On November 27, the Chinese medical association released complications “Chinese type 2 diabetes prevention guide (2020 edition)”, the guide from the beginning of the first edition published in 2003, every three to four years will be updated once, illustrates the type 2 diabetes has become one of the most important chronic diseases in our country, at the same time for the diagnosis and drug treatment of type 2 diabetes research has continuously developed, and the constantly have new discovery.
Due to new hypoglycemic drugs hit the market constantly in recent years, including the dipeptide base peptidase 4 inhibitors (DPP 4 inhibitors), sodium/glucose transporters together 2 inhibitors (SGLT2 inhibitor) and peptide glucagon samples – 1 agonist (glp-1 ra), we can put the DPP 4 inhibitors are collectively known as statins, have SGLT2 inhibitors are collectively referred to as the net class.
Although these categories of hypoglycemic drugs have been rising in the updated guidelines in recent years, metformin, as one of the old hypoglycemic drugs, is not to be outdone, and continues to maintain the “cornerstone” status of hypoglycemic drugs in the new guidelines.
The new guidelines strengthen the role of the three drugs
Based on the latest findings, the new guidelines further strengthen the first-line treatment status of three drug classes: metformin, glP-1RA and GlP-1RA.
Metformin has always been one of type 2 diabetes treatment drug of choice for new guidelines further stressed that as long as patients on metformin without contraindication, no matter adopt what kind of hypoglycemic drugs, should be on the basis of metformin, in other words, in the case of no contraindications to metformin should remain in the solution of an oral glucose-lowering drug, highlights the importance of metformin. This is mainly due to the metformin as a nearly a century old medicine, the clinical curative effect and security is very good, not only is the first choice for overweight or obese patients with type 2 diabetes drugs, but also has the prevention of pre-diabetes populations for the development of diabetes and cardiovascular protection, it monotherapy can make the glycosylated hemoglobin fell by 1.0% – 2.0%.
- Net class
Column net class C a debut in the new guidelines, so to speak, because of chronic kidney disease and cardiovascular disease is one of the common complications of type 2 diabetes mellitus, and a growing number of studies have found that the column net class can make major adverse cardiovascular events in patients with type 2 diabetes and kidney event a significant reduction in the risk occurrence and development of composite end point, hospitalization for heart failure rate has dropped significantly.
Therefore, the new guidelines stress that patients with type 2 diabetes with chronic kidney disease or heart failure should be added to metformin on a net basis, regardless of whether the hemoglobin a1C is up to standard and as long as there are no contraindications.
Currently listed on the domestic such drugs are mainly Essex lalu peptide and the peptide and the peptide and Mr Lu peptide, has significantly reduce weight and improve the levels of triglycerides, blood pressure, the new guidelines recommend the drugs and the column net classes for type 2 diabetes mellitus and atherosclerosis sex or patients with cardiovascular risk factors of cardiovascular disease, as long as no contraindications, whatever glycosylated hemoglobin levels, can be on the basis of metformin plus. In addition, diabetics with severe chronic kidney disease can choose such drugs instead if they are unable to use the listed drugs.
The new guidelines can be said to form an “iron triangle” of these three categories of drugs, which have significant benefits in terms of diabetes combined with chronic kidney disease and cardiovascular diseases. Therefore, in practical application, two-drug or three-drug combination hypoglycemic regimen can be adopted, and this regimen is superior to other hypoglycemic drugs.