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On May 21, 2022, the 18th "2022 Peking University Diabetes Forum" jointly sponsored by Peking University Diabetes Center and "Chinese Journal of Diabetes" was held as schedul.
The theme of this forum is "Diabetes and Obesity", and two sub-venues for basic and special topics are set up at the same ti.
This forum has a luxurious lineup and gathered experts and scholars in the field of endocrinology from well-known hospitals across the count.
At the meeting, Professor Zou Dajin from the Tenth People's Hospital Affiliated to Tongji University, gave a wonderful academic report on the topic of "The control goal of diabetes and obesity - normalization of blood sugar or normalization of body weight?"Expert introduction Professor Zou Dajin Professor, Chief Physician, Doctoral Supervisor of Tongji University Tenth People's Hospital; Honorary Director of Obesity Institute of Tongji University School of Medicine; Director of Shanghai Metabolic and Thyroid Disease Research Center; 2017 First National Famous Doctor; Chinese Medical Doctor Association The first to fourth vice presidents of the Endocrinology and Metabolism Physicians Association; the first chairman of the Obesity Professional Committee of the Chinese Medical Doctor Association; the vice chairman of the sixth, seventh and eighth Diabetes Association of the Chinese Medical Association; Obesity Science of the Diabetes Association of the Chinese Medical Association The first leader of the group; the second and third deputy editors of "Chinese Journal of Diabetes", the sixth deputy editor of "Shanghai Medicine"; currently the former chairman of the Shanghai Medical Association Diabetes Society, and the deputy director of the Shanghai Medical Association of Endocrinology and Metabolism Branch Chairm.
One of the primary causes of obesity, hyperglycemia, diabetes, and cardiovascular disease, Professor Dajin Zou pointed out that metabolic syndrome is a complex group of metabolic disorders, including obesity, hyperglycemia, hypertension, and dyslipidemia, and is the greatest risk of cardiovascular disease fact.
A survey report in China shows that the prevalence of metabolic syndrome in adults is as high as 39%, and women are higher than m.
Among them, obesity is an important part of metabolic abnormalities, and insulin resistance (IR) is an important pathological bas.
Obesity, as a recognized "source of all diseases", has been confirmed to have a very close relationship with MetS, cardiovascular disease (CVD), type 2 diabetes (T2DM) and major cance.
(Figure 1) Figure 1 The relationship between BMI and the incidence of various diseases According to the National Nutrition Survey (CNNSs) and the National Student Physical Fitness and Health Survey (CNSSCH), the BMI and overweight and obesity rates of all age groups in China continue to increa.
According to the 2021 Global Burden of Disease Study, according to WHO standards, China ranks first in the world in the number of obese children, and second only to the United States in the number of obese adults; according to Chinese standards, the number of obese people already ranks first in the wor.
In addition, a number of studies on centrally obese people with normal weight in China have shown that such patients have a higher excess risk of stroke and premature dea.
This suggests that waist circumference, like BMI, should be used as a routine indicator for monitoring metabolic disease risk facto.
Even more serious, the researchers predict that the prevalence of overweight and obesity in Chinese adults (≥18 years old) will reach 63% in 2030 (Chinese standard), and the prevalence of overweight and obesity in school-age children and adolescents (7-17 years old) will reach 6
Reaching 38% (Chinese standard), the prevalence of overweight and obesity in preschool children (≤6 years old) will reach 16% (WHO standar.
Therefore, it is conservatively estimated that the medical expenses attributable to overweight/obesity in China in 2030 will be 418 billion yuan (about 61 billion US dollars), accounting for about 22% of the total national medical expenses (Figure
Figure 2 The prevalence of overweight/obesity and medical expenses among Chinese adults in 2030 to predict diabetes and obesity, not only "diabetes + obesity" Professor Zou Dajin pointed out that obesity, overweight and other problems caused by imbalance of energy metabolism are common in T2DM patien.
It will exacerbate the occurrence and progression of diabetes and its complicatio.
The hyperresponsiveness of islet β cells brought about by obesity, as well as the consequent problems such as hyperinsulinemia (HI) and insulin resistance (IR), are often associated with T2DM, CVD, dyslipidemia, hypertension, and hyperuricem.
And a series of diseases are "wolverine", which is why patients with diabetes and obesity often do not appear in isolation, but are often accompanied by various other chronic diseas.
Figure 3 The imbalance of energy metabolism exacerbates the occurrence and aggravation of diabetes and its complications A well-known clinical study in China, the "4C Study", confirmed that obesity insulin resistance is significantly associated with a higher risk of diabetes, and is significantly higher than that of pure islet β-cell functi.
Barrier linkages are more pronounc.
IR, in turn, leads to further exhaustion of islet β cells, forming a vicious circle (Figure
Figure 4 The mechanism of IR leading to the functional operation of islet β cells "accurate typing" enables "precise treatment" Professor Zou Dajin pointed out that the "precise typing" of diabetes is very necessary for the subsequent "precise treatment", and it is recommended that clinicians Accurate typing of each diabetic obese patient, including the exclusion of special diabetes such as monogenic diabet.
How to type? Professor Zou Dajin briefly summarized as follows: Table 1 Classification criteria for diabetes (except for special types) After the classification is clearly defined, targeted interventions can be implemented according to the patient's own situation: Table 2 The recommended first-level and The secondary prevention and treatment program "treat diabetes first, cure obesity" - first cure obesity, then control sugar, and the intervention strategy for diabetes and obesity Professor Zou Dajin pointed out that in the vicious circle of "obesity→IR→islet β-cell dysfunction→T2DM worsening" , to solve the first "domino" - obesity is particularly importa.
The "Chinese Expert Consensus on Type 2 Diabetes Reversal" published in 2021 (written by Professor Zou Dajin as the core) clearly pointed out that for some obese patients with newly diagnosed T2DM, through substantial weight loss, it is possible to restore pancreatic islet function and achieve "reversal" of T2.
This consensus is based on solid evidence-based evidence at home and abroad in recent years, such as the famous Diabetes Remission Clinical Trial (DiRECT), which confirmed that clinical remission of T2DM can be achieved through life>
Figure 5 Type 2 diabetes remission rate after 12 months and 24 months of weight loss in the DiRECT study, and many subsequent studies have also provided many mechanisms and basic medical evidence for achieving clinical remission of T2DM through weight loss (Figure 6, Figure
Figure 6 Mechanism of weight loss to achieve clinical remission of T2DMFigure 7 Type 2 diabetes reverses pancreatic pathological changes in diabetes and obesi.
Professor Zou Dajin gave the following suggestions:Life>
The study, published in the New England Journal of Medicine, showed that life>
Some studies have even shown that strict life>
At the same time, in recent years, the relevant guidelines for the management of overweight and obesity in various countries also contain related content related to life>
For example, the only A-level recommendation in the "Chinese Expert Consensus on Medical Nutrition Treatment of Overweight and Obesity (2020 Edition)" is: an energy-restricted diet (an average daily calorie intake reduction of 30%-50% or a reduction of 500 kcal, or a daily calorie intake Limiting intake to 1000-1500 kcal) has the effect of reducing body weight and reducing fat conte.
Daily physical activity is also recommended in national guidelines (Figure Figure 8 Recommendations for physical activity in national guidelinesPharmacotherapy Pharmacotherapy is a treatment option when life>
In China, obesity drug treatment is more conservati.
Currently, only orlistat is approved for obesity treatme.
Orlistat: a gastroenteropancreatic lipase inhibitor, is currently the only drug approved for the treatment of obesity in Chi.
A multicenter, randomized, double-blind, placebo-controlled study showed that on the basis of a low-calorie diet, orlistat (120 mg, 3 times a day) after 24 weeks of treatment can significantly reduce body weight compared with the control group (P< 0001), the proportion of weight loss ≥5% was higher (65% .
28%, P<0001), and the proportion of weight loss ≥10% was higher (22% .
9%, P=000
However, orlistat's gastrointestinal adverse effects (eg, oily stools and stool urgency), fat-soluble vitamin malabsorption, and long-term cardiovascular risks are unclear, limiting its widespread u.
Liraglutide: 1 GLP-1 receptor agoni.
Although some countries have approved the 0 mg liraglutide dosage form for weight management, it has not been approved in Chi.
A multicenter, open-label, single-arm study of 328 overweight/obese patients with type 2 diabetes in China showed that after 24 weeks of treatment with liraglutide (2 or 8 mg QD), the patient's body weight decreased significantly from 86 kg to 71kg (P<01), 47% of the patients lost weight by 5% to 10%, and 31% of the patients lost more than 10% of their body weig.
This finding has clinical significance, but needs to be further verified in the Chinese populati.
Semaglutide: a GLP-1 receptor agoni.
The STEP series conducted worldwide found that in overweight or obese patients with weight-related complications, semaglutide 4 mg once weekly reduced body weight by 16% to 12% on the basis of life>
This suggests that semaglutide has promising weight loss prospec.
Currently, another multi-country, multi-center Phase 3 clinical study (STEP 7 study) is enrolling overweight or obese patients across China, South Korea and Brazil to analyze the efficacy and safety of semaglutide in weight management (NCT04251156) , we await the resul.
Bariatric surgery In clinical practice, bariatric surgery is considered an important means of treating severe obesi.
For severely obese patients, bariatric surgery is the only intervention that can achieve short- and long-term sustained weight loss, improve complications, reduce mortality, and improve quality of li.
Globally, four major bariatric procedures have established efficacy: laparoscopic adjustable gastric banding (LAGB), Roux-en-Y gastric bypass (RYGB), sleeve gastrectomy (SG) ), biliopancreatic diversion with or without duodenal transpositi.
Recommendations in the Chinese Guidelines for Surgical Treatment of Obesity and Type 2 Diabetes (2019): Active surgery is recommended when BMI ≥ 35kg/㎡; surgical treatment is recommended when BMI is 35 ≤ BMI < 35kg/㎡; 25 ≤ BMI < 35kg/㎡ Surgery is also recommended for patients with refractory weight control with intervention and drug therapy, with at least two components of the metabolic syndrome, or obesity-related complicatio.
Surgery may also be considered for patients with central obesity (waist circumference ≥ 90 cm in men or ≥ 85 cm in women) based on the Multidisciplinary Treatment Team (MDT) assessment
According to the existing literature reports, the most common surgical procedure is RYGB, followed by LAGB and SG, and most of the procedures are performed under laparosco.
Judging from the data in recent years, the dominance of SG has become increasingly evident, which may be related to its advantages of simple operation and low risk of serious complicatio.
Of course, there are still some difficulties in the promotion of bariatric surgery in China, such as the risk of short-term and long-term complications of surgery, and about 5% to 20% of patients experience weight rebound after surge.
Chinese medicine therapy Professor Zou Dajin pointed out that Chinese medicine, acupuncture, massage and massage, meridian thread embedding, e.
can also be used as supplementary therapy for weight lo.
The potential mechanisms of TCM health preservation may include suppressing appetite, reducing the absorption of exogenous lipids, reducing the synthesis of endogenous lipids, promoting lipid oxidation and consumption, and improving lipid metaboli.
At the end of this paper, Professor Zou Dajin summarized the lecture: insulin resistance is very closely related to the occurrence of metabolic syndrome such as obesity and diabetes; for metabolic syndrome such as diabetes and obesity, it is very necessary to correct obesity first; Among strategies to achieve weight goals, stringent life>
The theme of this forum is "Diabetes and Obesity", and two sub-venues for basic and special topics are set up at the same ti.
This forum has a luxurious lineup and gathered experts and scholars in the field of endocrinology from well-known hospitals across the count.
At the meeting, Professor Zou Dajin from the Tenth People's Hospital Affiliated to Tongji University, gave a wonderful academic report on the topic of "The control goal of diabetes and obesity - normalization of blood sugar or normalization of body weight?"Expert introduction Professor Zou Dajin Professor, Chief Physician, Doctoral Supervisor of Tongji University Tenth People's Hospital; Honorary Director of Obesity Institute of Tongji University School of Medicine; Director of Shanghai Metabolic and Thyroid Disease Research Center; 2017 First National Famous Doctor; Chinese Medical Doctor Association The first to fourth vice presidents of the Endocrinology and Metabolism Physicians Association; the first chairman of the Obesity Professional Committee of the Chinese Medical Doctor Association; the vice chairman of the sixth, seventh and eighth Diabetes Association of the Chinese Medical Association; Obesity Science of the Diabetes Association of the Chinese Medical Association The first leader of the group; the second and third deputy editors of "Chinese Journal of Diabetes", the sixth deputy editor of "Shanghai Medicine"; currently the former chairman of the Shanghai Medical Association Diabetes Society, and the deputy director of the Shanghai Medical Association of Endocrinology and Metabolism Branch Chairm.
One of the primary causes of obesity, hyperglycemia, diabetes, and cardiovascular disease, Professor Dajin Zou pointed out that metabolic syndrome is a complex group of metabolic disorders, including obesity, hyperglycemia, hypertension, and dyslipidemia, and is the greatest risk of cardiovascular disease fact.
A survey report in China shows that the prevalence of metabolic syndrome in adults is as high as 39%, and women are higher than m.
Among them, obesity is an important part of metabolic abnormalities, and insulin resistance (IR) is an important pathological bas.
Obesity, as a recognized "source of all diseases", has been confirmed to have a very close relationship with MetS, cardiovascular disease (CVD), type 2 diabetes (T2DM) and major cance.
(Figure 1) Figure 1 The relationship between BMI and the incidence of various diseases According to the National Nutrition Survey (CNNSs) and the National Student Physical Fitness and Health Survey (CNSSCH), the BMI and overweight and obesity rates of all age groups in China continue to increa.
According to the 2021 Global Burden of Disease Study, according to WHO standards, China ranks first in the world in the number of obese children, and second only to the United States in the number of obese adults; according to Chinese standards, the number of obese people already ranks first in the wor.
In addition, a number of studies on centrally obese people with normal weight in China have shown that such patients have a higher excess risk of stroke and premature dea.
This suggests that waist circumference, like BMI, should be used as a routine indicator for monitoring metabolic disease risk facto.
Even more serious, the researchers predict that the prevalence of overweight and obesity in Chinese adults (≥18 years old) will reach 63% in 2030 (Chinese standard), and the prevalence of overweight and obesity in school-age children and adolescents (7-17 years old) will reach 6
Reaching 38% (Chinese standard), the prevalence of overweight and obesity in preschool children (≤6 years old) will reach 16% (WHO standar.
Therefore, it is conservatively estimated that the medical expenses attributable to overweight/obesity in China in 2030 will be 418 billion yuan (about 61 billion US dollars), accounting for about 22% of the total national medical expenses (Figure
Figure 2 The prevalence of overweight/obesity and medical expenses among Chinese adults in 2030 to predict diabetes and obesity, not only "diabetes + obesity" Professor Zou Dajin pointed out that obesity, overweight and other problems caused by imbalance of energy metabolism are common in T2DM patien.
It will exacerbate the occurrence and progression of diabetes and its complicatio.
The hyperresponsiveness of islet β cells brought about by obesity, as well as the consequent problems such as hyperinsulinemia (HI) and insulin resistance (IR), are often associated with T2DM, CVD, dyslipidemia, hypertension, and hyperuricem.
And a series of diseases are "wolverine", which is why patients with diabetes and obesity often do not appear in isolation, but are often accompanied by various other chronic diseas.
Figure 3 The imbalance of energy metabolism exacerbates the occurrence and aggravation of diabetes and its complications A well-known clinical study in China, the "4C Study", confirmed that obesity insulin resistance is significantly associated with a higher risk of diabetes, and is significantly higher than that of pure islet β-cell functi.
Barrier linkages are more pronounc.
IR, in turn, leads to further exhaustion of islet β cells, forming a vicious circle (Figure
Figure 4 The mechanism of IR leading to the functional operation of islet β cells "accurate typing" enables "precise treatment" Professor Zou Dajin pointed out that the "precise typing" of diabetes is very necessary for the subsequent "precise treatment", and it is recommended that clinicians Accurate typing of each diabetic obese patient, including the exclusion of special diabetes such as monogenic diabet.
How to type? Professor Zou Dajin briefly summarized as follows: Table 1 Classification criteria for diabetes (except for special types) After the classification is clearly defined, targeted interventions can be implemented according to the patient's own situation: Table 2 The recommended first-level and The secondary prevention and treatment program "treat diabetes first, cure obesity" - first cure obesity, then control sugar, and the intervention strategy for diabetes and obesity Professor Zou Dajin pointed out that in the vicious circle of "obesity→IR→islet β-cell dysfunction→T2DM worsening" , to solve the first "domino" - obesity is particularly importa.
The "Chinese Expert Consensus on Type 2 Diabetes Reversal" published in 2021 (written by Professor Zou Dajin as the core) clearly pointed out that for some obese patients with newly diagnosed T2DM, through substantial weight loss, it is possible to restore pancreatic islet function and achieve "reversal" of T2.
This consensus is based on solid evidence-based evidence at home and abroad in recent years, such as the famous Diabetes Remission Clinical Trial (DiRECT), which confirmed that clinical remission of T2DM can be achieved through life>
Figure 5 Type 2 diabetes remission rate after 12 months and 24 months of weight loss in the DiRECT study, and many subsequent studies have also provided many mechanisms and basic medical evidence for achieving clinical remission of T2DM through weight loss (Figure 6, Figure
Figure 6 Mechanism of weight loss to achieve clinical remission of T2DMFigure 7 Type 2 diabetes reverses pancreatic pathological changes in diabetes and obesi.
Professor Zou Dajin gave the following suggestions:Life>
The study, published in the New England Journal of Medicine, showed that life>
Some studies have even shown that strict life>
At the same time, in recent years, the relevant guidelines for the management of overweight and obesity in various countries also contain related content related to life>
For example, the only A-level recommendation in the "Chinese Expert Consensus on Medical Nutrition Treatment of Overweight and Obesity (2020 Edition)" is: an energy-restricted diet (an average daily calorie intake reduction of 30%-50% or a reduction of 500 kcal, or a daily calorie intake Limiting intake to 1000-1500 kcal) has the effect of reducing body weight and reducing fat conte.
Daily physical activity is also recommended in national guidelines (Figure Figure 8 Recommendations for physical activity in national guidelinesPharmacotherapy Pharmacotherapy is a treatment option when life>
In China, obesity drug treatment is more conservati.
Currently, only orlistat is approved for obesity treatme.
Orlistat: a gastroenteropancreatic lipase inhibitor, is currently the only drug approved for the treatment of obesity in Chi.
A multicenter, randomized, double-blind, placebo-controlled study showed that on the basis of a low-calorie diet, orlistat (120 mg, 3 times a day) after 24 weeks of treatment can significantly reduce body weight compared with the control group (P< 0001), the proportion of weight loss ≥5% was higher (65% .
28%, P<0001), and the proportion of weight loss ≥10% was higher (22% .
9%, P=000
However, orlistat's gastrointestinal adverse effects (eg, oily stools and stool urgency), fat-soluble vitamin malabsorption, and long-term cardiovascular risks are unclear, limiting its widespread u.
Liraglutide: 1 GLP-1 receptor agoni.
Although some countries have approved the 0 mg liraglutide dosage form for weight management, it has not been approved in Chi.
A multicenter, open-label, single-arm study of 328 overweight/obese patients with type 2 diabetes in China showed that after 24 weeks of treatment with liraglutide (2 or 8 mg QD), the patient's body weight decreased significantly from 86 kg to 71kg (P<01), 47% of the patients lost weight by 5% to 10%, and 31% of the patients lost more than 10% of their body weig.
This finding has clinical significance, but needs to be further verified in the Chinese populati.
Semaglutide: a GLP-1 receptor agoni.
The STEP series conducted worldwide found that in overweight or obese patients with weight-related complications, semaglutide 4 mg once weekly reduced body weight by 16% to 12% on the basis of life>
This suggests that semaglutide has promising weight loss prospec.
Currently, another multi-country, multi-center Phase 3 clinical study (STEP 7 study) is enrolling overweight or obese patients across China, South Korea and Brazil to analyze the efficacy and safety of semaglutide in weight management (NCT04251156) , we await the resul.
Bariatric surgery In clinical practice, bariatric surgery is considered an important means of treating severe obesi.
For severely obese patients, bariatric surgery is the only intervention that can achieve short- and long-term sustained weight loss, improve complications, reduce mortality, and improve quality of li.
Globally, four major bariatric procedures have established efficacy: laparoscopic adjustable gastric banding (LAGB), Roux-en-Y gastric bypass (RYGB), sleeve gastrectomy (SG) ), biliopancreatic diversion with or without duodenal transpositi.
Recommendations in the Chinese Guidelines for Surgical Treatment of Obesity and Type 2 Diabetes (2019): Active surgery is recommended when BMI ≥ 35kg/㎡; surgical treatment is recommended when BMI is 35 ≤ BMI < 35kg/㎡; 25 ≤ BMI < 35kg/㎡ Surgery is also recommended for patients with refractory weight control with intervention and drug therapy, with at least two components of the metabolic syndrome, or obesity-related complicatio.
Surgery may also be considered for patients with central obesity (waist circumference ≥ 90 cm in men or ≥ 85 cm in women) based on the Multidisciplinary Treatment Team (MDT) assessment
According to the existing literature reports, the most common surgical procedure is RYGB, followed by LAGB and SG, and most of the procedures are performed under laparosco.
Judging from the data in recent years, the dominance of SG has become increasingly evident, which may be related to its advantages of simple operation and low risk of serious complicatio.
Of course, there are still some difficulties in the promotion of bariatric surgery in China, such as the risk of short-term and long-term complications of surgery, and about 5% to 20% of patients experience weight rebound after surge.
Chinese medicine therapy Professor Zou Dajin pointed out that Chinese medicine, acupuncture, massage and massage, meridian thread embedding, e.
can also be used as supplementary therapy for weight lo.
The potential mechanisms of TCM health preservation may include suppressing appetite, reducing the absorption of exogenous lipids, reducing the synthesis of endogenous lipids, promoting lipid oxidation and consumption, and improving lipid metaboli.
At the end of this paper, Professor Zou Dajin summarized the lecture: insulin resistance is very closely related to the occurrence of metabolic syndrome such as obesity and diabetes; for metabolic syndrome such as diabetes and obesity, it is very necessary to correct obesity first; Among strategies to achieve weight goals, stringent life>
