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    Home > Active Ingredient News > Endocrine System > Two tables to quickly grasp the clinical medication of "diabetic microcirculation disorder"

    Two tables to quickly grasp the clinical medication of "diabetic microcirculation disorder"

    • Last Update: 2021-05-22
    • Source: Internet
    • Author: User
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    Edited by Yimaitong, please do not reprint without authorization.

    Introduction: Microcirculation disorders are one of the important pathophysiological basis for the occurrence and development of chronic complications of diabetes.
    Improving microcirculation disorders is of great significance for preventing, delaying, and treating various chronic complications of diabetes.

    What are the related treatment drugs? How to standardize the application? The content is all on these two tables.

     What is diabetic microcirculation disorder? 1.
    What is microcirculation disorder? Microcirculation is the most basic structure of the circulatory system and the main place for material exchange between blood and tissues.

    Blood microcirculation refers to blood circulation in the capillaries between arterioles and venules.

    A typical microcirculation consists of arterioles, posterior arterioles, capillary presphincter, true capillaries, arteriovenous anastomoses and venules.

    Due to the abnormal structure and function of the microcirculation, it cannot adapt to the metabolic level of the tissues and organs, which affects the material exchange of the tissues and the functional state of the organs, which is called microcirculation disorder.

     The manifestations of microcirculation disorders include microvascular dysfunction, increased permeability of blood vessel walls, and changes in blood rheology, as well as abnormalities in microvascular structure and capillary density.

    2.
    What is diabetic microcirculation disorder? The microcirculation disorder caused by diabetes-related factors is called diabetic microcirculation disorder (the exact pathogenesis has not been fully elucidated).
    It not only plays an important role in the occurrence of diabetic vascular complications, but also participates in the occurrence and development of insulin resistance and diabetes.

    Diabetic microcirculation disorders not only play an important role in the occurrence and development of diabetic foot, which are mainly microvascular diseases, such as diabetic nephropathy, diabetic retinopathy, diabetic neuropathy, and diabetic foot, but also in the occurrence and development of diabetic foot that is jointly participated by macrovascular disease and microvascular disease.

    Recommendations at a glance-which drugs can help improve diabetic microcirculation disorders? The drugs to improve the microcirculation disorders of diabetes mainly include vasodilators, drugs that affect hemorheology, drugs to protect the vascular endothelium, and some Chinese medicine preparations.
    The clinical recommendations of drugs to improve microcirculation disorders are shown in Table 1.

    The treatment of diabetic microcirculation disorders should adhere to the principle of "controlling blood sugar, blood pressure, and blood lipids as the basis for diabetes treatment", and the medication should follow the principle of "early, individualized, rational combination, and safety".

    Table 1 Clinical recommendations of drugs for improving diabetic microcirculation disorders (click to view larger image) Recommendation level: ➤ Category I: Research evidence supports and/or unanimously recognized beneficial, useful and effective operations or treatments, recommended; ➤ Category II: Refers to operations or treatments in which useful and/or effective evidences are contradictory or have different opinions; ➤Class IIa: The evidence/opinions tend to be useful and/or effective, and the application of these operations or treatments is reasonable; ➤Class IIb: Relevant Evidence/opinion can’t be fully proven useful and/or effective, consider applying; ➤Type III: Refers to operations or treatments that have been proven and/or unanimously recognized as useless and/or ineffective, and may be harmful to some cases, and are not recommended.
    .

    Evidence level: ➤A: evidence is based on multiple randomized clinical trials or meta-analysis; ➤B: evidence is based on a single randomized clinical trial or multiple non-randomized controlled studies; ➤C: only expert consensus opinions and/or based on small-scale studies, Retrospective research and registration research results.

     List of medication methods-what problems should be paid attention to in clinical application? A brief description of commonly used drugs for improving diabetic microcirculation disorders is shown in Table 2.

    Table 2 A brief description of commonly used drugs for improving diabetic microcirculation disorders (click to view larger image) 1.
    Vasodilators ➤ Pancreatic kininogenase (PK): PK hydrolyzes kininogen to form bradykinin, which increases capillaries by dilating small arteries Blood flow; activate plasmin, reduce blood viscosity, improve blood rheology; improve tissue perfusion.

    It is clinically used to treat diabetic nephropathy, retinopathy, etc.

     ➤Alprostadil: Prostaglandin E1 (PGE1).
    Through its receptor, it can increase the content of cyclic adenosine monophosphate in vascular smooth muscle cells, relax vascular smooth muscle, and exert a powerful vasodilator effect, especially on the blood vessels in blocked parts.  ➤Beraprost Sodium: By acting on the prostacyclin receptors of platelets and vascular smooth muscles, it exerts antiplatelet and vasodilation effects, thereby improving microcirculation, and is clinically used to improve chronic distal arterial stenosis and ulcers caused by occlusive diseases , Intermittent claudication, pain and cold sensation and other symptoms.

     ➤Other vasodilators: such as pentoxifylline and calcium channel blockers (nimodipine and cinepazide), etc.
    , also have the effect of improving microvasospasm and correcting ischemia, but the related clinical research is of low quality .

     2.
    Drugs that affect hemorheology ➤Antiplatelet drugs: There are many drugs that have antiplatelet effects.
    Commonly used clinically are aspirin, clopidogrel, etc.
    , whose main role is to inhibit platelet function and prevent thrombosis.

     ➤Anticoagulant drugs: including anticoagulant factors, antiplatelet factors and coagulation factor Xa and IIa inhibitors.

    Commonly used clinical anticoagulants are low molecular weight heparin (usually administered intravenously), new oral anticoagulants factor Xa inhibitors (such as apixaban, rivaroxaban, edoxaban) and factor IIa inhibitors (Such as dabigatran etexilate).

    There are occasional small-sample clinical reports of low-molecular-weight heparin monotherapy or combination treatment of diabetic nephropathy, and few clinical reports of new oral anticoagulants used to improve diabetic microcirculation disorders.

     ➤Fibrinolytic drugs: Batroxobin has the effect of reducing fibrinogen concentration, blood viscosity, and inhibiting thrombosis.

    Clinically, it can be used to treat various obliterative vascular diseases and microcirculation disorders; lumbrokinase is a mixture of plasmin and plasminogen activator extracted from the open-air red earthworm Aisena, which can be used for treatment Ischemic cardio-cerebrovascular disease and diabetic peripheral vascular occlusion.

     3.
    Drugs to protect vascular endothelium ➤Vascular protective drugs: Calcium dobesilate improves vascular endothelial dysfunction and reduces microvascular leakage through anti-oxidative stress and reduces inflammation; reduces the binding of vascular endothelial growth factor (VEGF) to receptors , Inhibit angiogenesis.

    It is clinically used to treat diabetic retinopathy and diabetic nephropathy.

     ➤Anti-vascular endothelial growth factor drugs: Conbercept is a new type of fusion protein anti-VEGF drug that is clinically used to treat macular edema (such as diabetic macular edema), retinal neovascularization, choroidal neovascularization and Neovascular glaucoma and other diseases; aflibercept is the first anti-VEGF drug approved for the treatment of diabetic macular edema in my country; ranibizumab is clinically used to treat macular edema and retinal neovascularization caused by various reasons , Retinal vein occlusion, neovascular glaucoma and other diseases.

    Reference materials: Diabetes and Microcirculation Professional Committee of Chinese Microcirculation Society.
    Expert consensus on clinical medication for diabetic microcirculation disorders (2021 edition) [J].
    "Chinese Journal of Medical Frontiers (Electronic Edition)".
    2021 Vol.
    13 No.
    4.
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