Professor Wei Ping: Intensive treatment in diabetes management is not all, and long-term effectiveness can be stable and far-reaching

Type 2 diabetes mellitus (T2DM) is a progressive disease in which blood glucose tends to rise gradually as the course progresses, and some patients require hospitalization to achieve blood glucose attainment. However, in the clinic, many patients are still re-admitted to the hospital within one year after the blood glucose standard is discharged from the hospital, and the main reason is still severe blood glucose abnormalities. Studies have demonstrated that interventions at the clinician and patient level can reduce readmission rates for some patients, including improving long-term blood glucose management for T2DM patients from hospitalization to post-discharge. To this end, on the occasion of the "In-hospital-Out-of-Hospital Long-distance Management Demonstration Practice Project for Type 2 Diabetic Patients", this newspaper specially interviewed 60 experts involved in the project, and in this issue, we invited Professor Wei Ping, director of the Department of Endocrinology of Chongqing Southwest Hospital, to share his practical experience in clinical long-distance management of blood glucose in T2DM patients. chase

Expert Profiles

Transcript of the interview

Q1

What was your biggest impression during this long-term management project?

Professor Wei Ping: The biggest feeling that this project gives me is that we hate each other late, the clinical needs and practical urgency of long-range blood glucose management have been reflected for a long time, and in the past, I have repeatedly called for the implementation of long-distance management as soon as possible to bring tangible benefits to patients. As we all know, the concept of intensive treatment of diabetes has been deeply rooted in people's hearts, but in practice, whether patients can accept or need intensive treatment is still a question mark. Relatively speaking, long-term management will be more applicable in the treatment of diabetes. This is also my second feeling, that is, the project has a strong practicality and can bring clear clinical significance.

In the past, clinical treatment of diabetes was more concerned with how to reduce the patient's blood glucose in a short period of time, which often ignored the patient's own factors, compliance, and long-term management of diabetes. The implementation of this project can guide clinicians to pay more attention to the long-term management of patient blood glucose and the management of complications. In addition, through the detailed explanation of the treatment plan inside and outside the hospital and in the transitional period by the grass-roots doctors, the grass-roots doctors can be more targeted.

Q2

Can you give us a brief overview of the differences between blood glucose management strategies in and out of hospital?

Professor Wei Ping: The biggest feature of blood glucose management in hospitals is that most of the diabetic patients admitted to the hospital have experienced the failure of out-of-hospital blood glucose management, which also shows that there is a problem of poor effect of blood glucose management outside the hospital. For such patients, the clinical treatment method of three short and one long or insulin pump is mainly used, the sugar control effect is good, and the blood sugar is easy to adjust. However, from the perspective of effect, the premixed insulin regimen can also meet the requirements of clinical treatment. We know that short-term intensive treatment can achieve blood glucose standards in a short period of time, thereby improving the turnover rate of inpatient beds and achieving the requirements of hospitals for the average hospital stay of departments, but intensive treatment should not be the whole concern of clinicians. We should pay more attention to whether the treatment regimen used in the hospital can still be well implemented after the patient is discharged from the hospital, so as to achieve long-term and effective management of blood glucose in patients outside the hospital. Out-of-hospital glycemic management emphasizes the stabilization of blood glucose and minimizes blood glucose fluctuations, and premixed insulin can achieve this goal well.

Q3

Specifically, what do you think are the characteristics of the premixed insulin regimen?

Professor Wei Ping: Overall, the use of premixed insulin regimen in the hospital is more conducive to long-term blood glucose management of patients. Even if this may result in a patient staying longer than three short and one long or insulin pumping to regulate blood glucose, the in-hospital and in-hospital overrun will be smoother, and the number of patients re-admitted due to blood glucose fluctuations or poor blood glucose control outside the hospital will be reduced. If the doctor has already taken into account the need for blood glucose control outside the hospital when managing blood glucose in the hospital, he can start the premix mode directly in the hospital. For example, insulin aspart 30 (including 30% soluble insulin aspart, 70% sperm protein aspart), flexible in use, can be injected 1, 2 or 3 times a day, covering diabetic patients with different disease courses, while the efficacy is affirmative, the safety is good; for patients, the operation is simpler and the acceptance is higher.

What currently raises concerns among clinicians about the in-hospital use of the premixed insulin regimen is whether it can control blood glucose levels in a short period of time. My personal experience is that if we can make good use of the premixed insulin regimen, we can achieve the blood glucose management goals of approximately three short and one long, even close to the insulin pump.

Q4

What are the challenges and solutions you have in order for patients to receive the premixed insulin regimen as early as possible?

Professor Wei Ping: In my clinical practice, the biggest challenge is how to guide patients to initiate insulin therapy. Because patients are generally worried about becoming dependent on insulin therapy, they are afraid of having to get injections for the rest of their lives. I would first explain to the patient that it was not because of insulin therapy that insulin dependence occurred, but because the disease progressed to the point where we needed to rely on insulin, we started to take insulin. That is to say, insulin dependence is not made by injection, but by the conditions of the body itself. In addition, I will explain to patients the advantages of the premixed insulin regimen, such as clear efficacy, simple and convenient operation, and high safety, so that patients can fully understand and reduce concerns due to unknowns.

Q5

What are your outlook for the future of in-hospital and out-of-hospital glucose management?

Professor Wei Ping: The biggest feature of the future development trend is that diabetes treatment is no longer centered on controlling blood glucose, but is oriented on the outcome of treatment, and the connotation of individualized treatment is more abundant. In the past, the meaning of individualization was to take different sugar control programs for patients with different characteristics of blood glucose fluctuations; now the meaning of individualization has increased the difference in the patient's physical condition, such as the difference in blood vessels and the difference in complications of large blood vessels and microangioscular complications, to adjust our medication regimen. In addition to the change of concept, related research will continue to deepen, new drugs will continue to emerge, I believe that the future blood glucose management strategy will continue to improve.