells (death).
    The greater the loss, the higher the blood sugar.
    So Although progress is slow, it is impossible to cure it
    .

    Professor Domenico Accili, winner of the 2017 Banting Prize, believes that the onset of diabetes is motivated by high insulin demand.
    In other words, people who demand more insulin are more likely to develop diabetes
    .

    Therefore, reducing the body's demand for insulin is conducive to the improvement of the disease, and some can even be relieved (Remission or Honeymoon)
    .

     Understanding of β-cells In the past, it was believed that β-cells cannot replicate and cannot regenerate
    .

    Professor Domenico Accili believes that β cells can replicate limitedly, renew slowly, and even increase the number of β cells through the transdifferentiation of α cells, which means that β cells have a "reserve"
    .

     Professor Li Guangwei couldn't help but said with emotion: "Looking at it now, many things are wrong about the previous understanding of type 2 diabetes
    .
    "
    Professor Domenico Accili even broke the shortcomings of modern diabetes treatment: "The current strategy is to'keep away from the root of diabetes' rather than make it alleviate
    .

    " Obesity is the "root" of diabetes and poor cardiovascular outcomes, and treatment needs to be traced back to the roots.
    As early as 2014, Professor Steven Kahn, the winner of the Albert Renold Award, pointed out: "Obesity is the main cause of insulin resistance.
    The latter is the'motor' of β-cell failure
    .

    Insulin resistance precedes the decline of β-cell function.

    .

    Generally speaking, obesity leads to an increase in the body's demand for insulin.
    Under normal circumstances, beta cells increase the release of insulin to maintain normal glucose tolerance
    .

    If the insulin demand greatly increases and the β cells are tired of coping, partial apoptosis and dedifferentiation will occur, and then pre-diabetes will gradually appear, and then diabetes will develop
    .

    Relieving insulin resistance and "lightening" β cells is the most effective way to delay the progression of β cell function decline
    .

    "The 30-year follow-up study of the Daqing Diabetes Study revealed the dangers of obesity.
    Professor Li Guangwei pointed out that if a person who is 1.
    7 meters tall and weighs 66.
    5 kg gains 12 kg (BMI increases from 23kg/m^2 to 27kg/m^2), insulin Resistance will become 2.
    7 times as much as before, and β-cell burden will become 4 times as much as before.
    For example, if it was "one horse and one car" before, it will become "one horse and four cars" after getting fat.
    In the long run, β cells will inevitably fail.
    Studies have also confirmed that these people have a four-fold increase in the risk of diabetes within 6 years
    .

    Death from cardiovascular and cerebrovascular diseases has increased by 60% in 30 years
    .

     Table 1 In addition to the effects of weight changes, insulin resistance will also Carrying a variety of metabolic disorder factors accelerates type 2 diabetes to an unfavorable end point
    .

    "Just as climate change cannot be restricted without reducing carbon dioxide emissions, type 2 diabetes cannot be controlled without emphasizing the risk factors for obesity
    .

    For this reason, obese people should be more'careful'", Professor Li Guangwei commented
    .

     The material basis for diabetes relief is how many β cells are needed for strong β cells to maintain blood sugar close to normal? 30% is enough! Professor Li Guangwei pointed out that traditional concepts believe that The final and only way for the natural course of type 2 diabetes is β-cell death, which is not accurate now
    .

    It has been reported that although compared with healthy people, whether obese or not, β-cell apoptosis in type 2 diabetic patients does increase, but the mass spectrum is very broad and overlaps with non-diabetic people to a considerable extent
    .

    People with type 2 diabetes who have a disease course shorter than 10 years generally have 50% beta cells remaining.
    Although their insulin secretion function is not so active, it is important that they are still alive
    .

     How many beta cells are needed to maintain blood sugar close to normal? 30% is enough, so 50% of the remaining cells is a reason for our optimism in the treatment of diabetes
    .

    The beta cell that can be awakened is the key material basis for the alleviation of diabetes
    .

    The beta cells that enter the "dormant" state, waiting to be awakened.
    Professor Li Guangwei pointed out that cell failure is often due to the fact that beta cells go in two directions-death and dedifferentiation
    .

    "Dedifferentiation" is the main change of β cells after being stimulated.
    This seemingly "selfish" behavior ensures that it can continue to survive rather than die immediately
    .

    Studies have shown that "β-cells are dedifferentiating" is likely to be a way for the body to respond to increased insulin demand, and to recover when the standby body's insulin demand decreases (this process is called "redifferentiation")
    .

     In other words, β cells are not "obediently" waiting for death, but trying their best to "avoid death (irreversible loss)" and waiting to be awakened
    .

    The “honeymoon period of diabetes” reported for the first time in 1979—a long-term improvement in blood sugar and insulin secretion after two weeks of short-term intensive treatment—is a typical case of the “awakening” process
    .

    In recent years, European studies have found that simply restricting food to lose weight can also achieve this process
    .

    Wake up beta cells and pursue diabetes relief-how much weight should I lose? The DIRECT study found that a 10 kg weight loss on a very low calorie diet for newly diagnosed diabetic patients can achieve 60% diabetic remission, and a 15 kg weight loss can achieve 80% diabetic remission
    .

    At the EASD 2021 conference, Professor lldiko Lingvay called: "Weight loss should be the primary goal of diabetes treatment.
    Weight loss of more than 15% can change the disease course of T2DM patients, which is beyond the reach of any other hypoglycemic drugs
    .

    " For weight loss goals, Professor Li Guangwei pointed out: “The formulation of goals should follow the principle of individualization, and reduce the importance of'doing within one's ability and seeking truth from facts'
    .

    But for elderly diabetic patients, the goal of disease management is to achieve the best life under the premise of safety.
    Quality and life expectancy
    .

    Reduce the importance of careful consideration to avoid sarcopenia
    .

    " With "pursuing relief" as the first goal-a leap in the concept of diabetes treatment, Professor Li Guangwei pointed out: "Relieve by correcting hyperglycemia, removing sugar toxicity and reducing weight.
    The load of β cells and the promotion of their redifferentiation is an important way to contribute to the remission of diabetes.
    Future treatment strategies for type 2 diabetes should be based on the primary goal of'waking up β cells and pursuing relief', and three-level management should be carried out.
    This is a good heart for diabetic patients.
    The vascular outcome will have an immeasurable impact
    .

    As doctors, we must do our best to fight for a better future for people with diabetes
    .

    "
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