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Interviews with big coffee Focus on diabetes management and discuss diabetes alleviation strategies with experts!

 Last Update: 2023-01-06
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According to the latest data from the International Diabetes Federation (IDF), there are 141 million adult diabetic patients in China ^[1], and the prevalence rate is increasing rapidly, but the awareness rate (36.
5%) and treatment rate (32.
2%) and control rate (49.
2%) are still at a low level, which is one of the pain points in the current process of diabetes prevention and treatment in China ^[2].
Therefore, "how to prevent and treat diabetes" has become a perennial hot topic
in the field of endocrinology.

In line with the theme of UN Diabetes Day 2022 "Education for Tomorrow", we are honored to invite four celebrities to share their own clinical experience from the past, present and future of diabetes, and to teach doctors and patients together, so that diabetes management can take a step ahead!

Interview with experts

Qin Guijun

Director of the Department of Endocrinology, The First Affiliated Hospital of Zhengzhou University

Hu Ling

Director of the Department of Endocrinology, The Third Affiliated Hospital of Nanchang University

Li Xia

Director of the Department of Endocrinology, Second Xiangya Hospital, Central South University

Liao Yu

Chief physician of Sannuo Health Diabetes Clinic

The current situation is worrying, and diabetes management is fraught with dangers

"About 5%~10% of pre-diabetic people in China progress to diabetes every year, and in the absence of intervention, about 65% of pre-diabetic patients will progress to diabetes in 6 years ^[3-4]
.
" Professor Li sighed
.
Based on the potential danger of prediabetes, Professor Li pointed out that it is necessary to pay attention to the increase in blood sugar, and focus on the blood glucose monitoring index and regular review is what needs to be paid attention to in clinical practice
.

As the disease progresses, diabetes will also bring multiple complications, including acute and chronic complications, including but not limited to ketoacidosis, lactic acidosis, and heart, brain, kidney, eye and other related complications
。 Professor Hu shared with diabetic foot disease as an example: "Diabetic foot disease is currently the most expensive chronic complication with the highest disability and mortality rate, nearly 30 million new sugar foot patients in the world every year, every 30 seconds diabetic patients will lose their legs due to sugar foot, of which 34%-40% of patients need to be amputated because of incurable limbs, and the risk of death after amputation will increase sharply to 50%.

”

The road is at your feet, and the concept of diabetes management has changed

As we continue to understand type 2 diabetes mellitus (T2DM), management concepts are constantly changing
.
Professor Li said that the concept of diabetes management is changing from simple sugar control to focusing on heart-kidney-metabolism ^{management [5-6].}
Tracing back to the origin, diabetes diagnosis and treatment also pay more and more attention to islet β cell dysfunction and insulin resistance, aiming to accurately "hit" diabetes from the deep level of pathogenesis, pursue long-term control of blood sugar, and bring sustainable development
.

Diabetes management is not an overnight thing, and in the process of clinical diagnosis and treatment, diabetes management goals
should be reasonably planned from far and near.
Professor Hu proposed that diabetes management is actually divided into two phases, short-term management and long-term goals
.
Short-term management aims to correct abnormal metabolic markers such as blood glucose and avoid hyperglycotoxicity
.
The long-term goal is to prolong the patient's life, reduce complications, and improve the quality of life
.

Studies have shown that most patients have at least 50% impairment of β cell function at the time of initial diagnosis ^[7], and if we enter the early intervention if 80% of the β cell function is still 80%, Is there a greater clinical benefit for people with diabetes?
The answer is undoubtedly yes
.
According to the consensus of the latest "Type 2 Diabetes Remission" guidelines, diabetes is already a disease
that is expected to achieve remission for some patients with T2DM.
Diabetes is no longer an "incurable lifelong disease", it is preventable, controllable and reversible! After obtaining diabetes reversal, both the patient's happiness index and the financial burden of treatment will bring great improvement
.

In view of the goal of diabetes prevention and treatment, Professor Li also added that T2DM prevention and treatment has three levels of prevention goals, according to the different stages of the natural history of the disease, different corresponding measures are taken to prevent the occurrence, development or deterioration of the disease, and prevent or delay the occurrence and development
of various acute and chronic complications of diabetes.
In the process of clinical practice, we must combine the characteristics of patients for individualized treatment, so as to improve the quality of life of
patients.

The future can be expected, and diabetes remission is not a luxury

Although the criteria for tertiary prevention are different, they are ultimately aimed at achieving a better quality of
life for patients.
The benefits of early diagnosis and treatment are not limited to reducing the risk of preventing diabetes complications, but can even be alleviated
.

Definition of diabetes remission

"At present, the idea of diabetes alleviation is not particularly popular, and the definition of diabetes alleviation
is also different.
There are talks of relief, there are words of reversal, but they are all referring to the same thing
.
Professor Li said
.

In 2021, the American Diabetes Association (ADA) issued the "Consensus Report on the Definition and Interpretation of Remission of Type 2 Diabetes" ^{recommending that} glycated hemoglobin be discontinued for at least 3 months after discontinuation of hypoglycemic drugs (HbA_1c) <6.
5% as diagnostic criteria
for T2DM remission.

In terms of assessing the goal of remission, the diagnostic criteria for diabetes in our population are different from those in the United States, and China is more inclined to combine fasting blood glucose (FPG) and postprandial blood glucose (PPG).
Combined with HbA 1c, the definition of T2DM mitigation proposed in China includes FPG<7.
0mmol/L, PPG<10.
0mmol/L, and HbA _1c<6.
5^%[9].
。

Timing of diabetes remission

Professor Hu pointed out that since prediabetes, islet function has declined
at an average rate of 4% per year.
However, because most people do not know that they are in prediabetes, they have not yet found that pancreatic islet β cell damage has not been found, but in fact, by the time they are diagnosed with diabetes, islet function has already declined to 50%.

Therefore, in the early stage and early stage of T2DM, the function of pancreatic islets β cells is relatively well preserved, and it is easier to obtain reversal (remission) by intervening in diabetes, and seize the "golden period" to obtain remission
more effectively.

Diabetes mitigation strategies

Intensive lifestyle interventions, weight-loss drugs, non-insulin-lowering drugs, short-term intensive insulin therapy, and metabolic surgery can all be used to relieve T2DM ^[9].

Professor Li pointed out that in patients with T2DM who are comorbid with obesity, medical nutrition, controlled diet, and scientific weight loss, such as energy-restricted diet, low-carbohydrate diet, very low-energy diet, intermittent fasting, ketogenic diet, etc.
, can promote early T2DM remission
.
Intuitively, the results of DiRECT research also show ^[10] that diet and nutrition combined with exercise therapy can effectively improve the diabetes remission rate of T2DM and obesity patients, and when the weight loss is > 15kg, the complete remission rate of T2DM can reach 86%.

Professor Hu added, "Lifestyle intervention is one of
the more common clinical remissions 。 However, there are certain limitations, such as poor patient motivation and lack of medical knowledge; Doctors have tedious work and do not have extra energy to inform patients of changes in diet structure and manage patients' lifestyle; The disconnect between out-of-hospital lifestyle intervention and medical prescription requires the intervention of health managers and nutritionists equipped by a professional team to achieve better treatment results
.

In addition, in the Internet era, we can also use the fragmented time to reduce the dilemma
of clinical diabetes management by applying high-end technical methods and full-time managers to jointly control sugar.
"

Diabetes remission is not achieved overnight, but a long-term process that needs scientific and systematic management, and doctors and nutrition (doctors) are needed during remission Teachers and other medical team members work together with patients to achieve body weight targets through targeted diet and exercise, supplemented by individualized and reasonable glucose reduction programs, and metabolic surgery to lose weight if necessary, in order to achieve the goal
of T2DM remission.

In addition, Professor Li emphasized: "Diabetes remission and reversal is not a cure, even if the remission is successful, it does not mean that the future can be once and for all, in order to continue to maintain the state of remission, strict diet management, exercise management, weight management, etc
.
are still not to be left behind.
" ”

Wonderful practice to promote diabetes alleviation to the clinic

In this event, we are honored to invite Professor Qin Guijun from the First Affiliated Hospital of Zhengzhou University to talk with us about diabetes mitigation strategies
.
Professor Qin further supplemented the strategies of diabetes remission, and lifestyle intervention is the most important and basic strategy
for clinical remission of diabetic patients.
Clinically, we will apply short-term intensive insulin therapy to some patients with new-onset diabetes to improve islet β cell function and insulin resistance in patients with newly diagnosed T2DM, and increase the rate of diabetic remission, while other drugs such as metformin and glucagon-like peptide-1 receptor agonists (GLP-1RA) can also help remission
.

In addition, metabolic surgery is also one of the remission strategies, but this regimen is not suitable for everyone
.
For Asians, metabolic surgery is suitable for patients with T2DM with a body mass index (BMI) of >32.
5 kg/m², and if non-surgical treatment measures cannot significantly improve body mass and metabolic disorders, metabolic surgery can be considered to alleviate T2DM.

Summary Diabetes management is a long process, "prevention before disease, early diagnosis and early treatment, help alleviation", we should pay attention to the early screening and reversal of diabetes, so that more patients in pre-sugar can get rid of diabetes through early screening; For patients with diabetes, we should pay attention to the management of the whole course of diabetes, and formulate "individualized treatment plans" for patients to alleviate them
.

Education protects tomorrow, and we look forward to the future through the unremitting efforts of both doctors and patients, it will be easy to reach the standard of diabetic blood sugar and the quality of life of diabetic patients will continue to improve!
References: 1.
IDF Global Diabetes Atlas 2021 10th Edition 2.
Guidelines for the Prevention and Treatment of Type 2 Diabetes in China (2020 Edition) (Part I).
2021,41(08):668-695 3.
Sallar A .
Exp Biol Med (Maywood).
2020 May; 245(10):889-896.
4.
Vegt FD, et al.
JAMA.
2001 Apr 25; 285(16):2109-13.
5.
Lancet 2018; 392:1072–886.
JAMA.
2011 June 22; 305(24):2532–2539.
7.
UK Prospective Diabetes Study Group.
Lancet.
1998; 352(9131):837-53.
8.
RIDDLE M C, CEFALU W T, EVANS P H, et al.
Diabetologia.
2021.
9.
ZOU Dajin, ZHANG Zheng, JI Linong.
Chinese Journal of Diabetes.
2021,29(09):641-652 10.
LEAN M E, et al.
Lancet.
2018; 391(10120):541-551.

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