Step into the 2020 CDS guidelines, new programs, new drugs, new technologies, and diabetes treatment keep pace with the times

*Only for medical professionals to read for reference.
Freshly released! In the face of emerging hypoglycemic programs and various cutting-edge technologies, what are the recommendations of the "Guidelines for the Prevention and Treatment of Type 2 Diabetes in China"? On April 19, 2021, the full text of the 2020 version of "Guidelines for the Prevention and Treatment of Type 2 Diabetes in China" (hereinafter referred to as "CDS Guidelines") compiled by the Diabetes Branch of the Chinese Medical Association was officially released.
This is the sixth edition updated from 2003 to the present.
CDS Guidelines", which covers the epidemiology of diabetes in China, diagnosis and classification of diabetes, comprehensive control goals of type 2 diabetes (T2DM) and treatment pathways for hyperglycemia, medical treatment of hyperglycemia, diabetes-related technologies, acute and chronic complications of diabetes Disease, hypoglycemia, etc.

 The guidelines have been updated in many ways, incorporating innovative solutions and innovative technologies that have "rised international fame" in recent years, providing clinicians with cutting-edge information, as well as providing standardized and comprehensive management of T2DM patients and improving patient clinical outcomes.
Gave guidance and help.

So how does this updated version "advance with the times" compared with the 2017 "CDS Guidelines"? 1 Comprehensive update of hypoglycemic path of innovative treatment plan.
With the continuous emergence of innovative hypoglycemic drugs in recent years and the increase of relevant evidence-based evidence, major international guidelines have updated the treatment path recommendations for T2DM.
The "Guide" also incorporates many cutting-edge research results including the cardiovascular outcome of hypoglycemic drugs, updates the treatment path, and pays more attention to the comprehensive benefits of diabetic patients with macrovascular and microvascular complications [1].

The 2020 version of the "CDS Guidelines" added life>
 At the same time, the 2020 version of the "CDS Guidelines" newly incorporates new hypoglycemic drugs that have been marketed in China in recent years and their characteristics, including the sodium-glucose cotransporter 2 inhibitor (SGLT-2i) drug itogliflozin, pancreatic hypertension Glucose-like peptide-1 receptor agonist (GLP‑1RA) drugs dulaglutide, loxenatide, exenatide weekly preparations, a new generation of long-acting insulin analogues insulin deglubber, insulin glargine U300, And Degu aspart insulin, the world's first soluble double insulin (Figure 1) [1], keeps up with the trend of the times and provides patients with more and more ideal medication options.

 Figure 1.
"CDS Guidelines" newly added dual insulin as one of the initial insulin treatment options.
This time, as one of the initial insulin treatment options, degluaspart dual insulin recommended by the "CDS Guidelines" is currently the only one on the market The dual insulin analogues are composed of 70% insulin degludec (basal insulin) and 30% insulin aspart (prandial insulin), so while controlling fasting blood glucose (FPG), it can also manage postprandial blood glucose (PPG) ).

Degu aspartic double insulin was launched in China in December 2019.
It has been widely used and has been recognized so far.
It was included in the 2020 version of the "CDS Guidelines" for the first time, and it can be reimbursed by medical insurance from March 2021.
[2] .

 2 Newly added double insulin and new upgrade of insulin control sugar.
This updated "CDS Guide" also recommends the use of Degu aspart insulin, and provides clinical guidance for the majority of endocrinologists.

The "CDS Guidelines" point out that the starting dose is generally 0.
1 to 0.
2 U/kg/d, which is injected daily before the main meal, and the dose is adjusted according to the patient's fasting blood glucose level until the target is reached.

Patients with obesity or HbA1c>8.
0% can choose to start with a higher dose.

Degu aspart insulin is treated once a day, and the dose reaches 0.
5U/kg/d or the blood glucose is not well controlled after a meal of 30~40U, or the patient has two main meals a day, consider changing to two injections a day[ 1].

 As a new hypoglycemic drug, Degu aspartic acid double insulin can take 1 to 2 injections a day to take care of fasting and postprandial blood sugar control, and its effectiveness and safety are excellent [3].

 ★In terms of the effectiveness of glucose control: A Japanese Onishi study showed that after 26 weeks of treatment, compared with once-a-day (QD) insulin glargine, patients who initiated degluaspart QD treatment had a more significant reduction in HbA1c (p <0.
01), and the drop rates were 1.
4% (degu aspart insulin) and 1.
2% (insulin glargine).

At the end of the study, nearly 60% of patients in the Degu aspartic insulin group had reached the goal of <7% for HbA1c, which was significantly higher than that of the insulin glargine group (p<0.
01) (Figure 2) [4].

The Start Twice Daily study showed that after 26 weeks of treatment, starting premixed insulin twice a day (BID) had similar HbA1c control to patients treated with degluaspartin BID, and the HbA1c decreased by 1.
71% (degluaspartin).
And 1.
73% (premixed insulin), but the Degu aspart insulin group has better control of FPG, with a treatment difference of 1 mmol/L (p<0.
001) [5].

★In terms of safety: Onishi research shows that compared with insulin glargine QD, the number of confirmed hypoglycemia events in the Degu aspartate QD group decreased by 27%, and the number of confirmed hypoglycemia events at night decreased by 25% (p=NS ), and the proportion of patients with HbA1c<7% and no confirmed hypoglycemia events in the Degu aspart insulin group was higher than that in the insulin glargine group (43% vs.
25%) (p<0.
01) (Figure 2) [4 ].

Figure 2.
Comparison of blood glucose achievement rate between degluaspart and insulin glargine groups.
The Start Twice Daily study showed that compared with premixed insulin BID, patients who used degluaspartate with BID had overall confirmed hypoglycemia events.
The risk is reduced by 54%, and the risk of nighttime hypoglycemia events is reduced by 75% (p<0.
001) [5].

3 Innovative technologies to help blood sugar control goals are more comprehensive.
New drugs and innovative treatments provide doctors with "weapons" for lowering blood sugar.
With the progress of the times, more and more new technologies have injected new blood into diabetes management.
Complement with innovative treatment plans to bring more convenience and benefits to patients. The new version of the "CDS Guidelines" pointed out that the rapid development of digital health applications, the Internet and the Internet of Things technology has promoted the informatization and standardization of diabetes education and management.
The advancement of smart phone devices and wireless networks has increased the acceptance and ability of diabetic patients.
The development of visual/video games, wearable devices, and augmented and virtual reality technologies provide more means for diabetes education and management, and provide more opportunities for improving the self-management of diabetic patients.

 For example, this "CDS Guidelines" incorporates innovative technologies and indicators related to blood glucose monitoring to protect patients' blood glucose standards.

 Blood glucose monitoring is an important part of diabetes management.
The results help to assess the degree of glucose metabolism disorders in diabetic patients, and help doctors formulate reasonable hypoglycemic programs for patients, reflect the effects of hypoglycemic therapy and guide the adjustment of treatment programs.

Generally, the choice of treatment path is judged by whether HbA1c meets the standard, and patients who use insulin need to monitor fasting blood glucose, pre-meal blood glucose and other indicators to optimize the treatment plan [1].

 However, these data do not reflect the fluctuation of the patient's blood glucose.
Therefore, compared with the 2017 CDS Guidelines, this CDS Guidelines newly included the glucose target range (usually 3.
9-10.
0 mmol/L) time (TIR) The other parameters, that is, the time or percentage of glucose within the target range within 24 hours, are calculated from continuous glucose monitoring (CGM) data or self-blood glucose monitoring (SMBG) data (at least 7 blood glucose monitoring per day).
As an important indicator for evaluating blood glucose control, it helps doctors understand the characteristics of blood glucose changes, adjust treatment plans in time, make up for the deficiency of HbA1c, and is of great significance for optimizing blood glucose management [1].

 In addition, the new version of the "CDS Guidelines" also introduces the automatic fundus screening technology using artificial intelligence (AI), and prompts children, pregnant women, and patients with diabetic nephropathy to screen in time.
For the insulin pump, a common sugar control tool, a new tool has been added.
Key points, definitions, explanations, device introductions, methods of setting doses, etc.
, fully advance with the times, and deliver the most cutting-edge information on diabetes management to clinicians.  Summary The full text of the 2020 version of the "CDS Guidelines" was officially released.
Compared with the 2017 version, many updates have been made.
The innovative treatment plans and innovative technologies that have emerged in recent years have also been incorporated, and new hypoglycemic drugs have been recommended.
The clinical application provides guidance.

Among them, Degu aspart is the only analogue of double insulin currently on the market, and it has been recommended by the "CDS Guidelines".

These new-type hypoglycemic drugs provide patients with innovative hypoglycemic solutions, so that patients have more and more ideal treatment options, with innovative technology, strengthen the screening of diabetes complications, and blood glucose monitoring and management, I believe that with the latest "CDS Guidelines With the spread of ", more Chinese diabetic patients will receive better treatment.
"
References: [1] Diabetes Branch of Chinese Medical Association.
Chinese Journal of Diabetes.
2021;13(4):315-409.
[2] "National Basic Medical Insurance, Work Injury Insurance and Maternity Insurance Drug Catalog (2020)" [ 3]Mehta R, et al.
Diabetes Obes Metab.
2020;22(11):1961-1975.
[4]Onishi Y, et al, Diabetes Obes Metab.
2013;15:826–832.
[5]Franek E, et al.
Diabet Med.
2016;33(4):497-505.