The School of Metabolism gathers hot spots in the field and builds a new chapter in diabetes, cardiorenal metabolism

Multidisciplinary experts attended the Metabolism School Summit to focus on diabetes energy balance and weight management, and explore the new situation
of sugar, heart and kidney collaboration.

On November 12, 2022, the Lilly Institute of Metabolism Summit was successfully held
.

The Lilly School of Metabolism is a comprehensive platform
for Lilly metabolism and cardiovascular disease education, scientific exchange and mass education.
This summit is the annual summary of 2022 and the outlook
for 2023.

At this summit, a strong team of experts from all over the country was brought together to bring cutting-edge research in the field of metabolism and the latest concepts and practical experience in the management of sugar, heart and kidney comorbidities
.
The conference was chaired by Professor Guo Lixin of Beijing Hospital, Professor Ji Linong of Peking University People's Hospital, Professor Zhou Zhiguang of the Second Xiangya Hospital of Central South University, Professor Chen Lulu of Union Hospital Affiliated to Tongji Medical College of Huazhong University of Science and Technology, Professor Jin Wei of Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, and invited Professor Yu Miao of Peking Union Medical College Hospital, Professor Li Yan of Sun Yat-sen Memorial Hospital of Sun Yat-sen University, Professor Yan Xiaowei of Peking Union Medical College Hospital served as the
speaker.
Professor Hong Tianpei of Peking University Third Hospital, Professor Shi Yongquan of Shanghai Changzheng Hospital and Professor Yuan Haitao of Shandong Provincial Hospital served as the chairmen of the discussion, bringing a number of guests to discuss hot topics in the field of endocrinology and metabolism, bringing an academic feast of theory and practice in the fields of metabolism, cardiovascular and nephrology to the majority of colleagues (in no particular order).

Figure 1 The conference kicked off with the wonderful speeches of Professor Guo Lixin, Professor Ji Linong and Professor Zhou Zhiguang

Focus on energy surplus and promote metabolic balance, and weight management in patients with T2DM needs to be carried out throughout

With the change of people's lifestyle, obesity/overweight is an important concomitant disease of type 2 diabetes mellitus (T2DM), and has a common basis
with T2DM.
Overweight/obesity is considered to be one of the manifestations of energy metabolism imbalance, as early as 2011, the World Health Organization (WHO) stated that 90% of T2DM patients are mainly related to excess weight ^[1].

Therefore, the regulation of energy metabolism and the management of body weight are essential
for the treatment of T2DM.

• Energy balance is fundamental to reducing metabolic diseases

At the beginning of the summit, Professor Miao and Dr.
Tang Jiani brought a wonderful discussion on T2DM, and sorted out the complex relationship
between energy metabolism and T2DM.
Professor Yu Miao first showed the data on the prevalence of diabetes and the prevalence of overweight/obesity in China in recent years, and intuitively showed the high correlation
between the two through the prevalence trend.
Professor Yu Miao said that diabetes is a fundamental pathophysiological point of view, the imbalance of energy in and out, which leads to excessive energy accumulation, and excess energy is the "common soil" of T2DM and obesity, as well as the "common soil"
of metabolic diseases and cardiovascular diseases.

When asked whether restoring energy balance would benefit metabolic disorders and the feasibility of clinical practice for T2DM patients, Professor Yu Miao theoretically affirmed that restoring energy balance can restore glucose homeostasis and thus promote blood sugar to normalize by explaining the double circulation hypothesis^.

At the same time, a number of supporting studies are cited, such as the Counterpoint study [4], the Counterbalance study [5] and the DiRECT study ^[6].
These studies have shown that energy restriction helps improve islet β cell function and insulin sensitivity
in patients with T2DM.

Regarding the mechanism and means of energy metabolism system regulation, Professor Yu Miao introduced that the regulation of energy metabolism involves the participation
of multiple important organs (fat/muscle tissue, intestine, liver, brain, islets, etc.
) and hormones, such as glucagon-like peptide-1 (GLP-1), glucose-dependent insulin stimulating polypeptide (GIP), insulin, etc.
Effective methods to fully activate the energy regulation system include calorie-restricted diets, metabolic surgery, and some T2DM treatments
.
At present, there are already some drugs that can actively mobilize multiple important metabolic organs to play a synergistic energy-regulating drug, such as incretinoids
.
Incretin can fully stimulate multiple important organs involved in energy regulation and play a role in energy regulation ^[7].

Professor Guo Lixin concluded that a large number of evidence-based medical evidence shows that excess energy will bring a series of metabolic problems, and promoting energy balance through energy metabolism regulation is fundamental
to reducing metabolic diseases.

• To prevent T2DM, weight management is imperative

The Chinese Guidelines for Overweight/Obesity Medical Nutrition Treatment (2021) pointed out that overweight/obese T2DM patients in China account for about 58.
3% of the total diabetes patients ^[8], and weight management of T2DM patients should be paid attention to
.
At this summit, Professor Li Yan shared relevant views on the importance of weight control in the development of T2DM

➤ Studies have shown that T2DM patients have a U/J-shaped curve with body weight and cardiovascular death and all-cause mortality ^[9,10].

Both weight gain and inactive weight loss can lead to adverse outcomes
with T2DM.
Among them, overweight/obesity not only increases the risk of T2DM, but also has an important impact
on the prognosis of T2DM.

➤ Weight management throughout the development of T2DM may confer varying degrees of benefit: early life or pre-diabetes weight interventions reduce the risk of diabetes; For patients with overweight/obese T2DM, early effective weight loss can help achieve diabetes remission; For patients with intermediate and advanced diabetes, whether overweight/obese or low body weight, effective weight management improves glycaemic control, prevents complications, and reduces adverse outcomes
.

➤In the future, it is necessary to improve the weight management effect
of diabetic patients through the joint efforts of the state, medical staff and T2DM patients.

For the weight management of diabetic patients, Professor Ji Linong said that overweight/obese diabetic patients have many obesity-related problems, such as fatty liver, sleep apnea syndrome, etc.
, and the treatment of diabetes and obesity has become an important need for such patients, and the in-depth understanding of diabetes outcomes through weight control and the exploration of weight improvement strategies are of great help
to the treatment of overweight/obese T2DM.

For the first half of the summit, Professor Zhou Zhiguang also made a wonderful summary, whether from the results of epidemiological investigation or clinical intervention, overweight/obesity caused by excess energy plays an important role
in promoting the occurrence and development of diabetes.
Paying attention to the balance of energy metabolism, focusing on weight management at different stages of T2DM, and early individualized intervention will help the prevention and treatment
of diabetes.

Metabolic MDT, multidisciplinary cooperation to create sugar, heart and kidney all-round management

Diabetes is an independent risk factor for cardiovascular disease (CVD), and diabetic patients often have important risk factors for CVD such as hypertension and dyslipidemia [^11], and studies have shown that the comprehensive compliance rate of cardiovascular risk factor control in this category of patients is only 9% ^[12].

。 In addition, epidemiological data show that about 20%~40% of diabetic patients in China have diabetic nephropathy, which has become the main cause of chronic kidney disease (CKD) and end-stage renal disease ^[11], seriously threatening the life and health
of patients.

• Understand the mechanism and current status of sugar, heart and kidney comorbidities

At this summit, Professor Yan Xiaowei gave an in-depth explanation of the interrelationship between heart, kidney and metabolic system, and confirmed through a number of real-world studies that diabetes, cardiovascular disease and kidney disease are closely related, and T2DM is often combined with cardio-kidney-metabolic diseases, which seriously impairs the health outcomes
of patients.
For the comprehensive management of sugar, heart and kidney in the early stage of diabetic patients, Professor Yan Xiaowei shared:

Early identification of high-risk patients and potential treatment populations: The use of risk scores may help effectively estimate the risk
of atherosclerotic cardiovascular disease (ASCVD), heart failure (HF), and CKD progression.

➤ Select and adjust treatment options, manage risk factors, and reduce heart and kidney risks: For patients with T2DM, in addition to glycemic control, it is necessary to carry out comprehensive management from the early stage of T2DM, and consider the use of T2DM management methods including prevention and treatment of ASCVD, HF and CKD to further improve the quality of life and prognosis
of patients.

➤Multidisciplinary cooperation, taking into account the overall treatment at the same time, to achieve all-round management
of diabetes, sugar, heart and kidney.

➤Pay attention to patient education, guide eating habits, etc
.

The concept of T2DM hypoglycemic therapy has undergone changes of the times, from hypoglycemic efficacy to cardiovascular safety, and now more attention is paid to the comprehensive benefits
of T2DM cardiorenal metabolism 。 In this regard, Professor Chen Lulu pointed out that although metabolic abnormalities caused by the damage of target organs, the core of heart and kidney adverse outcomes is the problem of glucose metabolism, but sugar, heart, kidney still need to be systematically treated, a large number of clinical research data show that diabetes is a complex of multi-disease comorbidities, diabetes caused by heart and kidney diseases often affect each other as cause and effect, for individuals with sugar, heart and kidney diseases coexisting need to consider the benefits of target organs while blood glucose management, strengthen multidisciplinary cooperation to promote the solution of systemic metabolic problems
。

Professor Jin Wei finally added that diabetes is closely related to the occurrence of heart and kidney diseases, on the one hand, cardiologists and nephrologists for diabetic patients can not only be limited to the intervention of the disease in the department, but also need to raise blood sugar control to a certain height, and do a good job in the whole process of patient management
.
On the other hand, it is also called for the integrated management
of sugar, heart and kidney for patients with such diabetes combined with heart and kidney diseases.

• Multidisciplinary exploration of sugar, heart and kidney comprehensive management

The Metabolics Summit also brought together experts from endocrinology, cardiology and nephrology to discuss
the comprehensive management of diabetes.
First of all, under the chairmanship of Professor Shi Yongquan, Professor Li Yiming of Huashan Hospital affiliated to Fudan University, Professor Chen Hong of Zhujiang Hospital affiliated to Southern Medical University, Professor Zeng Tianshu of Union Hospital affiliated to Huazhong University of Science and Technology, and Professor Lei Minxiang of Xiangya Hospital of Central South University shared the understanding and experience of weight management of T2DM patients from different perspectives based on their respective clinical practices, and the guests pointed out that lifestyle interventions, innovative drugs, metabolic surgery and other means are helpful for weight management of T2DM patients
。 In addition, clinical assessment can also be used to formulate individualized and reasonable weight loss goals for T2DM patients, and multidisciplinary and multi-level cooperation can play the advantages
of comprehensive management.
Professor Shi Yongquan concluded that for the weight management of T2DM patients, the understanding and use of innovative drugs and long-term management concepts are very important, and he expects the emergence of more new drugs to help T2DM patients manage their weight
easily.

Under the chairmanship of Professor Haitao Yuan, Professor Li Yiming, Professor Chen Hong, Professor Zeng Tianshu, Professor Lei Minxiang and Professor Gu Leyi of Renji Hospital Affiliated to Shanghai Jiao Tong University School of Medicine shared their thoughts and suggestions on multidisciplinary collaborative management
.
The panelists proposed that the multidisciplinary collaboration of sugar, heart and kidney comorbidities should be based on the joint management
of metabolic indicators such as blood pressure, blood lipids and blood glucose on the basis of each discipline performing its own duties.
Regarding this discussion topic, Professor Haitao Yuan concluded that innovative drugs with multiple benefits will become a powerful "weapon"
for multidisciplinary collaboration.

Professor Hong Tianpei finally said that whether it is T2DM or simply obese patients, weight management is an eternal topic and a difficult treatment
.
In recent years, with the emergence of new hypoglycemic drugs, the treatment needs of T2DM patients have been met to a certain extent, but the weight management of T2DM patients still requires multidisciplinary team efforts
.
For patients with sugar, heart and kidney comorbidities, high-quality evidence, the emergence of new drugs, and changes in management concepts are all helpful to promote multidisciplinary integration and facilitate the management
of patients with comorbidities.

Figure 2 Discussion session

Based on practice and creating a better future, the School of Metabolism has built a multidisciplinary communication platform

The summit attracted more than 14,000 online and offline visitors and nearly 5,000 people
.
The School of Metabolism is committed to promoting academic exchanges on diabetes, cardiovascular diseases and metabolic diseases, providing a good learning platform for professionals and a good educational platform for the public, and also providing a platform
for experts in various fields to communicate and improve together.

Experts attending the meeting said that after the exchange of the School of Metabolism, they can have deeper exchanges and learning
in terms of concepts, processes, and management.
Many guests also sincerely hoped that the platform of the School of Metabolism can be constantly updated, continuously contribute to academic exchanges in the field of metabolic diseases, and promote the multidisciplinary management of
metabolic diseases in China.

Figure 3 Multi-local guest connection

References:

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[2] Taylor R.
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[3] Taylor R, et al.
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[4] Lim EL, et al.
Diabetologia.
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[5] Steven S, et al.
Diabetes Care.
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[6] Zhyzhneuskaya SV, et al.
Diabetes Care.
2020; 43(4):813-820.

[7] Samms RJ, et al.
Trends Endocrinol Metab.
2020; 31(6):410-421.

Chinese Guidelines for Medical Nutrition Treatment of Overweight/Obesity (2021)[J].
Chinese Journal of Medical Frontiers(Electronic Edition),2021,13(11):1-55.
)

[9] Andri Iona,et al.
BMJ Open Diabetes Res Care .
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[10] Tobias DK et al.
N Engl J Med.
2014 Jan 16; 370(3):233-44.

[11] Diabetes Branch of Chinese Medical Association.
Chinese Journal of Diabetes.
2021; 13(4):315-409.

[12] Yang X, et al.
Front Endocrinol (Lausanne) 2021,12:664183.

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