Type 2 diabetes mellitus (T2DM) is a class of metabolic diseases that are predominantly insulin resistant and accompanied by a relative lack of insulin, thereby causing elevated blood sugar. Long-term hyperglycemia can lead to damage to multiple systems such as eyes, kidneys, cardiovascular and cerebrovascular diseases, and nerves. But these metabolic diseases plague 140 million people on the continent.
Complex treatment options are prohibitive
Uncle Li is 62 years old this year, diagnosed diabetes 10 years ago, diagnosed coronary heart disease 5 years ago, and recently had chest tightness and discomfort after intermittent activity, so he did not dare to move too much. In addition, he has a BMI of 25.8 kg/m2 and has gained 5 kg in the last 1 year.
Currently, oral drugs such as metformin, acarbose, glimepiride, and SGLT-2 inhibitors are used for combination therapy. In the past 3 months, the detection of fasting and postprandial blood glucose control are not up to standard, and I tried to improve the diet structure appropriately, but the effect was still not satisfactory. Yesterday in the hospital to check HbA1c up to 9.1%, and complete the insulin C peptide release test, the results are as follows.
It is not difficult to see that Uncle Li is an overweight patient, due to poor cardiac function, limited activity, unable to lose weight through exercise. In addition, the insulin C peptide release test suggested that his islet β cell function defects, accompanied by insulin resistance. At present, although four different types of oral hypoglycemic drugs have been used in combination, blood sugar is still poorly controlled, and doctors recommend that he also add insulin to treat him, which needs to be injected once a day. In the face of such a complicated treatment process, Uncle Li felt that it was too difficult.
Poor blood sugar control, also old hypoglycemia
Aunt Liu is 48 years old and has been diagnosed with diabetes for 6 years. Three years ago, she began treating with the basal insulin analogue 22 IU precutaneously combined with metformin, acarbose, and SGLT-2 inhibitors orally. After six months of medication, due to repeated urinary tract infections, the SGLT-2 inhibitor was discontinued and changed to glyquinone.
In order to better manage her blood sugar, she constantly increased her insulin injections, but her blood sugar control was still not up to standard. Occasionally, symptoms of hypoglycemia may occur. Because of the fear of low blood sugar, Aunt Liu sometimes adds meals, and fruits and dried fruits are "addictive" as soon as they eat them. 2 days ago, she went to the hospital to check HbA1c up to 8.5%.
Aunt Liu is also overweight, and her weight is still increasing, and her diet is not well controlled on weekdays. Basal insulin therapy is currently used, but glycemic control is still not ideal, and occasionally hypoglycemia occurs. This feeling of not being able to control her own life also made Aunt Liu very mad.
Similar problems also trap most diabetics on the mainland
When choosing a hypoglycemic treatment regimen, patients often face the following challenges:
1) Even after receiving insulin therapy, the HbA1c compliance rate is still low. Patients receiving basal insulin therapy have been shown to have found that HbA1c does not meet the standard in most patients under long-term follow-up observation [1,2].
2) Weight gain is a "hidden danger" of insulin therapy [3]. Many patients who receive insulin therapy do not develop good eating habits. Increasing the dose of insulin in order to meet the blood glucose standard, resulting in excess energy stored in the body in the form of fat, so that the weight is gradually increased. In addition, some patients often eat defensively for fear of developing hypoglycemia, resulting in energy intake exceeding expenditure. Over time, weight will become more and more difficult to control. However, there is also a theory that insulin can affect the feeding center, increase appetite, and cause patients to consume too much energy.
3) Low blood glucose is a barrier to HbA1c compliance [4,5]. In the process of using insulin therapy, some patients will intermittently develop symptoms such as hypoglycemia, resulting in large fluctuations in their blood glucose, thus resisting insulin therapy. Therefore, it is often faced that blood sugar is higher than low.
4) Complex insulin regimens reduce patient compliance [5]. A survey of 1,530 patients treated with insulin injections found that more than one third of patients missed at least one insulin injection in the last 1 month, and 6% of them had significantly reduced adherence to treatment due to excessive insulin injections.
The new basal insulin GLP-1RA injection, dual-receptor, multi-target, is expected to break the game
On October 26, 2021, the State Drug Administration (NMPA) approved the listing application of Degu insulin liraglutide injection (IDegLira) in China. As the world's first basal insulin GLP-1RA injection, IDegLira is a new mechanism of hypoglycemic drugs, which has been written into the Guidelines for the Prevention and Treatment of Type 2 Diabetes in China (2020 Edition)[6].
In the formulation, degludel insulin and liraglutide maintain their respective soluble, stable polymer structures. After subcutaneous injection, the two main components exert their respective mechanisms of elongation: degu insulin self-polymerizes into multi-hexameric long chains and binds to albumin reversibility, and liraglutide maintains a hexameric structure and binds to albumin reversibility. After entering each target organ through blood circulation, the two components bind to their respective receptors to exert their respective regulatory metabolic effects (Figure 1).
Figure 1 IDegLira hypoglycemic mechanism
The birth of IDegLira and its DUAL Series Phase III clinical study gave us hope in the fog (Figure 2).
1) High rate of blood glucose control compliance [7-15]
Whether previously treated with oral hypoglycemic agents or in combination with basal insulin or GLP-1 agonist therapy, HbA1c decreased by up to 1.9% and HbA1c in the IDegLira treatment group compared to the control group after adjusting to IDegLira
2) Low incidence of hypoglycemia [8,11-13]
IDegLira resulted in a lower risk of hypoglycemia (0.16 to 3.5 events/PYE) compared to a 57% lower risk of hypoglycemia compared to insulin glargine (the DUAL V study), and a reduction in the incidence of hypoglycemia by up to 50% compared with basal insulin or basal-meal insulin groups.
3) Weight benefit is clear [7-11]
Weight gain may be reduced or weight loss may occur after treatment with IDegLira in patients with T2DM who have previously received oral hypoglycemic drugs, with the DUAL V study finding that patients with T2DM who previously received basal insulin therapy switched to IDegLira with a difference of 3.2 kg in mean weight change.
4) Simple scheme and high compliance [14,16]
Figure 2 Key findings of the DUAL series study
More about IDegLira than you didn't know is here
From 8:30 to 12:40 on March 5, Novo China will broadcast live offline and online synchronously, and authoritative experts in the endocrine industry will be invited to tell you about the research and development process of Degu insulin liraglutide injection, and explain its mechanism of action and clinical benefits in detail. On the day of the spring thunder of the recovery of all things, let us go to a spring date together and look forward to the wonderful presentation of Novo Ngoc China's listing.