What about the busy pace of work for diabetes? This option is worth having!

Details of the casepatient, MrWang, 46, auditorDry mouth, fatigue 7 years, aggravated with more than half a month of urinecurrent medical history:7 years ago appeared dry mouth, fatigue symptoms, to the hospital, check fasting blood sugar (FPG) 8.9mmol/L, glycated hemoglobin (HbA1c) 8.6%, diagnosed as "type 2 diabetes", that is, metformin oral, with diet, exercise therapybegan to use Gremeline 2 years ago, irregular monitoring of blood sugar, night overtime when occasionally panic, sweating, after eating can be alleviatedIn the past half month, the dry mouth is obvious, the amount of urine than before increased, self-test FPG 9.2mmol/L, to the hospital clinicpast history, personal history, family history:the history of "blood lipid abnormality, fatty liver" for 7 years, denied the "hypertension" historyDeny a history of trauma, a history of blood transfusions, no history of food or drug allergiesDrink alcohol when out for a good time, drink without alcohol, and deny smokingBoth her mother and uncle had diabetesphysical examination:height 178cm, weight 84kg, BMI 26.5kg/m2, abdominal circumference 92cm; HR 79 times/min, BP 134/82mmHg, general condition is OK; heart, lung, abdomen, etcdid not see obvious abnormalities, no double lower limb edema laboratory and auxiliary examination: , sugar metabolism: HbA1c 7.7%, fasting blood sugar 8.1mmol/L, C peptide 2.4ng/ml, after meal 2h blood sugar 13.2mmol/L C peptide 6.1ng/ml other examinations: urine routine: urinary ketones (-), urine sugar (?); blood lipids (mmol/L): TG 3.29 mmol/L, TC 5.75 mmol/L, HDL-C 1.06 mmol/L, LDL-C 4.29 mmol/L; liver function: ALT 75U/L, renal function, urine micro-white protein: not abnormal : Abdominal color super: fatty liver; cervical artery color super, under-eye examination: no abnormality; double lower limb induced potential: double lower limb sensory nerve conduction speed slowed down Diagnosis of patients: 1 Type 2 diabetes with peripheral neuropathy (DPN) 2 Blood lipid abnormalities 3 case characteristics and treatment needs analysis of fatty liver disease slowly and continuously progress; The next treatment plan should be continuous and effective sugar control, reduce blood sugar fluctuations, delay the progressofy of the disease sedentary mode, often travel, already have abdominal obesity, fatty liver, need to control weight, business meals, hope to simplify the program as much as possible, drug easy to carry, to avoid low blood sugar oral medicine treatment is not up to standard, the current two oral medicine blood glucose is not up to standard, metformin has enough, Gremequine 4mg/d, occasionally low blood sugar occurred, continue to add more oral medication may lead to increased risk of hypoglycemia Mr Wang should continue to increase oral sugar-lowering drugs? Or the starting injection (insulin/glucagon-like peptide 1 receptor agonists(GLP-1RA))? 1 recommendations to ensure that the efficacy and benefits of sugar reduction before adjusting treatment options, let's look at domestic and foreign guidelines 2017 China Guidelines for the Prevention and Treatment of Type 2 Diabetes, 2018 ADA-EASD Guidelines: Oral medication treatment is not up to standard for dicatomy treatment with an optional injection treatment The 2020ADA guidelines state that when choosing to inject a sugar-reducing drug to increase the effect of reducing sugar, the choice of GLP-1RA over insulin is preferred The clinical studies of GLP-1RA have been emerging, and several studies have confirmed that GLP-1RA has the advantageof of lowering blood sugar, improving beta cell function, and low blood sugar risk And from the approval of the first GLP-1RA drug essenatide (twice a day), to the launch of liraglutide (once a day) to the market in China with doglupeptides (once a week), GLP-1RA continues to optimize to provide patients with more choice Which GLP-1RA should this patient start with? 2 realistic considerations, the guardian patient's "poetry and the distant" 46-year-old Mr Wang is busy working life, regular monthly travel, each 3-5 days, but this job carries his idealand responsibility to the family Therefore, for the treatment plan, in addition to stable, comprehensive sugar-lowering efficacy, but also look forward to the daily work and quality of life protection first of all, from the treatment of sugar, a real-world study in the United States found that, after one year of follow-up, the efficacy of the degree-pulling glycopeptide reduced HbA1c was significantly better than liraglutide (HbA1c decreased by 0.98% vs 0.77%, P 0.05) (Figure 11 left), compliance is also better, adhere to the proportion of patients who adhere to the drug (treatment interruption time of 45 days), the degree of glutatinine group is 55%, liraglutide group is 43.8% (P 0.001) (Figure 1 right) (Figure 1 right) (6-8) Increased compliance can also further improve blood sugar control, significantly reduce the risk of all-cause death, and improve clinical outcomes figure 1 degree saccharide and liraglutide efficacy and compliance difference
degree saccharide in the protection of strong, long-lasting sugar reduction at the same time, once a week injection frequency is low, simple treatment plan, can allow patients to persist for a long time No need for advance suspension, automatic injection of the simple device, operation is simpler, can be used and thrown, effectively solve, after opening the improper preservation of the drug effect of the decline The advantages of these treatment sthets are well suited to Mr Wang's needs Therefore, the degree-pulling glycopeptide weekly preparation is a more suitable choice for it , after considering domestic and international guidelines and patient realities, has identified the next treatment plan: ? Metformin 1.0g bid, plus-degree glutaride qw ? to reduce the risk of hypoglycemia by discontinuing gremetre? Inform that there may be gastrointestinal reactions such as nausea, vomiting, diarrhea, and advise your diet to avoid oily, too full, if severe symptoms of discomfort occur, promptly follow up 5 weeks after treatment Mr Wang FPG reduced from 8.1mmol/L to 6.7mmol/L, PPG from 13.2mmol/L to 9.2mol/L (Figure 2) Figure 2 Changes in FPG and PPG for 5 weeks hbA1c after 3 months of treatment 6.5%; FPG 6.4mmol/L; PPG 8.8mmol/L; weight loss of 2.5 kg without hypoglycemia (Figure 3) It can be seen that Mr Wang's treatment plan using the degree-laced glucan weekly preparation works very well Figure 3 3 months of fPG, PPG, HbA1c, weight change , in addition, for the entire treatment patient also expressed their feelings: ? "The first injection after the second day when the number of stools increased, especially worried, although the doctor confessed that there may be adverse reactions, still worried about the symptoms can not adapt, but the diarrhea quickly improved, the fifth day of the bowel stool has been completely normal, blood sugar is also very well controlled" ? "After the suspension of Gremed, there is no feeling of heart palpitations, sweat" ? "Injection is quick and convenient, a little nervous the first time, then it's easy, and it doesn't hurt at all" ? "The frequency of weekly injections is perfect for our travelers, greatly reducing the psychological burden of medication, and now I don't have to carry it on business" ? "This program is very convenient to use, now blood sugar control is very good, work is not affected, thank the doctor to provide treatment advice " Professor Li Yiming comments we in accordance with the previous treatment concept, the patient oral medication treatment is not up to standard, may need starting insulin treatment, but there are often some problems (such as strict preservation conditions and injection time control lead to the use of inconvenient use, adverse weight control, low blood sugar risk, need to strengthen blood sugar monitoring, etc Taking into account the needs of patients in clinical treatment can greatly improve patient satisfaction and compliance the case combined with patient needs, and the guidelines recommended GLP-1RA treatment GLP-1RA drugs themselves can cover multiple hypoglycemic mechanisms, such as increasing insulin secretion, inhibiting glucagon secretion, reducing appetite, etc., so that patients benefit more; And the weekly preparation treatment plan is easy to use, but also conducive to patients adhere to the use in general, the case analysis is very detailed, and in the whole treatment, the doctor considered very thoroughly, clear approach to diagnosis and treatment, from the guidance of evidence-based, combined with the patient needs to travel frequently this practical factor, fully explained the use of the degree of glutamate this drug, in line with Mr Wang in the control of blood sugar, improve metabolism at the same time, convenient to adhere to the needs of the use, and achieved satisfactory treatment results Expert introduction Professor Li Yiming the director of the endocrinology department of Huashan Hospital affiliated with Fudan University, the chief physician, professor, doctoral tutor the Standing Committee of the Chinese Medical Association Diabetes Credit Union, the head of the diabetes and related endocrine disease group, the Vice Chairman of the Diabetes Branch of the Chinese Society of Gerontology and Gerontology
the Standing Committee of the Chinese Society of Microcirculation and Microcirculation, the International Society of The International Health Association of the National Association of Endocrinology and Microcirculation He has undertaken 6 projects on the surface of the National Natural Science Foundation of China and 3 key projects of the Shanghai Science and Technology Commission More than 70 published SCI papers Appendix: Concise Prescription for Doracoride Injection : Doraglupeptide Injection ": This product is a colorless clear solution : 0.75mg: 0.5ml (pre-filled injection pen); : This product is suitable for blood glucose control in adults with type 2 diabetes, including patients with poor dietary control and exercise blood sugar control alone, and patients who receive metformin, or sulphate drugs, or metformin combined with sulphate drugs, that are still poorly controlled on the basis of dietary control and exercise Usage: The recommended starting dose of this product is 0.75 mg once a week To further improve blood sugar control, the dose can be increased to 1.5 mg once a week The maximum recommended dose is 1.5 mg once a week This product is injected by subcutaneous medicine, the site can choose the abdomen, thigh or upper arm No intravenous or intramuscular injections are allowed Injections can be done at any time of the day, regardless of whether you eat or not If administration is omitted, if the next scheduled administration is at least 3 days (72 hours), the administration should be given as soon as possible If the next scheduled administration is less than 3 days (72 hours), the administration should be abandoned and the next scheduled administration should be performed regularly : A total of 12,654 patients were exposed to disglued glucopeptides in phase II, III/IIIb and IV clinical studies that have been completed and are ongoing The most common adverse reactions in the trial were adverse gastrointestinal reactions, including nausea, vomiting, and diarrhea These adverse reactions are usually mild or moderate and are sexual Special Population: Patients with renal impairment: Patients with light, moderate or severe renal impairment do not need to undergo dose adjustment (eGFR between 15 and 90mL/min/1.73m2) Do not recommend disacoride for patients with end-stage kidney disease (15 ml/min/1.73m2) Patients with liver impairment: Patients with liver function impairment do not need to undergo dose adjustment Elderly patients: No dose adjustment is required according to the age of the patient, however the treatment experience is very limited in patients over the age of 75 Child patients: There are no data on the safety and efficacy of doflyazole in children under 18 years of age Pregnant and lactating women: there is no relevant data or limited data, pregnancy is not recommended for the use of dofly-laced glycopeptides, degree-pulling glycopeptides should not be used in lactation The effect of daclyse peptides on human reproductive function is unknown Taboo: Patients who are allergic to the active ingredientor or any accessories of this product This product is prohibited in patients with an individual past or family history of thyroid myelin cancer (MTC) or with type 2 multiple endocrine adenoma syndrome (MEN2) Storage: Store in the refrigerator (2oC-8oC) Approval Number: 0.75mg: 0.5ml (pre-filled injection pen) Import Drug Registration Certificate Number: S20190021; 1.5mg: 0.5ml (pre-filled injection pen) Import Drug Registration Certificate Number: S20190022 Li Yiming Source: of the Endocrine Channel in the Medical Community