This type of newly diagnosed type 2 diabetes patients can benefit from short-term intensive treatment

no thumb

In the traditional treatment of patients with type 2 diabetes, a step-by-step treatment strategy is adopted, and the blood glucose level is used as the basis for the adjustment of the plan. Among the targets for the control of type 2 diabetes mentioned in the China Type 2 Diabetes Prevention Guide (2017 Edition), fasting blood glucose should be 4.4-7.0mmolL, non-fasting blood glucose was <10.0 mmol / L, and glycated hemoglobin was <7%.Glycemic control goals need to be formulated individually, and vary according to the patient's age, complications, and comorbidities.The lifestyle intervention in the hyperglycemia treatment path runs through, and then step-by-step treatment from monotherapy → dual therapy → triple therapy → multiple injections of insulin. When the blood glucose control is not up to standard (glycated hemoglobin ≥7.0%), the next stepOne step treatment.At present, the traditional treatment strategy is mainly to meet the blood glucose standard, and does not take into account the β-cell function of newly diagnosed type 2 diabetes patients. In fact, some patients with newly diagnosed type 2 diabetes do not perform step-down glucose therapy and directly give short-term intensive insulin therapy.Allow patients to achieve drug-free response with long-term benefits.The β cell function of newly diagnosed type 2 diabetes has recently been published in the China 4C study. It is concluded that the pathophysiological basis for the increase in diabetes in China is an increase in insulin resistance based on impaired islet function.β-cell dysfunction is divided into two parts, one is the deficiency of insulin secretion, the other is the abnormal insulin secretion pattern and the change of proinsulin.Defects in first-phase insulin secretion in newly diagnosed type 2 diabetes are common.The first-phase insulin secretion is also known as the acute insulin release response. In normal people, the first-phase insulin secretion peaks 2-4 minutes after intravenous glucose injection, and disappears after 6-10 minutes. If the sugar load persists, the first insulinIt is secreted in two phases until glucose is cleared.The acute insulin secretion phase (AIR) in the intravenous glucose tolerance test and the calculation of the area under the insulin curve (AUC) in IVGTT can all reflect islet β-cell function.The study found that severely impaired islet β-cell function in patients with newly diagnosed type 2 diabetes is mainly manifested in the absence of AIR and a significant decrease in insulin AUC, a significant decrease in β-cell function index (Homa β), and a decrease in insulin secretion quality.Among them, islet β-cell function is impaired and progressive failure occurs with the progression of type 2 diabetes.Traditional treatment regimen PK early intensive therapy A large number of studies have shown that progressive islet β-cell function is a decisive factor for the occurrence and development of type 2 diabetes. At present, the traditional treatment plan uses stepwise treatment, which cannot block the progressive failure of β-cell function.As the islet function of patients with type 2 diabetes weakens year by year, the treatment plan also transitions from a single drug to a multi-drug combination, oral hypoglycemic drugs are initiated, and then combined with hypoglycemic drugs or insulin injections with different mechanisms of action.This traditional treatment strategy focuses on achieving the standard of treatment, does not remove reversible factors, and does not pay attention to β-cell protection. The goal is often to achieve the standard, and with the increase in the number of drugs, it will increase the difficulty of doctors' decision-making and make patients graduallyLose confidence in blood sugar control.In actual clinical cases, the decline of β-cells occurs earlier than expected. Studies have shown that mild hyperglycemia causes significant impairment of β-cell function.Strict control of early long-term blood glucose is beneficial to long-term protection of β-cell function.As early as possible, short-term glucose intensive therapy can effectively reverse type 2 diabetes. Related research conducted by Professor Weng Jianping and Professor Li Yanbing showed that 382 patients with newly diagnosed type 2 diabetes were included. Compared with the oral hypoglycemic regimen, short-term intensive insulin therapy was used (CSII / MDI), the islet β-cell function was significantly improved, and it was better maintained for 1 year, and the remission rate was significantly higher than that of the oral drug group after 1 year.Which newly diagnosed type 2 DM patients are suitable for short-term intensive insulin therapy. Glucose toxicity exists in the case of high glucose. This situation requires short-term intensive insulin therapy to improve the condition in a short time.When newly diagnosed type 2 diabetes patients have HbA1c> 9.0% or FPG> 11.1mmol / L with obvious symptoms of hyperglycemia, it is recommended to start short-term intensive insulin therapy.The shorter the course of the disease, the lower the HbA1c and FPG at the time of diagnosis. After a short period of intensive insulin therapy, better islet function improvement can often be obtained, and a higher proportion of patients can obtain clinical remission.After so many years of research and clinical practice, the Department of Endocrinology, the First Affiliated Hospital of Sun Yat-sen University, after short-term intensive insulin therapy based on the baseline glycosylation of 10.1% to 11.6% of newly diagnosed type 2 diabetes, can achieve a 1-year remission rate of more than 50%.The 2-year remission rate is about 42%. The arginine stimulation test can find the recovery of first-phase insulin secretion. In short, short-term intensive insulin therapy can significantly restore islet β-cell function and improve insulin sensitivity.At the 2018 ADA Conference, Professor Li Yanbing’s team reported China’s gratifying results. Short-term insulin pump intensive treatment in 95 newly diagnosed and untreated patients with type 2 diabetes (average saccharification is 11.2%) can relieve 1 year.The rate reached 58.9%.Regarding the administration of insulin doses, Professor Li Yanbing’s team formulated a formula based on experience, as follows: Daily Total Estimation Formula = 0.35 * weight (kg) + 2.05 * FPG (mmol / L) + 4.24 * TG (mmol / L) +0.55 * waist (cm) -49.1, can be started at 80% of the calculated dose to avoid hypoglycemia. Patients usually reach their blood glucose level within 1-2 days.The ratio of basal and meal insulin is set according to about 4: 6 (not given according to the 1: 1 ratio of European and American populations). Insulin pump applications generally require the insulin dose to be set in stages, but it is relatively new for islet function.For patients with type 2 diabetes, you can do it without segmentation. On the first day of compliance, reduce the insulin consumption from 10 pm to 3 am the next day, and reduce it by about 10% -20%.Meal insulin distribution was based on: 30%, 35%, and 35%.In addition, patients who have been diagnosed with T2DM (have a certain course of disease) and are receiving hypoglycemic drugs. Due to the significant increase in blood glucose or large blood glucose fluctuations, short-term insulin intensive therapy can also be used to correct hyperglycemia or severe blood glucose fluctuations.This includes: ① the maximum tolerated dose of 2 oral hypoglycemic agents combined for more than 3 months, HbA1c> 9.0%; ② using basal insulin or premixed insulin 2 times a day, and undergoing sufficient dose adjustment for 3People with poor blood glucose control (HbA1c> 7.0%) or recurrent hypoglycemia after more than one month.In short, short-term intensive insulin pump therapy can quickly achieve the standard of blood glucose in patients with type 2 diabetes, significantly recover islet function, delay disease progression, and simplify treatment options.At the same time that patients achieved drug-free remission, no significant complications were found during long-term follow-up, which means that intensive short-range insulin pump therapy can benefit patients in the short and long term.For those patients with newly diagnosed diabetes with high blood glucose, timely intensive insulin therapy is used to relieve the patients’ high glucose toxicity and benefit from lowering glucose.The above content is only authorized by for exclusive use, please do not reprint without authorization of the copyright party..


The author ouyangshaoxia