*For medical professionals only for reading reference
On September 25, 2022, the "Eleventh AstraZeneca Diabetes Summit Forum" organized by AstraZeneca Medical Department successfully concluded! The forum invited Professor Yang Wenying from the Department of Endocrinology of in Sino-Japanese Friendship Hospital, Professor Gao Yan from the Department of Endocrinology of First Hospital of Peking University, Professor Zhou Zhiguang from the Department of Endocrinology of Xiangya Second Hospital of Central South University, and Professor Zou Dajin from the Department of Endocrinology of 10th Affiliated People's Hospital of Tongji University to serve as the chairman of the conference. Experts from the endocrine field, nephrology field, and cardiac field across the country gathered in the cloud to discuss hot topics such as diabetes diagnosis and treatment, the latest international frontiers, scientific research and innovative achievements, and guidance path updates. This article collects the essence of the conference for readers!
The main venue chairman
Professor Yang Wenying
State Friendship Hospital
Professor Gao Yan
Peking University First Hospital
Professor Zhou Zhiguang
Central South University Xiangya Second Hospital
Professor Zou Dajin
Tenth People's Hospital Affiliated to Tongji University
Professor Ji Linong
Peking University People's Hospital Department of Endocrinology
SGLT2i Ten-year Journey: 1835, French chemist C. Petersen isolated root from apple tree roots. From then on, SGLT2i's path to lowering sugar [1] was opened. In 2008, FDA required that new antidiabetic drugs should be launched to complete CVOT tests to verify their cardiovascular safety. SGLT2i started the path of "self-proving innocence" with "original sin". It was unexpectedly found that it has cardiovascular benefits in diabetics. In subsequent series of studies, it was confirmed that it also has cardiovascular benefits for non-diabetics. In the renal field: SGLT2i can benefit from high or low eGFR in patients with or without T2DM. There have been guidelines to downgrade the renal function usage limitation of SGLT2i in adult CKD patients to eGFR ≥25ml/min/1.73m2[2].
Professor Guo Lixin
Beijing Hospital National Elderly Center
Real-world Research DONATE Research Interpretation: DONATE Research is the first study in China to evaluate the safety of SGLT-2i in real-world clinical practice. The results suggest that Chinese T2DM patients took dapagliflozin once a day and had good overall safety and tolerability. The overall safety events and safety events of special concern, such as urinary tract infection , reproductive system infection, hypoglycemia, DKA, etc., were all lower than those of [3].
Dr. Nayyar lqbal
AstraZeneca's global clinical metabolic R&D department
Door to diabetes R&D future: AstraZeneca's goal is to prevent, reverse and cure diseases, focusing on four disease areas - Dyslipidemia , Hand failure , kidney disease and non-alcoholic steatohepatitis (NASH). AstraZeneca has a rich product line for cardiovascular, renal and metabolic diseases. Dr. Nayyar lqbal introduced its new products and research in four areas.
Professor Hong Tianpai
Peking University Third Hospital Department of Endocrinology
2022ADA/EASD Type 2 diabetes hyperglycemia management consensus: new version of consensus pays more attention to the full management of T2DM blood sugar control, weight management , cardiorenal protection and other multiple links. Updated the overall patient-centered management method, 24-hour behavior management, and updated the key points such as drug selection paths, weight management, etc. [3].
Professor Wang Weiqing
Shanghai Ruijin Hospital
New model of standardized management of diabetes cracks the dilemma of comprehensive management: Health management of chronic diseases has become a very important content in the field of health management.The National Standardized Metabolic Disease Management Center has broken through the traditional treatment model and connected three important scenarios related to diabetes management, including hospitals, communities, families, etc. More than 900 hospitals have participated, jointly managing nearly 1 million diabetic patients. The patient follow-up and early detection of complications have increased significantly, and has developed into a chronic disease management network that connects hospitals-pharmacies-families, better serving the majority of chronic disease patients [4].
Professor Yan Li
Section of Endocrinology Department of Sun Yixian Memorial Hospital of Sun Yat-sen University
Reflection and realistic enlightenment of diabetes management strategies: The epidemic trend of diabetes is becoming more and more serious, and the number of young (40 years old) patients is increasing; the risk of death and the economic costs caused by the simultaneous increase in diabetes have brought huge burdens to individuals and society, and must be taken seriously. Obesity, insulin resistance and β-cell disorder may be the main reasons for accelerating the prevalence of diabetes; based on the pathological characteristics of diabetes, it is necessary to manage the entire process from prevention to treatment [5].
Professor Li Xiaoying
Section of Endocrinology Department of Zhongshan Hospital Affiliated to Fudan University
Fatty liver and diabetes: From the basic to clinical: The close relationship between diabetes and fatty liver, the body's excess nutrition leads to the occurrence of fatty liver, and the instability of liver glycolipid metabolism is closely related to the occurrence and development of diabetes. The liver is an important source of diabetes. While preventing and treating diabetes, we must pay attention to metabolic-related fatty liver disease [6].
At the same time, this conference set up three sub-venues: "Diabetes and Chronic Kidney Diseases", "Glycolipid Metabolism and Cardiovascular Diseases", and "Get Friends to Defend to Better Sugar World".
Sub-venue 1: Diabetes and chronic kidney disease
Professor Zhao Minghui
Director of the Institute of Nephrology, Peking University
"Guidelines for the Early Assessment and Management of Chronic Kidney Diseases in China" Interpretation: my country's chronic kidney disease, like chronic kidney disease in the world, is showing a rapid rise and serious international public health problems. The demand for early screening and early identification is more urgent. The Guide provides a reference for clinical workers and policy makers, which helps promote the rational diagnosis and treatment of chronic kidney disease and standardized management. Professor Zhao Minghui pointed out that the Guidelines recommend the use of SGLT2i for treatment in patients with CKD or without diabetes (1a, A); SGLT2i for treatment in patients with CKD and chronic symptomatic heart failure (1a, A) [7].
Professor Xue Yaoming
Director of the Endocrinology and Metabolism Department of Southern Hospital
From diagnosis to treatment, focus on Diabetic nephropathy full management: is very important for early screening of diabetic nephropathy, and early screening and processing can bring very good benefits. It is crucial to early detection, early treatment, and effective full-process management. Active intervention includes comprehensive control of blood sugar, , blood lipids, , and blood pressure [8].
Professor Liu Bicheng
Director , Institute of Nephrology, Southeast University,
SGLT2i in CKD cardiorenal protection: The application of SGLT2i is not only a simple reduction of sugar, but more importantly, re-adjustment of energy metabolism. Through the loss of diabetes and net energy, a metabolic pattern similar to that of fasting is induced, which reduces the utilization rate of glucose , increases fatty acid ketone bodies and branched amino acid , and reduces cell damage caused by excessive metabolism of heart and kidney cells through metabolic reprogramming. At the same time, it reduces weight and blood pressure, and also promotes diuresis and reduces heart load. It can also simulate hypoxia, restore bulbar feedback, reduce glomerular hyperfiltration, reduce proteinuria, reduce myocardial sodium hydrogen exchange, anti-inflammatory , antioxidant stress, etc., improve cardiomyocyte energy metabolism [8].
Professor Zhou Zhiguang summarized: The prevalence of diabetic nephropathy is high, the disease burden is heavy, and the prevention and treatment situation is severe. Early screening, early detection and early intervention are the key to improving the outcome of diabetic nephropathy, especially early screening of proteinuria, trace proteinuria, and glomerular filtration rate eGFR.Multidisciplinary management is the general trend of diabetic nephropathy management and can significantly improve the clinical outcome of patients. SGLT2i has a good protective effect in the heart and kidneys, and its mechanism covers many aspects such as SGLT2i can improve energy metabolism, hemodynamics , cardiac structure reconstruction, and anti-inflammatory [9].
Sub-venue 2: Glycolipid metabolism and cardiovascular disease
Professor Li Yong
Huashan Hospital Affiliated to Fudan University
"heart" future of metabolic diseases and cardiovascular diseases: cardiovascular metabolic disease coexistes with hypertension and diabetes. Only by actively evaluating cardiovascular risks and strengthening the comprehensive management of multiple risk factors can we bring greater cardiovascular protection to patients. The establishment of a specialty in cardiovascular metabolic medicine requires the joint efforts of endocrinology, obesity medicine, nutrition , sports medicine, nephrology, and gastroenterology, to understand the concept of cardiovascular metabolic syndrome, understand the means and measures for the management and control of metabolic cardiovascular diseases, and ultimately improve the outcome of patients with metabolic cardiovascular diseases [10].
Professor Peng Yongde
Section of Endocrinology Department of First People's Hospital Affiliated to Shanghai Jiaotong University School of Medicine
From energy metabolism, see new evidence of SGLT-2i: Energy metabolism is crucial in the entire life activities of the human body. Energy imbalance can lead to multiple damage, especially the occurrence of cardiovascular diseases. Improving energy imbalance is an extremely effective method to treat metabolic circulatory diseases. Among them, SGLT-2i is the most direct in improving energy metabolism, and ultimately improves the compound endpoint event of cardiovascular by improving endothelial cells function, anti-inflammatory, increasing cardiovascular blood flow, improving myocardial contractility and other aspects.
Professor Feng Bo
Department of Endocrinology, Oriental Hospital Affiliated to Tongji University
Deeply analyze "glycolipid comorbidity", discussing the importance of "glycolipid co-management": The abnormal lipid metabolism and abnormal sugar metabolism in diabetic patients interact and promote each other, which is closely related to the occurrence and development of diabetes-related complications. In clinical treatment, we should not only look at the points, but also look at the surface. We should not only look at the abnormalities of a certain lipid spectrum, but also see the interaction of components of multiple lipid spectrums to comprehensively control blood sugar and improve blood lipid [12].
Professor Zou Dajin summarized: The three professors gave wonderful speeches on the importance of "heart" future of metabolic diseases and cardiovascular diseases, from the perspective of new evidence of SGLT-2i from energy metabolism, and deeply analyzed "Glycolipid comorbidity " . Cardiovascular disease is composed of many risk factors, among which metabolism is the most important factor. The most important thing in controlling cardiovascular diseases is to control metabolic diseases. There is an interaction between high sugar and high fat, and the combined existence jointly promotes the occurrence and development of ASCVD diseases. Multidisciplinary team (MDT) management is more helpful in improving risk factors for metabolic cardiovascular disease. Improving energy imbalance is an effective solution for the treatment of metabolic cardiovascular diseases [13].
Sub-venue 3: Meeting friends by debate, the sugar industry is better, SGLT2i VS metformin , who is the first-line treatment for hypoglycemia: The debate and the two sides debated fiercely, put forward their supportive scientific evidence and core views:
Professor Wang Guang
Beijing Chaoyang Hospital Affiliated to Capital Medical University
SGLT2i is comparable to metformin: classic hypoglycemia research has laid a treatment path centered on blood sugar, but pure blood sugar control alone cannot meet the treatment needs of complications, and the "post-lowering glucose era" treatment strategy has changed from purely lowering glucose to focusing on the heart and kidney outcomes. Domestic and foreign guidelines recommend SGLT2i for first-line drug selection for 2 diabetes patients with ASCVD or high-risk factors, heart failure, and chronic kidney disease [14].
Professor Xia Wenfang
Department of Endocrinology, Union Hospital Affiliated to Huazhong University of Science and Technology
The first-line status of metformin is unshakable: The ideal first-line anti-glycemic drugs need to meet a variety of conditions, such as safe, effective, and lasting, suitable for patients with various stages of diabetes and multiple comorbidities, and can be used in combination with other anti-glycemic drugs.Authoritative domestic and foreign guidelines recommend metformin as a first-line drug for T2DM hypoglycemia treatment, and its therapeutic status has not changed for many years. Although there is a lot of evidence to improve cardiorenal outcomes in the new type of hypoglycemic drugs as support, it is still too early to become a first-line hypoglycemic drugs [15].
Professor Gao Yan summarized: Due to the different targets and mechanisms of metformin and SGLT2i, the benefit groups of diabetic patients also have different advantages. Clinically, it is necessary to select appropriate first-line therapeutic drugs individually according to different patients. For patients with diabetes who have ASCVD or high-risk factors, heart failure, and chronic kidney disease, SGLT2i drugs should be selected as the first-line drugs according to the guidelines. Through the voting session of the conference interactive end, more than 70% of the doctors present supported SGLT2i to become a front-line choice for diabetes treatment, reflecting the spirit of following up the update of guidelines and continuously improving the treatment level and serving patients in my country's clinical practice.
With the improvement of my country's economic and health level and the influence of factors such as population aging and urbanization, problems such as diabetes heart and kidney and dyslipidemia in my country have become prominent, and the prevention and treatment and management of diseases are facing huge challenges. Colleagues in the field of diabetes have always been lofty and united, and dedicated themselves to diabetic patients with practical actions, and strive to think about new ways and new methods of diabetes management from multiple angles and all aspects.
Note: Dagliflozin has not been approved in China to improve the risk of cardiovascular disease/renal disease in diabetic patients, and has not been approved to reduce the risk of cardiovascular death or heart failure in diabetic patients. Dagliflozin has not yet obtained the indication for treatment of obesity/hypertension in China, and weight/blood pressure reduction is the secondary endpoint of clinical research.
Statement: This information is provided by AstraZeneca. It is for reference only by medical and health professionals and is not for promotional purposes.
Approval number: CN-103586, valid until 2022-12-29
References:
[1]Watson, Mr Michael, et al."UK Kidney Association Clinical Practice Guideline: Sodium-Glucose Co-transporter-2(SGLT-2)Inhibition in Adults with Kidney Disease
[2]https://www.easd.org/virtualmeeting/home.html#!resources/real-world-safety-of-dapagliflozin-in-elderly-patients-with-type-2-diabetes-in-china-post-hoc-analysis-of-the-donate-study.Oral Presentation#547.2022.9.23
[3]2022 Academic Seminar on the Professional Committee of the Chinese Preventive Medicine Association of Nephrology Prevention and Control: Guidelines for Early Evaluation and Management of Chronic Kidney Disease in China. https://live.meetingmedmei.cn/watch/10762291?sharedBy=51817750invitedBy=51817750
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