"Talk about sugar control with internal and external training"-OAD is not well controlled, how can T2DM patients control sugar smoothly?

This article shares a case of basal insulin therapy in a type 2 diabetes (T2DM) patient with poor blood sugar control by oral antidiabetic drugs (OAD), and invited Professor Zhang Meiying from the Second Affiliated Hospital of Nanchang University to comment on the case
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The case of Professor Zhang Meiying from the Second Affiliated Hospital of Nanchang University: The case described in this issue is a T2DM patient with poor OAD blood sugar control, combined with type 2 diabetic nephropathy, type 2 diabetic retinopathy, type 2 diabetic peripheral vascular disease, and hypertension.
Coronary heart disease, blood sugar is not up to standard, poor compliance, after starting insulin glargine U300 blood sugar is stable and up to standard
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Case Narrator Dr.
Tu Wei, Department of Endocrinology, The Second Affiliated Hospital of Nanchang University, swipe up to read the patient information.
Female, 65 years old.
Chief complaint: 8 years of elevated blood sugar, and edema of both lower extremities for more than half a year.
, accompanied by dry mouth, polydipsia, polyuria, blurred vision, and no numbness in the limbs, so he was diagnosed as "diabetes mellitus" in another hospital
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He was given metformin combined with acarbose to lower blood sugar, but he did not take the medicine regularly, and he did not regularly monitor blood sugar
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In the past six months, the patient has had edema of both lower extremities without obvious incentives, no chest tightness, shortness of breath, no abdominal distension, and no abdominal pain.
Now the patient came to our hospital for further diagnosis and treatment, and his HbA1c was 10.
2%.

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Since the onset of the disease, the patient has been in poor spirit, with acceptable sleep, diet, normal bowel movements, and weight loss of 10 kg.
Past history: The patient has a history of hypertension for 15 years, and the highest blood pressure is 185/130 mmHg.
He is currently taking irbesartan, hydrochlorothiazide, and nifedipine for treatment.

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He has a history of chronic gastritis for more than 10 years and a history of coronary heart disease for 3 years.
He is currently taking aspirin and atorvastatin for treatment
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Denied the history of kidney disease, hepatitis, tuberculosis, trauma, and food and drug allergy
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No history of residence and/or travel in epidemic areas within 14 days before the onset of the disease, no contact with people infected with the new coronavirus (COVID-19), no history of contact with fever, respiratory symptoms, no history of contact with wild animals, and no family history of clustered disease in the same family : Physical examination of patients with healthy parents, no infectious disease and family history of genetic disease, slide up to read physical examination TPRBP36.
8 ℃ 80 times/min 20 times/min 140/85 mmHg HWBMI_169 cm68 kg23.
81kg/m2_ Physical examination: conscious, Superficial lymph nodes were not palpable and enlarged
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No pharynx congestion, no tonsil enlargement
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The neck was soft, there was no jugular vein filling, the trachea was centered, the breath sounds of both lungs were clear, and no wet or dry rales were heard
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The heart sound was strong, the heart rate was 80 beats/min, the rhythm was uniform, and no pathological murmur was heard in the auscultation area of ​​each valve
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The abdomen was soft, with no tenderness and rebound tenderness in the whole abdomen, and no palpable enlargement of the liver, spleen and kidney
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Bilateral dorsal artery pulses are symmetrical
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Mild edema of both lower extremities
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The physiological reflexes were normal, and the pathological reflexes were not elicited.
Laboratory examinations were randomly measured after admission.
Fingertip blood glucose was 21.
8 mmol/L.
Urine routine: urine glucose 4+ urine protein 3+ C-peptide: serum C-peptide determination (fasting): CP 0.
96ng/ml Serum C-peptide assay (1h): CP-1h 1.
26ng/ml Serum C-peptide assay (2h): CP-2h 1.
35ng/ml Other laboratory tests: blood routine: no obvious abnormality Liver function: no obvious abnormality kidney Function: BUN: 4.
3mmol/l, uric acid: 241umol/l, creatinine: 80.
9umol/l, eGFR: 90.
7ml/min LDL-C: 3.
32 mmol/l, HDL-C: 0.
94 mmol/l) Auxiliary examination: no obvious abnormality was found in electrocardiogram and chest X-ray.
Fundus photography showed no obvious abnormality in the nerve conduction velocity of diabetic retinopathy in both eyes.
Abdominal B-ultrasound: fat Color Doppler Ultrasound of Hepatic Carotid Artery Prompts Subclavian Plaque Clinical Diagnosis Swipe up to view the main diagnosis Type 2 Diabetes Type 2 Diabetic Nephropathy Type 2 Diabetic Retinopathy Type 2 Diabetic Peripheral Vascular Disease Coronary Heart Disease Hypertension Grade 3 High Risk Fatty Liver Case characteristics of lipidemia Patients with type 2 diabetic nephropathy, type 2 diabetic retinopathy and type 2 diabetic peripheral vascular disease, poor fasting blood glucose and postprandial blood glucose control, poor compliance Treatment goals improve patient compliance and stabilize blood sugar control Inpatient treatment plan Swipe up to read hypoglycemic treatment plan After treatment plan: Intensive pump for 5 days and switch to insulin glargine U300 combined with OAD Type of OAD used concomitantly: Oral acarbose (the first bite with rice and chew) 2 tid tablets each time 1 tablet of dapagliflozin qd Life>
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2.
Basal insulin is the cornerstone of individualized treatment of diabetes, throughout the whole process
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3.
Insulin glargine U300 is a more ideal choice for initial insulin therapy: it can achieve stable glucose control while lowering the risk of hypoglycemia.
It can take into account both efficacy and safety, and the adjustment is more flexible and convenient, which is convenient for simplifying medication, and the patient experience is high.
high, which can improve patient compliance
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Expert Comments Professor Zhang Meiying from the Second Affiliated Hospital of Nanchang University The case described in this issue is a T2DM patient with poor OAD blood sugar control, combined with type 2 diabetic nephropathy, type 2 diabetic retinopathy, type 2 diabetic peripheral vascular disease, hypertension, coronary Heart disease, etc.
, the patient has a long course of disease, more complications, decreased pancreatic islet function, and the blood sugar is not up to standard, and the compliance is poor
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In treatment, it is necessary to control blood sugar steadily, improve patient compliance, and benefit the heart and kidney of patients at the same time
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Intensive treatment with an insulin pump was given to the hospital to quickly bring the patient's blood sugar to the standard.
Considering the patient's compliance and blood sugar status after discharge, the pump was switched to insulin glargine U300 combined with OAD therapy
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Insulin glargine U300, a new generation of basal insulin analogues, uses subcutaneous reservoir micro-precipitation technology to achieve stable and sustained release, which can achieve stable glucose control without increasing the risk of hypoglycemia, and better balance both efficacy and safety [1-4]
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BRIGHT subgroup analysis showed that in the elderly and patients with renal insufficiency, insulin glargine U300 had better hypoglycemic effect[5-6]
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BRIGHT subgroup analysis showed that: in elderly and patients with renal insufficiency, insulin glargine U300 hypoglycemia risk was not significantly different from insulin degludec [5-6]
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In this case, the patient's compliance was poor, and it was necessary to improve the patient's compliance
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Insulin glargine U300 SoloSTAR® injection pen has accurate dose, low injection pressure and good patient experience[7-8]
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Insulin glargine U300 can allow more free injection time (± 3h) to cope with changes in daily life situations [9]
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Insulin glargine U300, as a new long-acting basal insulin, has been officially approved by the China National Medical Products Administration (NMPA) and has been included in the National Medical Insurance List
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For T2DM patients with renal insufficiency and poor blood sugar control, it can improve patient compliance and avoid blood sugar fluctuations without affecting renal function.
The unique subcutaneous reservoir microprecipitation technology of insulin glargine U300 can stabilize Sugar control has the advantages of good patient experience and more free injection time.
It is a more ideal choice for insulin therapy
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References: [1] Hedrington MS et al.
Diabetes Technol Ther.
2011;13 Suppl 1:S33-42.
[2] Becker RH et al.
Diabetes Care.
2015;38:637-43.
[3] Jax T et al.
Poster presented at EASD 2013; Abstract 1029.
[4] Steinstraesser A et al.
Diabetes Obes Metab.
2014;16:873-6.
[5]Bernard Charbonnel, et al.
Presented at: American Diabetes Association Scientific Sessions 2019, 131-LB.
[6]Haluzík M, et al.
Diabetes Obes Metab 2020,22(8):1369-1377.
[7]Klonoff D, et al.
J Diabetes Sci Technol 2015,10(1):125-130 .
[8]Pohlmeier H, et al.
J Diabetes Sci Technol 2017,11(2):263-269.
[9] Riddle MC, et al.
Diabetes Technol Ther 2016,18(4):252-257.
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