Why Protecting Kidney Is The Primary Goal in Treating Diabetes?

On June 7, the 82nd Annual Meeting of the American Diabetes Association came to an end in New Orleans. Based on the latest clinical research evidence, the management of hyperglycemia was discussed at the meeting and the 2022 edition of "American Diabetes Association/European Association for the Study of Diabetes: Consensus on Hyperglycemia Management in Type 2 Diabetes (Draft)" (hereinafter referred to as "Consensus ( draft)"). This newspaper specially invited Zou Dajin, a professor of the Department of Endocrinology of Shanghai Tenth People's Hospital, to explain in detail the new version of the "Consensus (Draft)", which has significant adjustments in seven aspects including drug treatment goals and strategies.

Click Here To Know More Info about How Cistanche treats type 2 diabetes

Propose a drug treatment strategy centered on the etiology, pathology, and physiological changes of patients. Hyperglycemia in type 2 diabetes patients is mainly caused by insufficient insulin secretion, insulin resistance, and decreased incretin. Therefore, in the face of different causes of hyperglycemia, the new version of the consensus clearly puts forward the etiology and pathology of hyperglycemia in patients. According to the special circumstances of physiological changes and complications, drugs should be selected, rather than "one size fits all" as in the past. Zou Dajin said that "targeting the cause and treating at the source" is an unprecedented revolutionary change, which reminds doctors to understand the source of hyperglycemia and the complications that have occurred in each diabetic patient individually, and to use drugs in a targeted manner.

The primary goal of drug therapy is to reduce the risk of cardiorenal adverse events. The new version of the "Consensus (Draft)" draws a brand-new roadmap for drug treatment, and divides type 2 diabetes patients into two categories. The former should take "reducing the risk of cardiorenal adverse events" as the primary goal, and propose that two types of drugs can effectively prevent the risk of cardiorenal complications - GLP-1 receptor agonists and SGLT-2 inhibitors. The former category of drugs is hypoglycemic drugs administered by injection, representative drugs include dulaglutide, stigemeglutide, etc.; the latter includes various oral hypoglycemic drugs such as empagliflozin and dapagliflozin.

The new version of the "Consensus (Draft)" recommends that patients with confirmed atherosclerotic cardiovascular disease or without the disease but with multiple cardiovascular risk factors (55 years and over, obesity, hypertension, smoking, dyslipidemia or proteinuria) For patients with type 2 diabetes, GLP-1 agonists or SGLT-2 inhibitors are preferred; for patients with heart failure, SGLT-2 inhibitors are preferred; for patients with chronic kidney disease, SGLT-2 inhibitors are preferred, and GLP-1 can also be used agonist. In the absence of the above conditions, metformin and lifestyle intervention should be preferred, and combined therapy should be added according to individual conditions.

Officially list "weight loss" as one of the management goals of type 2 diabetes. An international authoritative study suggests that the reason why overweight and obese type 2 diabetes patients cannot be relieved is because of the islet dysfunction caused by the massive deposition of fat in the liver and islets. After a large amount of fat is reduced, it can recover about 60%~ 70% of islet function. Therefore, the "Consensus (Draft)" officially established weight loss as the primary control goal of type 2 diabetes.

Zou Dajin said that weight loss may have benefits beyond blood sugar control. For some people with type 2 diabetes, a weight loss of 5% to 10% can improve metabolic status, and a weight loss of 10% to 15% or more can reduce the risk of complications and even bring diabetes remission. In addition, the new version of the "Consensus (Draft)" recommends that type 2 diabetics who need to lose weight use GIP/GLP-1 dual receptors with "very high" hypoglycemic effect, "low" risk of hypoglycemia, and "highly effective" weight loss effect agonist.

A triple combination formulation containing metformin is recommended. For the multiple causes of hyperglycemia, a single hypoglycemic drug is obviously unable to meet the needs of patients. The "Consensus (Draft)" recommends "224" triple drug therapy, that is, a fixed compound preparation containing metformin, SGLT-2 inhibitors, and DPP-4 inhibitors. Zou Dajin said that its advantages are that it can achieve complementary mechanisms, synergistic hypoglycemia, reduce the damage of hypoglycemia, easy to take, less side effects, and weight loss effect. Although this drug has not been introduced in China, the compound combination of two or three oral hypoglycemic drugs has become the future trend of hypoglycemic drugs.

Combination regimens of GLP-1 receptor agonists and long-acting insulin are emphasized. The "Consensus (Draft)" suggests that in the future, sugar friends should take GLP-1 receptor agonists before taking insulin, and combine them with long-acting insulin as a fixed compound. Zou Dajin said that this method can make up for the defects of insulin injection. The first is to reduce the number of injections and the pain of the patient; second, it can have a synergistic hypoglycemic effect; third, it can make the weight more stable and reduce the risk of hypoglycemia.

Four elements of high-quality blood sugar control are put forward. According to Zou Dajin, the so-called high-quality hypoglycemia should have four elements: first, glycosylated hemoglobin reaches the standard; second, the time ratio of glucose within the target range (TIR) within 24 hours reaches the standard; third, no hypoglycemia occurs; , the weight should be kept within the normal range and not increased.

Use a healthy lifestyle as the basis for drug therapy. First of all, avoid sitting for a long time. It is recommended that sugar friends get up and move around every half an hour, and do regular slow walking or simple resistance exercise. Second, let the body sweat. It is recommended that people with diabetes should do more than 150 minutes of moderate-intensity exercise and more than 75 minutes of high-intensity exercise per week. Third, moderately increasing strength training can improve insulin sensitivity and glucose tolerance. Fourth, go to bed early and get up early to maintain regular sleep. The "Consensus (Draft)" pointed out that sleep duration of more than 9 hours and less than 6 hours has a negative impact on the control of glycated hemoglobin. Zou Dajin said that staying up late is an important cause of hyperglycemia and complications, and one should maintain 7-8 hours of sleep every day. Fifth, maintain a low-energy balanced diet, that is, appropriately reduce energy intake, rationally distribute nutrients such as protein, fat, and dietary fiber, and cooperate with drug treatment to be more effective.

Support：

wallence.suen@wecistanche.com   0015292862950