​Starting from the "heart", join hands to start a new journey of anti-sugar

*Only for medical professionals to read for reference.
The 20th Novo Nordisk Diabetes Forum: Change together! In April 2020, the latest diabetes epidemiological survey data in China showed that the prevalence of diabetes in China has reached 12.
8%, and the prevalence of pre-diabetes is 35.
2%[1].
Diabetes management is facing huge challenges.
To cope with this situation , New perspectives, new concepts, and new drugs for diabetes treatment are also emerging in endlessly.

On March 6, 2021, the 20th Novo Nordisk Diabetes Forum (NNDU) will be held simultaneously online and offline in Beijing, Shanghai, Nanjing, Shenyang and other places, starting from the "heart" and working together to fight sugar.

NNDU is always the same, innovation and change are always on the way.
Professor Zhu Dalong from the Department of Endocrinology, Nanjing Gulou Hospital, delivered an opening speech to extend his New Year’s blessings to fellow colleagues, and introduced that NNDU’s mission is to share the latest developments and treatment plans in the field of diabetes.

Ms.
Zhou Xiaping, Global Senior Vice President and President of Greater China of Novo Nordisk, gave a speech thanking the participating experts for their participation and the persistence and dedication of medical workers in the field of endocrinology.
She also pointed out that although the treatment of diabetes has made considerable progress, there is still more The huge patient population does not meet the treatment needs, and diabetes management has a long way to go.
Experts and colleagues in all fields are called on to work together to change diabetes and other serious chronic diseases.
This is also the original intention of NNDU.
Through such a platform, The clinical treatment work of medical workers provides new perspectives, new ideas, and new developments.

Academician Ning Guang from Ruijin Hospital affiliated to Shanghai Jiaotong University gave a generous speech.
First, he reviewed the interesting facts about his growth and progress with NNDU in the past 20 years, and proposed that the 20 years of successful NNDU has benefited from its consistent persistence and innovation.
Medical workers in the field have seen new hope in diabetes management, which is worth learning and reference for clinicians.

With the increasing awareness of diabetes in China, biological preparations that focus on the treatment of diabetes and metabolic related diseases have also received more and more attention.
In the ever-changing medical field, only innovations can continue to develop. Before the forum officially started, Professor Teng Weiping from the Institute of Endocrinology, China Medical University and Professor Mu Yiming from the Chinese People’s Liberation Army General Hospital made speeches as the chairpersons of the conference, saying that the advancement of science and technology and the development of the medical field have opened a new journey of diabetes management.
At the forum, top domestic and foreign experts and scholars discussed the difficulties and turning points in the diabetes management process through keynote speeches, research interpretations, experience sharing, and hot discussions.

From the CAPTURE study, see the status of diabetes management "heart" Professor Hong Tianpei from Peking University Third Hospital analyzed the cardiovascular status of patients with type 2 diabetes (T2DM) based on the CAPTURE study.

Professor Hong Tianpei pointed out that cardiovascular disease (CVD) is the leading cause of death in patients with T2DM.
In recent years, many cardiovascular outcome studies (CVOT) have confirmed that the glucagon-like peptide-1 receptor agonist (GLP-1RA) ) Or sodium-glucose cotransporter 2 inhibitors (SGLT2i) can reduce the risk of major cardiovascular adverse events (MACE) in patients with T2DM combined with cardiovascular risk.
Therefore, it has also promoted the update of major guidelines, the 2020 version of the CDS guidelines and The 2021 version of the ADA guidelines all pointed out that for patients with ASCVD or high-risk factors, heart failure, chronic kidney disease (CKD), they should be independent of the level of glycosylated hemoglobin (HbA1c), goals, and whether metformin has been applied, and GLP can be selected in combination -1RA or SGLT2i.

The CAPTURE study suggests that 34.
8% of T2DM patients worldwide have combined CVD.
Among these patients, only 22% have used the cardiovascular benefit drugs recommended by the guidelines.
This situation is not optimistic in my country.

Chinese subgroup research data [2-3] show that the prevalence of CVD in T2DM patients in China is 33.
9%, of which ASCVD accounts for 94.
9%, while the use rate of hypoglycemic drugs that have proven cardiovascular benefits is far lower than the global Level.

Based on the results of the CAPTURE study, Professor Hong Tianpei believes that in the future, China needs to further strengthen the management of risk factors for patients with T2DM and CVD, and actively promote the application of drugs recommended by the guidelines.

Reading the new version of the guide, the management of T2DM patients starts from the "heart".
In 2020, the Diabetes Branch of the Chinese Medical Association (CDS) will update the guide.
At this forum, Professor Zhu Dalong, who participated in the discussion and revision of the guide, discussed its updated background and key points Interpretation.

As the awareness of HbA1c continues to deepen and the level of HbA1c detection continues to improve, the results are playing an increasingly important role in clinical diagnosis.

In the new version of the guidelines, HbA1c is included in the diagnostic criteria for diabetic patients for the first time, and it is proposed that the control target of HbA1c should follow the principle of individualization.

Professor Yiming Mu pointed out that although the development of new hypoglycemic drugs is in full swing, the 2020 China A1c Hemoglobin Monitoring Network (CNHSS) research data[4] shows that the HbA1c compliance rate of Chinese T2DM patients is less than 1/3, and the fasting and postprandial blood glucose levels rise High, and long-term blood sugar control is not up to standard, especially postprandial blood sugar increase is closely related to macrovascular and microvascular diseases, such as retinopathy, CVD, CKD, and so on.

In this regard, referring to the International Diabetes Diagnosis and Treatment Guidelines, combined with the characteristics of Chinese T2DM patients, the new version of the guidelines updates the clinical treatment path of T2DM.
In addition to clearly pointing out different solutions for HbA1c compliance, it also emphasizes the importance of reducing the risk of cardiovascular disease in patients Sex.

Professor Zhu Dalong pointed out that in the process of diabetes management, prevention of cardiovascular events requires early, full course of treatment and proper use of GLP-1RA.

Professor Yiming Mu believes that the combined application of basal insulin and GLP-1RA may play a synergistic and complementary role, and may become a new option for T2DM treatment, and studies [5-6] have confirmed that Chinese patients with T2DM are treated with insulin and GLP-1RA combined therapy.
Such as the compound preparation IDegLira (long-acting insulin/liraglutide), which can effectively control blood sugar and bring benefits related to weight and hypoglycemia, while effectively improving insulin resistance.

GLP-1RA, multiple aids to diabetes management Afterwards, Professor Ji Linong from Peking University People's Hospital gave a detailed explanation on the mechanism and effect of GLP-1RA on T2DM management.

▌ Significantly lower blood sugar and help blood sugar reach the standard.
GLP-1RA new weekly preparation smeglutide is a natural human GLP-1 analogue, which can improve the response ability of pancreatic β cells to glucose to the level of normal people.
According to the actual situation of the human body, it can promote insulin secretion.

SUSTAIN series of studies show that 1.
0 mg of smeglutide can significantly reduce HbA1c by 1.
8%, and the HbA1c compliance rate can reach 80%, which is better than most other hypoglycemic drugs.

▌ Lipid and blood pressure lowering, heart and kidney benefit studies have shown [7-8], smeglutide 0.
5mg/1.
0mg has clear cardiovascular benefits, which can significantly reduce the risk of MACE and non-fatal stroke, and its cardiovascular benefits The beneficial mechanism may be due to the anti-atherosclerotic effect-inhibiting the process of arteriosclerosis by inhibiting inflammation, inhibiting oxidative stress, improving endothelial function, etc.
, further reducing the occurrence of cardiovascular and cerebrovascular events and reducing cardiovascular death.

On January 16, 2020, the U.
S.
Food and Drug Administration (FDA) formally approved the cardiovascular indications for smegaglutide.

At the same time, research [7] also showed that smegaglutide can effectively improve proteinuria and other symptoms of diabetes-related nephropathy, and can significantly reduce the risk of renal events by 36%.

In addition, studies have confirmed [9] that smegaglutide can significantly reduce systolic blood pressure up to 7.
3mmHg, and can effectively improve blood lipid profile.

▌ Once a week, convenient and effective smegaglutide is a weekly preparation.
Studies have shown [10] that once a week subcutaneous injection can maintain the effective drug concentration.

Through subcutaneous injection once a week, the number of injections can be reduced, the patient's resistance to injections can be relieved, compliance can be effectively improved, and blood sugar control can be achieved.

Summary As the global prevalence of diabetes continues to rise, based on the current status of diabetes management in my country, it is imminent to promote and apply the effective hypoglycemic drugs recommended by the new version of the guidelines.

Professor Yang Wenying from the China-Japan Friendship Hospital and Professor Gao Yan from Peking University First Hospital believe that clinical studies at home and abroad have proved that smeglutide has the strongest hypoglycemic effect in the recommended clinical doses, as high as 1.
8%, and HbA1c The compliance rate is higher than that of the same type of hypoglycemic drugs. In addition to being effective and safe for lowering blood sugar, smeglutide helps to lower lipids and blood pressure, while controlling blood sugar, while benefiting multiple organs.

In clinical studies in China, smeglutide, as the first-choice drug for secondary prevention of patients with T2DM combined with CVD, has a definite effect in long-term application and has good cardiovascular protection.

Smeglutide subcutaneous injection once a week can effectively improve patient compliance, thereby helping patients with blood sugar management.

Novo Nordisk is committed to changing diabetes and other serious chronic diseases.
This academic feast at home and abroad has conveyed new perspectives and concepts of diabetes management to clinicians and researchers, demonstrated new progress in diabetes treatment, and provided opportunities for diabetic patients.
A new hypoglycemic program. References[1]Prevalence of diabetes recorded in China using 2018 diagnostic criteria from the American Diabetes Association:national cross sectional study[J].
British Medical Journal.
2020;28(4);369:m997.
[2]Mosenzon O, et al.
CAPTURE Abstract 158.
Presented at the 56th Annual Meeting of the European Association of the Study of Diabetes,Macrovascular complications and beyond,10:15 CDT on 24 September 2020.
[3]Hong Tianpei,et al.
CAPTURE GW-ICC 2020 Poster:GW31-e1199.
[4]Liu G,et al.
Diabetes Metab Syndr Ob es.
2020 Nov 27;13:4651-4659.
[5]Li C,et al.
Cardiovasc Diabetol.
2012 Nov 15;11: 142.
[6] Wang Ping, et al.
Chinese Journal of Diabetes.
2015;23(6):524-526.
[7]Marso SP,et al.
N Engl J Med 2016;375:1834-44.
[8]Rakipovski G et al.
JACC Basic Transl Sci 2018;3:844-57.
[9]Diabetes&Metabolism 45(2019)409-418.
[10]Kapitza C,et al.
Diabetologia 2017;60:1390-9.
Novo Nordisk.
Data on file.