More than 70 % of patients died of complications, and patients with diabetes should pay attention to "sugar heart and kidney" joint prevention and treatment

As of 2021, China has become the world's "top" diabetes country 1, and now it is not just a problem of "hypoglycemic" clinically solved.

In December 2021, the International Diabetes Alliance officially updated the tenth edition of "Global Diabetes Map". In the past ten years, the number of Chinese diabetic patients has increased from 90 million to 140 million, and the total number of patients is nearly 70 million more than the second -ranked India.

According to Professor Guo Lixin, director of the Department of Endocrinology, Beijing Hospital · National Senior Medical Center, the biggest problem facing diabetic patients is chronic complications: "Due to cardiovascular disease death accounts for about 75%of the death of diabetic patients, followed by kidney disease, followed 20%-40%of Chinese diabetic patients have different degrees of kidney damage 3. "

Due to type 2 diabetes, cardiovascular diseases such as heart failure and chronic kidney disease often appear on the same person. Professor Guo Lixin believes that diabetes should form a macro concept: "Diabetes treatment is not only controlled blood sugar, but also delaying complications and improving. Promotion and improve quality of life. "

Regarding the three major diseases of "sugar heart and kidney", he mentioned: "When we diagnose any of these three diseases, we must think of the possibility of two other diseases."

Complications: Invisible killer behind diabetes

Data show that about 20%-40%of diabetic patients in my country are accompanied by cardiovascular disease 4 with type 2 diabetic patients with diabetic nephropathy 3,1/3. Another data says that one of each three patients with heart failure has type 2 diabetes; at least one of the three patients with chronic kidney disease is 6 with cardiovascular disease; at least one of the three patients with heart failure suffers from chronic chronic patients with chronic patients with chronic patients. Kidney disease 7.

The number of patients with diabetes, cardiovascular diseases, and chronic kidney diseases in China are more than 100 million or more 8,9,10. There is a cross between these diseases. Diabetic diseases are extremely easy to appear with cardiovascular disease and chronic kidney disease.

According to Professor Guo Lixin, a survey of the Diabetes Credit of the Chinese Medical Association shows that the incidence of nephropathy in domestic diabetic patients is close to 40%3, and the proportion of cardiovascular disease is close to 33%4. "If the base is based on 140.9 million diabetes patients, they will get astronomical numbers after a proportion."

"Due to the extensive complications of diabetes, especially the high incidence of heart and kidney disease, many diabetic patients have worsening. Therefore, in order to control diabetes, the life of patients with diabetes, improving his clinical ending, paying attention to and improving the heart of patients' hearts The ending of the kidney is crucial. "Professor Guo Lixin emphasized.

The transformation of the concept of treatment: from simply controlling blood sugar to the end of the patient's heart and kidney

The concept of routine treatment of diabetes is mainly to control blood glucose. However, the use of some hypoglycemic drugs increases the cardiovascular risk of patients. In 2008, the US Food and Drug Administration stipulated that drugs for treating patients with type 2 diabetes needed long -term safety tests to exclude potential hidden dangers 11 in cardiovascular risk.

With the deepening of research, multiple studies have confirmed that drugs such as SGLT-2 inhibitors and GLP-1 receptor agonists will not only increase the cardiovascular risk of diabetic patients, but also protect the heart and kidney 12.

Thanks to this, the concept of diabetes treatment has also changed significantly. The Jianzhi Bureau learned that in order to maximize the protection of patients such as patients and kidneys, the authoritative guidelines for diabetes at home and abroad have "fundamentally changed": they no longer simply pursue sugar control, but instead the benefits of cardiovascular and kidney benefits. Standardize the push of the important complications of patient life to the forefront of the treatment goals.

However, in public cognition, the combination of diabetes, cardiovascular disease and kidney disease is still a strange concept. According to the "Clinical Guidelines for Prevention and Treatment of Diabetes Nephrology": Although the prevalence of nephropathy in patients with type 2 diabetes can reach up to 40%, the awareness rate is less than 20%13.

Professor Chen Nan, chief physician of the Department of Nephrology of Ruijin Hospital affiliated to the School of Medicine of Shanghai Jiaotong University, said: "Many of us who come here to see a doctor are patients with advanced patients, such as the late complications of diabetic and nephropathy, and the treatment is also difficult. The system is a whole. When medication is treated, we must comprehensively evaluate. If you join forces to diagnose and take medicine reasonably, you can save a lot of medical resources. "

"Sugar Heart and kidney" Early screening early diagnosis: grassroots hospital responsibility is heavier

In order to strengthen the combined treatment of diabetes, cardiovascular diseases, and chronic kidney disease at the clinical level, many experts expressed a point of view: the center of gravity moved forward, the center of gravity moved down.

When talking about the prevention and treatment of kidney disease, Professor Chen Nan pointed out: "Kidney is a silent organs, and functional damage is often silent. When diabetes concurrent kidney disease, the difficulty of treatment will increase significantly. In the early days, special attention should be paid to trace proteinuria. Monitoring of blood pressure and renal function. We recommend that simple and effective treatment methods in early diseases to reduce the occurrence of complications. "

Trace white proteinuria is a characteristic of early renal damage to diabetic nephropathy. Regular proteinuria screening is very important for early detection and treatment of diabetic nephropathy. According to the 2021 "Guidelines for Prevention and Control of China Diabetes and Kidney Diseases", all patients with type 2 diabetes and patients with type 1 diabetes with a course of disease should be tested during diagnosis at the time of diagnosis. The second screening 14.

Professor Chen Nan also emphasizes the importance of micro proteinuria screening: "If there is a little trace albuminuria in diabetic patients, it can actually be reversed. Urine, no more control, this patient is likely to affect the renal function in two or three years, and then develop to the end of the end of the renal disease. The risk of cardiovascular events such as heart failure and myocardial infarction will also increase. " Early intervention and management of major illnesses, Professor Chen Nan believes that grass -roots medical institutions play a very important role: "Third -level hospitals work hard on dysfunction, but during prevention and treatment, they must play more the role of communities and secondary hospitals. The center of gravity moves down. For example, the community can strengthen publicity during the day of various diseases, and advocate the concept of common prevention and treatment in the early stage of disease. "

Jianzhi Bureau learned from the industry personnel that with the popularity of the Internet medical service platform, in some areas, patients can already choose community hospitals or retail pharmacies to conduct "three high" diseases to follow the "three highs" diseases. Psychological management efficiency and effect.

In addition, patients should also prevent comprehensive prevention. Professor Guo Lixin suggested that individuals should develop a healthy lifestyle, reasonable diet, moderate exercise, and regular physical examination: "For example, you have high blood pressure, in addition to weight loss, you must also avoid tiredness or mental tension, low -salt diet, quit smoking and alcohol, and drink alcohol. These are very useful ways. "

*This material is only used for disease education purposes. If you have any questions, please consult medical professionals.

references:

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3. Chinese Medical Association Diabetes Branch. China Type 2 Diabetes Guide (2020 Edition) [J]. Chinese Diabetes Magazine, 2021, 13 (4): 315-409.

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: challenes and solutions. Curr Cardiol Rev. 2016; 12: 249.

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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 Study.

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 Outcom TRIALS in Diabetes. Cardiovasc Diabetol 15, 139 (2016)..

12. Tian Xinda, Wang Mengdi, Song Guangyao. SGLT-2 inhibitor and GLP-1 receptor agonist in patients with type 2 diabetes are treated [J]. The world's latest medical information excerpts, 2020 (8): 3.13.Chinese Medical Association Diabetes Branch Microba complications. The clinical guidelines for prevention and treatment of diabetic and kidney disease in China [J]. Chinese Diabetes Magazine, 2019, 11 (1): 14.

14. The Microba complications of the Diabetes Branch of the Chinese Medical Association.

Writing | Su Lin

Edit ｜ Jiang Yun Jia Ting

Operation | Xiaoxi

Picture Source | Visual China

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