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    Home > Active Ingredient News > Endocrine System > Steady control of glucose, TIR over 90%, see how GLP-1RA weekly preparations deal with high glucose, dyslipidemia and obesity!

    Steady control of glucose, TIR over 90%, see how GLP-1RA weekly preparations deal with high glucose, dyslipidemia and obesity!

    • Last Update: 2022-01-10
    • Source: Internet
    • Author: User
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    *Only for medical professionals to read for reference.
    Young women with newly diagnosed obesity and diabetes have obtained the triple benefit of improving blood sugar, body weight and blood lipids after starting the GLP-1RA weekly preparation
    .

    Case characteristics: The patient, female, 38 years old
    .

    Main complaint: thirsty, polydipsia and polyuria for 2 weeks
    .

    History of present illness: The patient had a history of impaired fasting blood glucose for 1 year, was found to be thin for 3 months, thirsty, polydipsia and polyuria for 2 weeks, and went to the outpatient clinic
    .

    Past history: No history of special diseases
    .

    Personal history: I have had a son
    .

    Usually addicted to sweets, obese
    .

    Family history: Grandma has a history of diabetes
    .

    ▌ Physical examination: Note: Body Mass Index (BMI)
    .

    Body temperature is 36.
    6℃, blood pressure is 125/80 mmHg, heart rate is 76 beats/min, body is obese, and the skin is free of purple streaks and acne
    .

    There was no swelling of the thyroid gland, and no positive signs were found on physical examination of the heart, lungs and abdomen
    .

    There was no edema in both lower limbs, no abnormal pain and temperature sensation in limbs, dorsal artery pulsation was normal, and fundus examination was normal
    .

    ▌ Auxiliary examination: Note: Alanine aminotransferase (ALT), aspartate aminotransferase (AST), uric acid (UA), total cholesterol (TC), triglycerides (TG), high-density lipoprotein cholesterol (HDL-c), low density Lipoprotein cholesterol (LDL-c), glycosylated hemoglobin (HbA1c)
    .

    ▌ Preliminary diagnosis: Type 1.
    2 diabetes 2.
    Obesity 3.
    Fatty liver ▌ Treatment plan: Phase 1: Enhancing life>
    .

    Second stage: Glucagon-like peptide-1 receptor agonist (GLP-1RA) smeglutide was added on October 9th.
    The initial dose was subcutaneous injection of 0.
    25 mg QW, and the blood glucose level was stable on the fourth day.
    , TIR exceeds 90%
    .

    The dose of 0.
    25 mg was injected twice on October 9th and 16th, and the dose was adjusted to 0.
    5 mg on October 23rd
    .

    ▌ Patient TIR data: Note: See the blood glucose profile from October 7 to 13 on the left slide.
    ▌ Follow-up status: After treatment for more than 1 month, no hypoglycemia occurred, weight loss was 2.
    4 kg, abdominal circumference 91 cm, and the relevant auxiliary examination results are as follows
    .

    ▌ Comparison of auxiliary examinations after 1 month of treatment: ——Interview with the director——Medical circle: In this case, considering the characteristics of the patient, why would you choose smeglutide for the patient? What benefits does the new program bring to patients? Director Ye Shenghua: The patient was treated with metformin during the initial treatment, but he was very dissatisfied with the way and frequency of administration
    .

    After analyzing the medical history, we can draw several personal characteristics for the patient: young women, obesity, addiction to sweets, and abnormal blood lipids
    .

    Therefore, when we formulate the second-step hypoglycemic program, we hope that the drug has several characteristics: effective control of sugar, control of appetite, weight reduction, and improvement of metabolic indicators.
    It is easy to think of GLP-1RA
    .

    GLP-1RA stimulates insulin secretion and inhibits glucagon secretion in a glucose concentration-dependent manner by activating GLP-1 receptors, and at the same time increases glucose uptake in muscle and adipose tissue, inhibits liver glucose production and exerts a hypoglycemic effect, and can delay Stomach emptying, suppress appetite [1]
    .

    As a new type of hypoglycemic drug, GLP-1RA can effectively lower blood sugar, partially restore pancreatic β-cell function, reduce body weight, improve blood lipid profile and lower blood pressure [1]
    .

    Combining the characteristics of the above patients, we believe that GLP-1RA is a class of drugs suitable for this patient
    .

    Patients hope that the administration schedule of hypoglycemic drugs is as simple as possible, and even hope that others do not know that they are using hypoglycemic drugs
    .

    Smeglutide is a weekly GLP-1RA preparation.
    Due to the innovative peptide chain structure, the half-life can be extended to 7 days.
    It can be injected once a week to effectively control sugar.
    The patient readily accepted this program
    .

    The curative effect of hypoglycemic therapy is very satisfactory.
    As an index related to the clinical outcome of the patient, the patient’s TIR increased from about 30% when using the original regimen to 92% in just 4 days after using smegaglutide.
    At the same time, the patient's blood lipids, body weight and other cardiovascular metabolic indicators have been improved, providing cardiovascular protection for this early diabetic patient
    .

    After treatment, the patient also changed from severe fatty liver to mild fatty liver, and satisfactory results were obtained
    .

    Medical community: In this case, did the patient have any adverse reactions after the patient's smeglutide dose was adjusted to 0.
    5 mg QW? How to choose the therapeutic dose? Director Ye Shenghua: The patient experienced gastrointestinal discomfort once at the initial stage of the medication when the dose was increased to 0.
    5mg QW, but it improved quickly
    .

    We also explained to patients the causes of such adverse reactions.
    GLP-1RA can delay gastric emptying and control appetite.
    Therefore, the mechanism of action can explain the adverse reactions of patients.
    The prolonged symptoms gradually alleviated [2], and it is well tolerated
    .

    As far as my personal experience is concerned, after patients have switched from other GLP-1RA daily or weekly preparations to smeglutide treatment, there are fewer gastrointestinal adverse reactions, and it is well tolerated and can be used with confidence
    .

    ——Share with the same people——Medical community: Which patients do you think are suitable for early initiation of smeglutide therapy? Director Liang Linlang: According to the mechanism of GLP-1RA, it can start at any stage of diabetes
    .

    Faced with a diabetic patient, we need to analyze what is the clinical problem that needs to be solved most, and then choose the drug according to the patient's individual situation
    .

    As a weekly GLP-1RA preparation, semaglutide is aimed at multiple targets of the pathophysiological abnormalities of diabetes, and benefits from various aspects such as blood sugar, weight, and lipid profile
    .

    For patients with atherosclerotic cardiovascular disease (ASCVD) or related risk factors, it is the "first choice"
    .

    This case is a very good example.
    As a diabetic patient with only one year of disease, his intestinal secretion of GLP-1 is impaired.
    The application of GLP-1RA can be said to be a very good treatment plan
    .

    In addition to blood sugar benefits, it also brings weight and blood lipid profile benefits to patients, which is very important for delaying the progression of ASCVD
    .

    It can be said that GLP-1RA has achieved "nearly lowering blood sugar but far lowering the risk of ASCVD", which is undoubtedly of great significance to diabetic patients
    .

    Medical circle: As an injection preparation, do you think the application of smeglutide in clinical practice is convenient? How is patient compliance? Director Liang Linlang: The difficulty of injection therapy is generally higher than that of oral medication.
    Patients need a process of learning and adapting.
    They need to understand the steps of adjusting the dose, changing the needle, and injection.
    After being familiar with it, the operation is still very convenient and easy to adhere to the treatment
    .

    The frequency of injections is a more important issue.
    The compliance of patients with multiple injections a day and once a week must be different.
    Semaglutide injection once a week can meet the needs of all-week blood glucose control, which is simpler and more susceptible to the majority of diabetic patients.
    Welcome
    .

    References: [1] Diabetes Branch of Chinese Medical Association.
    Chinese Journal of Diabetes.
    2021;13(4):315-409.
    [2] Endocrinology Branch of Chinese Medical Association.
    Chinese Journal of Internal Medicine.
    2020;59(11):836 -846.
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