The 2022 Spring Festival is coming, and the winter Olympics that Chinese people have been looking forward to for will also restart in the New Year's Eve, so for diabetics, how to fully control blood sugar while getting up is a serious task. How do people with diabetes manage their blood sugar during the festive season? How does the consensus of the guidelines recommend the management of diabetic patients and the use of drugs? In this issue, let's take stock and review it together.
Spring Festival + Winter Olympics, diabetic patients during the festival under the premise of controlling blood sugar, but also need to be more aware of postprandial blood glucose rise and hypoglycemia risk
If diabetic patients have irregular meal times and increased meal intake per meal during the holidays, it may lead to an increase in blood glucose after meals, and changes in dinner time may also cause low blood sugar at night. Whether it is an increase in blood glucose after a meal or the occurrence of hypoglycemia, it will bring adverse outcomes, so it is recommended that people with diabetes should maintain a regular life and diet during the holidays. At the same time, family activities increase, diabetic patients may not follow the doctor's instructions, compliance is reduced, especially in patients with multiple oral medications or multiple injections of insulin, resulting in poor blood glucose control and even complications. Therefore, during the holidays, it is recommended that diabetics must take medication on time and in quantity to ensure good blood sugar control.
For people who need to improve the ease of insulin injections, they can choose to treat insulin with a combination of efficacy and fewer injections. So what kind of insulin has the above characteristics? What recommendations do guidelines and experts recommend for this type of insulin?
Follow the guide to unlock the new double insulin that takes into account the fasting postprandial blood glucose, low risk of hypoglycemia, and safe and simple medication
The ease of medication is an important treatment need in the treatment of diabetic patients, and the new double insulin brings hope for patients who need to balance fasting and postprandial blood glucose at the same time to achieve easy injection. Degu aspart is the world's first new generation of soluble double insulin, which is a mixture of 70% basal insulin (degu insulin) and 30% meal insulin (insulin aspart)[1], which can cover both fasting and postprandial blood glucose, and is easy to inject, can be administered one or two times a day, greatly improving patient compliance. In 2021, a number of guidelines have been issued, all of which are recommended as the first-line drugs for initiating insulin therapy, let's take stock of how double insulin is recommended in various guidelines.
The latest CDS guidelines emphasize blood glucose compliance and the inclusion of double insulin first-line initiation into the insulin therapy pathway
Based on a number of evidence-based evidence, the 2020 edition of the China Guidelines for the Prevention and Treatment of Type 2 Diabetes[2] not only adds a double insulin analogue to the classification of type 2 diabetes treatment, but also makes de gu menpart the only double insulin as the first-line choice for insulin initiation therapy.
Guidelines indicate that initiation of insulin therapy may be considered in 7.0% of patients treated with oral hypoglycemic agents for 3 months HbA1c ≥, with double insulin analogues available as a first-line option (Figure 1). At present, the only marketed double insulin analogue is Degu Aspart double insulin (IDegAsp), which is generally started from 0.1 to 0.2U/kg/day, injected before the main meal, and adjusted according to the fasting blood glucose level until the standard is reached. In patients who are obese or HbA1c>8.0%, higher dose initiation is an option. Degumeneus twin insulins may be considered to be injected twice a day when the dose reaches 0.5 U/kg/day or 30 to 40 U after a meal or if the patient has two main meals per day.
Figure 1. The 2020 CDS guidelines recommend double insulin analogues as a first-line option for insulin initiation therapy
The "Guidelines for the Diagnosis and Treatment of Diabetes in the Elderly" was released, and the special population of double insulin was recommended at the first level
Elderly patients with T2DM have a large risk of hypoglycemia and poor ability to perceive hypoglycemia, in the formulation of blood glucose control goals, diet and exercise programs, blood glucose monitoring strategies and drug selection should be vigilant about the occurrence of hypoglycemia, while some elderly due to cognitive decline, comorbidities lead to more types of medication, so the principles of drug treatment for the elderly include: preferential selection of drugs with low risk of hypoglycemia, selection of simple, high adherence to drugs, reduce the risk of multiple medications. At the same time, the benefit-risk ratio should be weighed to avoid over-treatment. Attention should be paid to factors such as liver and kidney function, heart function, complications, and concomitant morbidity. China Geriatric Diabetes Diagnosis and Treatment Guidelines (2021 Edition)[3] point out that Degu Mendon double insulin 1 to 2 injections per day is equivalent to multiple insulin injections, the number of injections is small, the patient medication compliance is high, and it has similar pharmacokinetics, efficacy and safety similar to that of non-elderly patients in elderly diabetic patients, so for the first time, double insulin is recommended for elderly patients, and for patients with poor blood glucose control using basal insulin, mealtime insulin or premixed insulin, it can be converted to double insulin 1-2 times / Daily injection therapy. (Figure 2)
Figure 2. Path map of insulin therapy in elderly patients with T2DM
Chinese expert guidance is the pilot for the standardized application of double insulin - timely start, flexible conversion
In July 2021, the "Expert Guidance on the Clinical Application of Degu Aspart Double Insulin" [4] published by Chinese experts was published in the Chinese Journal of Diabetes, which provided specific guidance and suggestions for the application of Degu aspart double insulin in clinical scenarios such as insulin initiation and conversion.
One
Initiation of insulin therapy
Degumenxon can be used for insulin initiation therapy and is superior to basal insulin initiation therapy, especially in patients with severe hyperglycemia and/or predominantly postprandial hyperglycemia; it can be started once or twice daily with the main meal, and the dose adjustment is simple. The recommended starting dose is 10 units (U), or 0.1 to 0.2 U/kg/day, and may be started at a higher dose in patients who are obese or have HbA1c>8.0%. Dose adjustment is made according to the use of a 2-0-2 regimen for blood glucose on an empty stomach or before two main meals.
Two
Conversion scenarios
Switch from premixed insulin to dual insulin regimen:
Patients on premixed insulin may switch to dual insulin therapy when blood glucose is not up to standard after adequate dose regulation. Here's how to convert:
In patients with 1-day premixed insulin, the isoid dose is converted to d'oromepartic insulin once a day, and the total dose is unchanged; in patients who > 1 premixed insulin per day, the equivalent dose is converted to d'dgu asparticil 2 times a day, and the total dose is unchanged.
When switching from premixed insulin to degu asparticle, the initial dose of degumeneus asparticil in some patients (with a high risk of hypoglycemia) can also be reduced by 10% to 20% compared with the previous premixed insulin dose after considering the individualized situation of the patient.
Conversion from basal insulin to double insulin regimen: the basic principle is that the total dose is converted equally, and the total dose is unchanged. Specific recommendations include:
Patients with poorly controlled blood glucose at doses of 0.5 U/kg/day can be switched to double insulin for treatment.
Switching to double insulin therapy is recommended when there is nocturnal hypoglycemia with basal insulin other than deglum insulin.
HbA1c is not up to standard and at a high level, and the dose of insulin can be appropriately increased when switching to dual insulin therapy.
Switch from a short-term intensive regimen to a dual insulin regimen:
Adjustments can be made according to the patient's long-term treatment regimen, islet β cell function, blood glucose level, insulin dosage, ratio of insulin during the meal, and willingness to treat. Diabetes treatment closely monitors blood glucose levels during the transition and in the weeks that follow.
Degumendon is a soluble di-insulin formulation that does not require mixing before injection[1]. At the same time, compared with the premixed human insulin must be eaten within 30 minutes after insulin injection, Degu Mentong can be administered with the main meal, and can be eaten without waiting after injection [1]. Easy to apply.
In addition, the latest 2021 "Expert Consensus on the Application of Insulin for Type 2 Diabetes at the Grassroots Level" [5] also recommends Degu Mendon as a first-line drug for insulin initiation treatment, adding an important weapon to the standardized management of diabetes at the grassroots level.
summary
Diabetics should pay attention to maintaining dietary rules, taking medication according to doctor's instructions, and maintaining emotional stability during the happy holiday of spring festival + Winter Olympics. Degu Mentongoud,which takes into account postprandial blood glucose, stable hypoglycemicity, and convenient medication, has solid evidence evidence and has been recommended by a number of consensus guidelines, bringing new tools to the clinical treatment of T2DM, and hoping to benefit more diabetic patients in the future.
bibliography:
1. Degu Mendon double insulin injection instructions
2. Guo Lixin et al. Chinese Journal of Diabetes. 2021 ; 13(1) :14-46
3. Diabetes Branch of Chinese Medical Association. Chinese Journal of Diabetes,2021,13(4):315-409.
4. Zhu Dalong, et al. Chinese Journal of Diabetes,2021,13(7):695-701.
5. Wishing Beads, etc. Chin J Gp,2021,20(7):726-36