Regarding the postprandial blood glucose as the "target", sound the clarion call for the whole blood glucose management

Only for medical professionals to read for reference.
To solve the problem of postprandial hyperglycemia, it must be targeted! The latest epidemiological studies have shown that the prevalence of diabetes in my country is 11.
2% in people aged 18 and over [1], but only 39.
7% of patients have glycosylated hemoglobin (HbA1c) <7.
0% [2].

At the same time, the prevalence rate of prediabetes in my country is 15.
5%, and the prevalence rate of impaired glucose tolerance (IGT, that is, fasting blood glucose <7.
0mmol/L, PPG≥7.
8mmol/L but <11.
1mmol/L) is 11.
0%[3] , Diabetes "reserve army" is also huge.

From the perspective of blood glucose composition, most Chinese type 2 diabetes (T2DM) patients are accompanied by elevated postprandial blood glucose (PPG) [4].

Among patients with diabetes diagnosed by epidemiological screening, the proportion of patients with elevated PPG alone is up to 50%, and about 70% of pre-diabetes are pure IGT [4].

With the progressive decline of pancreatic β-cell function, IGT can eventually progress to T2DM [5], and the increase of PPG throughout the course of the disease has become an important content of blood glucose management in Chinese patients.

Part1 The "common problem" of elevated blood sugar after meals, how much harm is known? Studies have shown that Chinese T2DM patients mainly consume carbohydrates (more than 65%) [6], which may be the main "cause of PPG increase in Chinese patients" ".

Whether it is IGT patients or T2DM patients, the harm caused by elevated PPG is huge.

The increase in PPG that prevents blood glucose from reaching the standard has become one of the main reasons for the increase of HbA1c [4], thereby preventing blood sugar from reaching the standard.

When HbA1c<7.
3%, PPG contributes 70%; HbA1c is 7.
3%-9.
2%, PPG contributes about 50%; even when HbA1c>9.
3%, PPG contributes 40% [4].

In addition, postprandial hyperglycemia is the main cause of intra-day blood glucose fluctuations [4].

Increase the risk of complications.
Postprandial hyperglycemia leads to vascular endothelial dysfunction through multiple pathways, which is related to the development of chronic complications such as microvascular complications such as diabetic retinopathy and macrovascular complications such as cardiovascular disease[4,7 ].

Even in the IGT stage, the risk of microvascular complications and cardiovascular and cerebrovascular diseases in patients is significantly increased [3].

PPG and blood sugar fluctuations that damage the function of β-cells can further deteriorate the function of pancreatic β-cells [4].

Part2 takes PPG as the "target", and the two-pronged approach to control PPG should be two-pronged, including life>
The quality and quantity of life>
Therefore, on the basis of controlling total calorie intake and reasonable diet, encourage the intake of foods with low glycemic index (GI) [4], such as vegetables and legume products.

Exercise after a meal can reduce PPG [4].
Some scholars have reported that compared with exercise at 60 or 30 minutes after a meal, exercise at 90 minutes after a meal has the strongest immediate hypoglycemic effect on patients with T2DM [8].

Choosing hypoglycemic drugs.
Various hypoglycemic drugs can reduce PPG to varying degrees, including α-glycosidase inhibitors, short-acting sulfonylureas secretion promoters, Glinide secretion promoters, etc.
[4].

Among them, α-glycosidase inhibitors are not only commonly used oral hypoglycemic agents to reduce PPG, but also play a role in reducing the risk of diabetes and the overall management of blood sugar.

The results of a systematic review of clinical studies carried out in T2DM populations, including Chinese, showed that α-glycosidase inhibitors can reduce HbA1c by 0.
50%-1.
4%, and can reduce weight [9].

A study conducted in a Chinese population with coronary heart disease and IGT showed that α-glycosidase inhibitors did not increase the risk of subjects’ major composite cardiovascular end points, and at the same time reduced the risk of IGT transitioning to diabetes [2].

Part3 Deliberation: The way to choose α-glycosidase inhibitors.
The main mechanism of α-glycosidase inhibitors is to reversibly inhibit α-glycosidase at the brush border of the mesentery in the upper small intestine, and delay α-glycosidase from converting polysaccharides ( Such as starch, oligosaccharides, etc.
) are decomposed into monosaccharides (mainly glucose), which slows down the absorption of glucose to reduce PPG, and it is not easy to have hypoglycemia before meals [9].

In addition, α-glycosidase inhibitors can also improve insulin sensitivity to a certain extent, and promote a large amount of undigested carbohydrates to reach the lower small intestine, and stimulate the continuous increase of glucagon-like peptide-1 secretion, which in turn stimulates insulin release and reduces Blood glucose concentration [9].

Currently, the domestically marketed α-glycosidase inhibitors are acarbose, voglibose and miglitol.

Although both are α-glycosidase inhibitors, there are differences in the mechanism of action between acarbose and voglibose.

Acarbose not only inhibits disaccharidase, but also inhibits α-amylase.
Therefore, a part of starch enters the large intestine without being decomposed in the small intestine, and is fermented by bacteria in the large intestine to produce gas, causing bloating, diarrhea, bowel, and increased exhaust.
Gastrointestinal symptoms [10].

The difference is that voglibose focuses on inhibiting disaccharide hydrolase, and its inhibitory effect is stronger than that of acarbose, and its inhibitory effect on amylase is weaker.
The starch in food is converted into disaccharides in the small intestine and enters The large intestine has very little starch, so there are fewer gastrointestinal reactions such as abdominal distension and increased gas [10,11].

In general, voglibose has accumulated certain evidence-based evidence in terms of hypoglycemic efficacy, safety and delaying the progress of IGT.

Hypoglycemic efficacy A study included 110 patients with T2DM who were poorly controlled with metformin or sulfonylureas combined with metformin (HbA1c≥7.
0%, at least 2 postprandial blood glucose drift amplitude ≥7.
8mmol/L), and were randomly given voglib The sugar tablets are treated with 0.
2mg bid or 0.
3mg tid, and blood glucose is monitored by a transient scanning glucose monitoring system [12].

After 14 weeks of treatment, the patient's PPG, HbA1c and average blood glucose fluctuation range were significantly reduced (Figure 1), and body weight and blood lipid profile were also significantly improved after 6 months of treatment [12].

Safety A domestic study included 90 patients with T2DM who were treated with voglibose tablets and acarbose tablets respectively [13].

The study showed that there was no statistically significant difference between the two groups in PPG, HbA1c and other indicators (P>0.
05), but the proportion of patients with adverse reactions such as bowel and gas in the voglibose group was significantly less than that of Acarbose In the sugar group, the difference was statistically significant (P<0.
05) [13].

Delaying the progression of IGT A phase III clinical trial in Japan confirmed that compared with patients using exercise and diet therapy, voglibose can effectively prevent the progression of IGT population to T2DM [14].

On the basis of exercise and diet therapy, taking voglibose at the same time not only saves the patient's life-long treatment cost of 504,989 yen, but also increases the patient's life expectancy by 0.
42 years [15].

Figure 1 Baseline and treatment 14 weeks after breakfast (a), after lunch (b), and after dinner (c) blood glucose within 3 hours.
It is worth noting that the voglibose tablets produced by the domestic manufacturer Suzhou Sinochem (Huayi Ping) The specifications include 0.
1mg/tablet, 0.
2mg/tablet, 0.
3mg/tablet, with a wider range of options, which is convenient for clinical accurate adjustment of dosage.

Summary The population of IGT and T2DM in my country is huge, and elevated PPG is a common feature, which is closely related to the occurrence of diabetic macrovascular and microvascular complications.

From IGT to T2DM, the management of PPG must be emphasized.

In addition to improving life>
The α-glycosidase inhibitor Voglibose not only effectively reduces PPG and HbA1c, reduces blood glucose fluctuations, and has good safety.
It can also prevent IGT from progressing to T2DM, save treatment costs, and extend patient life.

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