As of 2021, China has become the world’s “number one” diabetes country1, and now, clinical solutions are not only about “hypoglycemic”.
In December 2021, the International Diabetes Federation officially updated the tenth edition of the Global Diabetes Map. Over the past decade, the number of diabetic patients in China has increased from 90 million to 140 million, nearly 70 million more patients than second-ranked India1.
According to Professor Guo Lixin, Director of the Department of Endocrinology at Beijing Hospital National Geriatrics Center, the biggest problem faced by diabetic patients is chronic complications: “Deaths from cardiovascular disease account for approximately 75%2, followed by kidney disease, 20%-40% of Chinese diabetic patients have kidney damage to varying degrees3.”
Due to type 2 diabetes, heart failure, chronic kidney disease and other cardiovascular diseases often appear in the same person one after another. Professor Guo Lixin believes that diabetes treatment should form a macro concept: “Diabetes treatment is not only a Controlling blood sugar can delay complications, improve prognosis and improve quality of life.”
As for the three major chronic diseases of “sugar heart and kidney”, he mentioned: “When we diagnose any of these three diseases, we must think of the other two diseases. possible“.
Complications: The Hidden Killer Behind Diabetes
Data show that about 20%-40% of diabetic patients in my country are complicated with diabetic nephropathy3, and more than 1/3 of type 2 diabetes patients are associated with cardiovascular disease4. According to other data, one in three patients with heart failure has type 2 diabetes5; at least one in three patients with chronic kidney disease has cardiovascular disease6; and at least one in three patients with heart failure has Has chronic kidney disease7.
The number of patients with diabetes, cardiovascular disease and chronic kidney disease in China is more than 100 million8,9,10. It is very likely to appear together with cardiovascular disease and chronic kidney disease.
According to Prof. Guo Lixin, a survey of diabetes credits by the Chinese Medical Association shows that the incidence of nephropathy in domestic diabetic patients is close to 40%3, and the rate of cardiovascular disease is close to 33%4. “If you take the 140.9 million diabetics as a base, multiplying by any ratio is astronomical.”
“Due to the wide range of complications of diabetes, especially the high incidence of heart and kidney disease, the outcome of many diabetic patients has deteriorated. Therefore, in order to control diabetes, the life expectancy of diabetic patients and the improvement of It is crucial to pay attention to and improve the cardiac and renal outcomes of patients.” Professor Lixin Guo emphasized.
The change of treatment concept: from simply controlling blood sugar to focusing on the patient’s cardiac and renal outcomes
The conventional treatment concept for diabetes is to control blood sugar. However, the use of some hypoglycemic drugs can increase the cardiovascular risk of patients. In 2008, the U.S. Food and Drug Administration mandated long-term safety trials of drugs to treat patients with type 2 diabetes to rule out potential cardiovascular risks.
With the deepening of research,multiple studies have confirmed that drugs such as SGLT-2 inhibitors and GLP-1 receptor agonists not only do not increase cardiovascular risk in diabetic patients, but also can Protect the heart and kidney12.
As a result, there has also been a major shift in the mindset of diabetes care. The Health Knowledge Bureau learned that in order to maximize the protection of target organs such as the heart and kidneys of patients, the authoritative diabetes guidelines at home and abroad have undergone “fundamental changes”: they no longer simply pursue sugar control, but instead focus on cardiovascular and kidney functions. Benefit and standardize the treatment of important complications that endanger patients’ lives and push them to the forefront of treatment goals.
However, in public perception, the combined treatment of diabetes, cardiovascular disease, and kidney disease is still a relatively unfamiliar concept. According to the “Chinese Clinical Guidelines for the Prevention and Treatment of Diabetic Nephropathy”, although the prevalence of nephropathy in patients with type 2 diabetes in China is as high as 40%, the awareness rate is less than 20%13.
Professor Chen Nan, Chief Physician of the Department of Nephrology, Ruijin Hospital Affiliated to Shanghai Jiaotong University School of Medicine, said: “Many people who come to us to see a doctor are late.Patients with advanced stage, such as diabetic nephropathy, are more serious in advanced complications, and the treatment is also more difficult. The human heart, kidneys, and endocrine system are a whole, and must be comprehensively evaluated during drug treatment. If everyone joins hands in diagnosis and rational drug use, a lot of medical resources can be saved. “
Early screening and diagnosis of “sugar heart and kidney”: primary hospitals are more responsible
In order to strengthen the combined treatment of diabetes, cardiovascular disease and chronic kidney disease at the clinical level,a number of experts expressed a view: the focus is shifted forward, the focus is lower Move.
Professor Chen Nan pointed out when talking about the prevention and treatment of kidney disease: “The kidney is a silent organ, and its function damage is often silent. When diabetes is complicated by kidney disease, the treatment will be very difficult. Special attention should be paid to the monitoring of microalbuminuria, blood pressure and renal function in the early stage. We recommend using simple and effective treatments in the early stage of the disease to reduce the occurrence of complications.”
Microalbuminuria is a sign of early kidney damage such as diabetic nephropathy. Regular proteinuria screening is of great clinical significance for early detection and treatment of diabetic nephropathy >. According to the 2021 edition of the “Guidelines for the Prevention and Treatment of Diabetic Nephropathy in China”, all patients with type 2 diabetes and patients with type 1 diabetes with a course of more than 5 years should have urine albumin related tests at the time of diagnosis, and at least 1 test every year thereafter. Screening 14 times.
Professor Chen Nan also emphasized the importance of microalbuminuria screening: “If we intervene at the stage when diabetic patients have a little microalbuminuria, it can actually be reversed. However, if it is allowed to evolve into overt proteinuria naturally, and if it is not controlled, the patient is likely to have renal function involvement in two or three years, and then develop end-stage renal disease, and the risk of cardiovascular events such as heart failure and myocardial infarction will also be increase.”
For the early intervention and management of the three major diseases of “sugar heart and kidney”, Professor Chen Nan believes that primary medical institutions play a very important role: However, in the prevention and treatment, the role of the community and secondary hospitals should be brought into play, and the focus should be shifted downward. For example, the community can strengthen publicity on each disease day, and advocate the concept of joint prevention and treatment in the early stage of the disease.”
Health Knowledge Bureau learned from industry insiders that with the popularization of Internet medical service platforms, in some areas, patients can already choose the nearest community hospital or retail pharmacy for “three high” diseases Follow-up, dispensing, monitoring and management to improve the efficiency and effectiveness of chronic disease management.
In addition, patients should also take comprehensive preventive measures. Professor Guo Lixin suggested that individuals should develop a healthy lifestyle, a reasonable diet, moderate exercise, and regular physical examinations: “For example, if you have high blood pressure, in addition to losing weight, you should also avoid fatigue or stress, eat a low-salt diet, and quit smoking and drinking. , these are very beneficial ways.”
*This material is for disease education purposes only, if in doubt, consult a healthcare professional.
References:
1. International Diabetes Federation. Tenth Edition Global Diabetes Map
2. Hu Wei. Seventy percent of diabetic patients die of cardiovascular disease at a higher rate in women than in men [J]. Diabetes World: Digest, 2011.
3. Diabetes Branch of Chinese Medical Association. Guidelines for Prevention and Treatment of Type 2 Diabetes in China (2020 Edition) [J]. Chinese Journal of Diabetes, 2021, 13(4):315-409.
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4. Einarson TR., et al. Prevalence of Cardiovascular Disease in Type 2 Diabetes: A Systematic Literature Review of Scientific Evidence From Across the World in 2007-2017. Cardiovasc Diabetol. 2018;17 (83):1–19.
5. Thomas MC., et al. Type 2 Diabetes and Heart Failure: Challenges and Solutions. Curr Cardiol Rev. 2016;12:249.
6. Lovre D., et al. Managing Diabetes and Cardiovascular Risk in Chronic Kidney Disease Patients. Endocrinol Metab Clin North Am. 2018;47(1):237-257.
7. Ahmed A., et al. Epidemiology of chronic kidney disease in heart failure. Heart Fail Clin. 2008;4(4):387-99
8. “China Cardiovascular Health and Disease Report 2021”
9. Yongze Li et al. Prevalence of diabetes recorded in mainland of China using 2018 diagnostic criteria from the American Diabetes Association: national cross sectional study. BMJ 2020;369:m997
10. Zhang L, Wang F, Wang L, et al. Prevalence of chronic kidney disease in China:across-sectional survey[J]. Lancet,2012,379(9818):815 -822.
11. Schnell, O., Rydén, L., Standl, E. et al. Current perspectives on cardiovascular outcome trials in diabetes. Cardiovasc Diabetol 15, 139 (2016).
12. Tian Xinda, Wang Mengdi, Song Guangyao. Research progress of SGLT-2 inhibitors and GLP-1 receptor agonists in the treatment of patients with type 2 diabetes [J]. The World’s Latest Medicine Information Digest, 2020(8):3.
13. Microvascular Complications Group of Diabetes Branch of Chinese Medical Association. Clinical Guidelines for Prevention and Treatment of Diabetic Kidney Disease in China [J]. Chinese Journal of Diabetes, 2019, 11(1):14.
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14. Microvascular Complications Group of Diabetes Branch of Chinese Medical Association. Guidelines for Prevention and Treatment of Diabetic Nephropathy in China (2021 Edition)[J]. Chinese Journal of Diabetes, 2021, 13(8):23 .
Writing | Surin
Editing｜Jiang Yun Jia Ting
Operation | Xiaoxi
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