22 minute read
SD Symposium-Diabetes (1-7
from 108年年會
by Endo 電子書上傳區
SD1-1
EDWARD J. BOYKO, M.D.,M.P.H.
Professor, Department of Medicine, Adjunct Professor, Department of Epidemiology, Adjunct Professor, Department of Health Services, University of Washington
Since the early 1990s, the prevalence of type 2 diabetes in the United States has more than doubled from 3.6% in 1990 to 8.7% in 2015 among adults ages 18 years or older. The large increase occurred concomitantly with an epidemic of overweight and obesity. I will discuss whether the increase in body weight explains completely the increase in number of diabetes cases. Since 2015, the of the method to identify diabetes cases is an active question that I will discuss. Multiple surveys are conducted at regular intervals in the United States that include laboratory testing (NHANES), in person interview (NHIS), and telephone survey (BRFSS). These different surveys are used to estimate occurrence of diabetes and its complications nationally and regionally, as well as identifying risk factors such as overweight/obesity. Laboratory testing to identify diabetes is based on fasting glucose, 2-hour oral glucose tolerance testing, and Hemoglobin A1c. Advantages and disadvantages of each methodology will be discussed. Although obesity is well recognized as a risk factor for diabetes, certain body composition differences at a normal weight have also been identified as risk factors. Such measurements though are typically not available in populations due to the need for imaging technology. Occurrences of diabetes complications in the United States are captured by multiple national data resources related to hospitalizations and payment for renal dialysis. Progress in reducing end stage renal disease (ESRD) occurrence was seen between 1996 and 2009, but ESRD incidence has since stabilized. Similarly, progress in reduction of diabetic amputations was seen over that same time period but since 2009 the number of hospitalizations for diabetic amputations has increased. I will discuss online database and search engine resources from the Centers for Disease Control and Prevention which once understood will allow any website visitor to track diabetes trends in the United States in real time.
SD1-2
CHIH-CHENG HSU1
1Institute of Population Health Sciences, National Health Research Institutes
The task force of National Health Research Institutes (NHRI) has collaborated with the DAROC and TADE and used the National Health Insurance Research Database (NHIRD) to conduct epidemiological studies and publish the 2019 Diabetes Atlas, which delineated epidemiological features of diabetes and practice patterns of diabetes care in Taiwan for the last decade between 2005 and 2014. The contents of 2019 Diabetes Atlas included trend analyses for diabetes’ incidence, prevalence, mortality, micro and macrovascular complications, physicians’ accountability, hospitalization, and anti-diabetic medication use. The current status of the diabetes pay-for-performance program was also reported in the series. The publication of the 2019 Diabetes Atlas emphasizes importance of continuous monitoring and surveillance of quality of diabetes care. The collaborative effort from the academia and clinicians also declares determination from the whole society to better diabetes care in Taiwan. In this talk, I will show epidemiological pattern of diabetes in Taiwan, achievements of the diabetes care we have made, and the challenges ahead we must face to improve quality of diabetes care in the future.
SD1-3
DESIGN AND PRELIMINARY FINDINGS OF TAIWAN DIABETES REGISTRY (TDR)
1SHIH-YI LIN ON BEHALF OF TAIWAN DIABETES REGISTRY GROUP
1Center for Geriatrics and Gerontology, Taichung Veterans General Hospital
Diabetes is a widespread chronic disease, and in Taiwan the total diabetes population is estimated at around 2.2 million out of the 23 million residents. The Diabetes Association of the Republic of China (Taiwan) launched Taiwan Diabetes Registry (TDR) study in October, 2015, which enrolled three patient groups, participants in the diabetes quality control studies in 2006 and 2011(group 1), type 1 diabetes (group 2), and type 2 diabetes diagnosed within 6 months (group 3) from medical centers, regional and local hospitals and general practice clinics. The general characteristics, reports of blood and urine tests, diabetic complications evaluation, and use of medications were recorded at baseline and then every 1-2 years. To evaluate the status of diabetes control, the percentage of attaining targets for (HbA1c) less than 7%, blood pressure (BP) less than 130/80mmHg or 140/90mmHg, lowdensity lipoprotein cholesterol (LDL-C) less than 100mg/dL or total cholesterol < 160mg/dL, and all 3 target at the baseline enrollment were analyzed. Until August, 2018, 13 medical centers, 19 regional and local hospitals and 32 general practice clinics participated in the TDR and a total of 5,600 patients with diabetes, including 1,207 in group 1 (mean ± SD, 65.1 ± 12.1 years; M/F 636/571), 1,092 type 1 diabetes in group 2 (32.7 ± 13.9 years; M/F 442/650), and 3,301 newly diagnosed type 2 diabetes in group 3(54.4 ± 13.9 years; M/F 1,869/1,432) were included. The attained percentage of various metabolic goals in group 1, 2, and 3 was 37.6%, 22.8%, and 38.5%, respectively for HbA1c < 7%, 69%, 56.4%, and 41.0% for LDL-C < 100mg/dL or total cholesterol < 160 mg/dL, 37.0%, 66.2%, and 37.0% for BP < 130/80mmHg, 67.4%, 87.0%, and 68.6% for BP < 140/90mmHg, and 11.7%,10.3%, and 7.6% for all 3 ABC controls with BP < 130/80mmHg, or 20.4%, 12.8%, and 13.6% for all three ABC controls with BP < 140/90mmHg.The data of the TDR are continuously expanding, and we anticipate that it will become a valuable source to address relevant information in diabetes management. It is shown in TDR that the proportion of patients achieving ABC targets get improved gradually in comparison with that in previous surveys in Taiwan.
SD2-1
DIABETIC KIDNEY DISEASE: UNMET ISSUES
JIN-SHUEN CHEN, MD. PHD General Secretary of Taiwan Society Nephrology; Chief, Department of General Medicine, Tri-Service General Hospital, Taipei, Taiwan; Professor, Department of Medicine, College of Medicine, National Defense University, Taipei, Taiwan
Diabetic kidney nephropathy (DKD) and diabetic nephropathy (DN) are the leading causes of end-stage renal disease (ESRD), that contribute to heavy medical costs in Taiwan and most developed countries. Researchers around the world, particularly endocrinologists, nephrologists and associated medical personnel, are working to solve the disease; however, many unmet issues remain for this DN will be reviewed and updated according to data from Taiwan and the rest of the world. After a comprehensive review and input from a nephrologist, some of the major unmet issues in DN research will be presented. The first issue is the current problems in early DN-glomerular hyperfiltration; The second issue is current problems of diagnosis of DN, and the difference between pathological and clinical diagnosis for DN will be discussed. The third issue concerns the current pathogenesis of DN; factors from diabetic mellitus contributing to development of DN will be discussed. The fourth issue is current treatment of DN, and precision medicine and care will be reviewed and proposed. All of unmet issues discussed in this lecture will be integrated with the findings from my studies, and potential directions for physicians and researchers will be proposed.
SD2-2
MANAGEMENT OF DKD WITH OR WITHOUT CARDIOVASCULAR DISEASE
DAISUKE YABE, M.D.,PH.D.
Department of Diabetes and Endocrinology, Gifu University Graduate School of Medicine, Gifu, Japan; Division of Diabetes and Endocrinology, Kansai Electric Power Medical Research Institute, Kobe, Japan
Diabetic kidney disease (DKD) is the most common cause of chronic kidney disease and represents a large and ominous public health problem. Patients with DKD is highly associated with cardiovascular morbidity and mortality. Despite advances in care, ever increasing number of patients suffering from diabetic kidney disease and end-stage renal disease implies that the current management is not adequate in many aspects. Currently, treatment for diabetic kidney disease include blockade of the renin-angiotensin-aldosterone system, and glycemic and blood pressure control. Recently, some (T2D). SGLT2 inhibitors were shown to reduce albuminuria, prevent decline in estimated glomerular anti-hyperglycemia agents for DKD will be shared.
SD2-3
SELECTION AND CHOICE OF ANTI-DIABETIC DRUGS IN DKD, ESPECIALLY IN MODERATE TO ADVANCED STAGE CKD.
In patients with diabetes and impaired kidney function (DKD), the risk of CV events are higher than those who have normal kidney function. However, better HbA1c still stands for better outcome in patients with CKD. Oral anti-diabetic medications should be adjusted by declining kidney function as well as insulin. The aim of glucose control in DKD patients should emphasize the importance of avoiding hypoglycemia event. In stage 1 and 2 of CKD, the aim of HbA1c could be < 7% but in stage 3 to 5 of CKD, the aim of HbA1c should not less than 7% to minimize hypoglycemia events.
The oral anti-diabetic agents should be adjusted by the progression of renal function in each patient. In pre-ESRD or anemia patients, the HbA1c could be affected by red blood cells and could not stand for the glucose control condition of patients. Glycated albumin represented the average of glucose level in those patients in the past 2-3 weeks and could replace HbA1c in this condition. Selfmonitor blood glucose (SMBG) were also suitable for these patients.
Metformin should be used carefully and adjusted dose by renal function between 30-45 ml/ min/1.73 m2. Metformin should not be used in patients with eGFR < 30 ml/min/1.73 m2 only be prescribed in patients with eGFR > 60 ml/min/1.73 m2 45 ml/min/1.73 m2 2 . However, the effects of SGLT2i is decreased while the renal function is decreasing and should be used carefully. In recent CVOT studies, SGLT2i and GLP-1 both can reduced the CV events in patients with diabetes especially at higher risk patients.
In recent years, the functions of anti-diabetic agents were getting more and more mechanisms and could deal our patients with diabetes not only the glucose control but also preventing them from major CV events even mortality. They provide us a new tool to treat our patients with diabetes more safely and effectively. It is important that how to use these medications safely and effectively on our patients with diabetes.
SD3-1
GLYCEMIC CONTROL AND VASCULAR COMPLICATIONS: A FOCUS ON RECENT LONG-TERM FOLLOW-UP OF GLUCOSE LOWERING TRIALS AND THE TRIUMVIRATE OF GLUCOSE MANAGEMENT
PETER REAVEN, M.D.
Professor of Clinical Medicine; University of Arizona; Phoenix, Arizona
Cohort studies have demonstrated that both macrovascular and microvascular events increase as the level of blood glucose rises. In contrast, trials using more modern treatment regimens conducted in more advanced type 2 diabetes patients (such as the VA Diabetes Trial, ACCORD, ADVANCE), demonstrated that improved glucose control over a median of 3-6 years provided modest reductions in CVD events and did not reduce CVD or total mortality. However, 10-year follow-up of the VADT
Longer post-trial follow-up of glucose lowering efforts is providing additional insight into key for a “legacy effect” in patients with established type 2 diabetes, 3) is there any long-term harm that results from these interventions. As several of the recent studies of type 2 diabetes had very long follow-up period, they are well positioned to determine whether improved glucose control in the past results in risk reduction for new CVD events after glucose levels have equalized between treatment groups. Importantly, as reductions in death may take many years to become apparent, extended followup may also be necessary to understand the effects of intensive glucose lowering on this outcome.
However, there is also growing appreciation that optimal glucose management for reducing diabetes complications requires not just lowering average glucose levels, but also reducing glucose variation and episodes of hypoglycemia. Increasing evidence indicates that both of these latter metrics of glucose control are also related to development of diabetes complications. Particularly useful measures which capture sequential visit-to-visit “long-term” variation and appear good markers of
The current presentation will review outcomes of longer-term follow-up of glucose lowering studies and highlight the potential importance of managing all three aspects of glucose control including hyperglycemia, glycemic variation and hypoglycemia.
SD3-2
PHYSIOLOGY AND FRIENDSHIP
PHILIP S. TSAO, PH.D.
Professor of Medicine (Cardiovascular Medicine); Stanford University School of Medicine Associate Chief of Staff for Precision Medicine; VA Palo Alto Health Care System Director; VA Palo Alto Epidemiology Research and Information Center (ERIC) for Genomics Co-Principal Investigator; Million Veteran Program
Almost thirty years ago I walked onto the campus of Stanford University as a freshly minted cardiovascular physiologist looking to make an impact upon clinical medicine. I soon met a kindred spirit in Jerry Reaven who, as the archetype physiologist, had already made a career (and helped start many more) of adding insight into how dyslipidemia, hypertension, and type 2 diabetes clustered together to produce a syndrome that increased the risk of cardiovascular disease. Through his unyielding curiosity and elegant communication skills, Jerry not only taught me how to be a better scientist but also to enjoy a life of exploration. I look forward to sharing some memories of our collaboration with you.
SD4-2
OLD SOLDIERS NEVER DIE THEY JUST “FRAIL” AWAY--SARCOPENIA AND FRAILTY IN DIABETIC PATIENTS
CHING-LING LIN M.D.
Endocrinology and Metabolism Department of Internal Medicine Cathay General Hospital.
Aging is rapidly accelerating in Taiwan. As the average life expectancy becomes longer island wide, prolong life expectancy is no longer the only goal for most diabetic patients. Longer life expectancy is meaningful only when activity of daily life (ADL) and the ability of living independently can be maintained. Sarcopenia and frailty are both highly relevant entities with regards to ADL and autonomy of the aging population. Skeletal muscle maintains our posture and produces body movement. It not only is important for maintaining normal activity but also contributes to basal metabolic rate in the body. Insulin receptors in the muscle play a major role in glucose regulation, and muscle is a major site of glucose disposal. Muscle is also a fuel source under certain conditions, such as starvation, and provides amino acids for gluconeogenesis in the liver. Recent studies have shown that skeletal muscle secretes several factors, so-called myokines, which are associated with maintaining healthy conditions. In patients with metabolic syndrome or type 2 diabetes reduced muscle glucose of skeletal muscle mass and strength. Aging related reduction of muscle mass may further jeopardized metabolic dysregulation in type 2 diabetic patients. Frailty is a state of increased vulnerability to stressors, responsible for exposing the older person to enhanced risk of adverse outcomes. Physical frailty and sarcopenia substantially overlap and several adverse outcomes of frailty are likely mediated by sarcopenia. Patient with diabetes mellitus already tend to have an accelerated ageing process that places them at greater risk for developing frailty at an earlier age. The development of frailty and sarcopenia is multifactorial and includes nutritional, physical and hormonal elements; these elements are interlinked with those of diabetes. A lower muscle mass will lead to higher insulin resistance, lower muscle glucose disposal and poorer glycaemic control. Lower muscle glucose disposal leads to higher insulin secretion and insulin resistance, which is the stepping stone for diabetes itself. The biological novel and pivotal insights for the assessment and treatment of these conditions not only in elderly but all diabetic patients.
SD4-3
THE EPIDEMIOLOGY AND PATHOPHYSIOLOGY OF DIABETES IN THE OLD PEOPLE
I-TE LEE
Chief in Division of Endocrine/Metabolism in Taichung Veterans General Hospital; Associate Professor in School of Medicine Faculty of Medicine in National Yang-Ming University; Deputy Secretary General in Diabetes Association of the Republic of China
65 330 14% (aged society)
SD5-1
AI FOR DIABETES MANAGEMENT: THE LAST MILE OF DIGITAL HEALTH
Recent digital technologies, such as cloud, IoMT, bigdata, AI, blockchain, has been applied to personalized medicine, or precision medicine for years. Dr. Wu will present several use cases in this session, including an IoMT Platform, a decentralized patient network for clinical research, and some medical AI projects. Dr. Wu will also discuss opportunities and challenges of digital health in Taiwan.
SD5-2
EARLY DETECTION OF ACUTE COMPLICATIONS IN IDDM PATIENTS USING NOVEL MULTI-BIOMARKER CGM DEVICE
1C-C HUANG, 2LIZ GODWIN, 2Y-L DING
1 Seknova Biotechnology Co., Ltd. Taiwan, R.O.C. 2Department of Marketing and Sales, Seknova Biotechnology Co., Ltd. Taiwan, R.O.C.
BACKGROUND: Diabetes mellitus is a rapidly growing global epidemic, impacting over 400 million people. The number of diabetics is expected to exceed 600 million in the next twenty years. Crucial to diabetes management is patient self-monitoring of blood glucose (SMBG), largely through resulting in poor glycemic control. More importantly, SMBG monitoring does not detect severe acute complications, including diabetic ketoacidosis (DKA), hyperosmolar hyperglycaemic state (HHS), and hypoglycaemia.
METHODS: Research on a multi-biomarker CGM device is being conducted at the National Applied Research Laboratories in Taiwan in conjunction with the device inventor, Seknova Biotechnology. The device is worn on the upper arm and continuously monitors glucose, ketones and to SMBG values collected using a traditional blood glucose meter. Performance was evaluated in terms of proportion of the system values within ± 20% of blood glucose meter reference values for glucose levels > 80 mg/dL and ± 20 mg/dL at meter glucose levels < 80 mg/dL.
RESULTS: Mean absolute relative difference (MARD) was < 10% and %20/20 was 92%.
CONCLUSION: Initial laboratory testing of the Seknova CGM system shows high effectiveness needles to penetrate the subcutaneous tissue, the Seknova CGM technology measures biomarkers in the dermal tissue, minimizing pain and risk of infection and injury. The unique design also allows for the simultaneous monitoring of multiple biomarkers.
SD5-3
DASHBOARD FOR IMPROVING DM CARE: TCVGH EXPERIENCE
1YI-JING SHEEN
1Division of Endocrinology and Metabolism, Department of Internal Medicine, Taichung Veterans General Hospital, Taiwan, R.O.C.
Diabetes mellitus and diabetes-related complications may cause disabilities, vital organ failure, premature death, and a high burden on individuals and society. Patients with diabetes have a greater chance of hospitalization and readmission compared to those without diabetes. Integrated information quality diabetes care. We will share the experience of an electronic dashboard management system for improving diabetes care at Taichung Veterans General Hospital.
SD6-1
INSULIN RESISTANCE: THE GENETIC AND PHYSIOLOGIC INTER- RELATIONSHIP BETWEEN TYPE 2 DIABETES AND CARDIOVASCULAR DISEASE; AND THE INTERFACE BETWEEN TAIWAN AND CALIFORNIA: BOTH THE LEGACY OF PROFESSOR YII-DER IDA CHEN.
JEROME I. ROTTER, M.D.
Professor of Pediatrics, UCLA School of Medicine Professor of Human Genetics, UCLA School of Medicine; Director, Institute for Translational Genomics and Population Sciences, LABioMed/Harbor-UCLA; Director, Division of Genomic Outcomes, Departments of Pediatrics and Medicine, Harbor-UCLA
One of the seminal observations in diabetes/endocrine/cardiac pathophysiology over the last 4 decades was the characterization of insulin resistance (IR) as the key physiologic (and pathophysiologic) abnormality for type 2 diabetes (T2D); but not only for T2D, but for cardiovascular disease (CVD) risk factors such as dyslipidemia (especially hypertriglyceridemia and low HDL) and obesity, for cardiac physiologic abnormalities such as hypertension, and for the end product of coronary artery disease itself. This also has been referred to as the metabolic syndrome. And major contributors (perhaps the major contributors) to this concept was the scientific duo of Dr. Gerald Reaven and Dr. Ida Chen. Starting in the 1980’s, they developed the evidence for IR as a key (possibly the key) CVD risk factor. Many of these seminal observations were done in collaboration with Taiwanese collaborators. At the end of the 1990’s and beginning of the current century, Dr. Chen expanded this work into examining genetic determinants of IR and its CVD associations through TAICHI (Taiwan Metabolic Study for Cardiovascular Disease), THRV (Taiwan Study for Hypertension Rare Variants), and THRV TOPMed (Trans-Omics for Precision Medicine). This collaboration of Taiwan-California (i.e. Dr. Chen) remains extremely active, and has contributed, since 2013 alone, to some 44 papers, with multiple papers delineating the genetic basis of insulin resistance, diabetic retinopathy, blood pressure variation, lipid variation, adiposity, coronary artery disease, and type 2 diabetes. This work has helped delineate the genetic architecture of diabetes and insulin resistance disorders, and should lead to improved biologic understanding and advances in therapy of the most common metabolic disorder, i.e. insulin resistance.
SD6-2
TRNASLATIONAL RESEARCH OF ADIPONECTIN- A TALE OF COLLABORATION
L-M CHUANG
Division of Endocrinology and Metabolism, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
Adiponectin, an adipocytokine, plays important biological roles involving insulin sensitizing, anti-inflammation, anti-atherosclerosis, and anti-cancer effects. However, its regulation is not fully understood. differentiation with a mRNA differential display. The expression of adiponectin in human was studied in twin and family studies, revealing that both genetic and environmental influences on circulating adiponectin levels. To understand the regulation of expression, we employed classical genetic approaches including candidate gene approach, genome-wide linkage study, regional and genome-wide association studies.
Through a genome linkage study in the Stanford Asia-Pacific Program for Hypertension and 15 at 31cM with 1-LOD SI: 24 to 34cM. After regional SNP studies, we found that haplotypes composed of single-nucleotide polymorphisms in the ryanodine receptor 3 (RYR3) gene had a strongest association with plasma adiponectin levels. To validate the biological function of RYR3 on adiponectin expression, we demonstrated in human and a type 2 diabetes model db/db mice studies showing silencing expression of RYR3 in adipocytes/adipose tissue would increase circulating body insulin sensitivity.
Our study provide understanding of novel mechanisms that regulate expression of adiponectin, leading to improving insulin sensitivity. Further translational potential remains to be evaluated. These work was indebted to extensive collaboration both domestically and internationally.
SD6-3
MY JOURNEY OF RESEARCH FROM INSULIN SENSITIVITY TO GENETIC STUDY: LEARN FROM IDA CHEN
When I was a young clinical fellow in the division of Endocrinology of Tri-Service General Hospital, Prof. Chen and Reaven were our visiting professors and they almost would visit our hospital obese subjects under the instruction of Prof. Chen and Dr. Jerng.
In Oct, 2001, I had a chance of one-year clinical fellow training in the division of endocrinology under the instruction of the professor Chen, Rotter and Braunstein in Cedars-Sinai Medical Center in LA. We conducted microarray studies on thyroid samples of benign adenoma, examined by Affymetrix chips. We also immersed extensively in the bioinformatics and analysis of these expression data including at least 10,000 named genes. We had discovered many interesting probes differentially expressed between the two condition, some up-regulated and some down. our instructors and collaborated with Prof. Chen, including SAPPHire study. Finally, I really appreciate Prof. Chen in my research career and glad to be together with her.
SD6-4
I must express my deep respect and appreciation to Prof. Ida Chen. Before my exchange-visitor program, Prof. Ida Chen had visited Taichung VGH, and she established several study programs for cooperation. Being a member of the study team group, I had a chance to learn genetic study in CedarsSinai medical center under Prof. Ida Chen’s supervision between Oct. 2009 and Oct. 2010. to be familiar with the persons, the backgrounds and the activities of our laboratory. I have practiced the study meeting, I gained knowledge about the organization and discussion on the study issues.
In addition to explaining the detail of each ongoing project, Prof. Ida Chen also encouraged me join the study team lead by Prof. Rotter. Under Prof. Ida Chen’s introduction, I could approach the UCLA intercampus training program, from which I learned various methods for genetic studies, including quantitative trait analysis and family-base association tests. In Medical Genetics Seminar Series, I experienced many examples of practice in genetic studies.
Before my training course finished, we had completed the DNA preparation for running Chip based on the clinical manifestation of diabetic retinopathy. We also completed the genetic data and clinical phenotypes of coronary artery disease. I finished my first article of genetic research. I also medical genetics training program.
Finally, I thank Prof. Ida Chen for her help in whole my training period. She helped me resolve all of my problems in American life. It is a precious experience for me. Prof. Ida Chen still encourages me to keep forward to genetic studies. Now, she has several ongoing projects for cooperation with us, and several articles have been being published. I deeply appreciate Prof. Ida Chen’s help in my carrier.
SD7-1
UPDATE OF INTERNATIONAL GUIDELINES FOR DIABETES MANAGEMENT
1H-Y LI
1Division of Endocrinology and Metabolism, Department of Internal Medicine, National Taiwan University Hospital
After the release of the DAROC guideline for diabetes care 2018, there are several international guidelines published. In late 2018, the ADA and the EASD have published a consensus for diabetes management. Later, the ADA standards of medical care in diabetes adapted the content of the consensus. Patient centered collaborative care is emphasized, and the goal of care is to prevent complications as well as to optimize quality of life. Several key steps in the decision cycle are medication, the consensus suggests that the presence of established atherosclerotic cardiovascular and GLP-1 receptor agonists are recommended in the presence of ASCVD or CKD. Besides, the consensus also suggest choices of second-line medications based on different goals, such as to minimize weight gain, to avoid hypoglycemia and to consider the cost. For injection therapy, the consensus also provided an algorithm for the choice among them. In 2019, the AACE updates their clinical practice guideline about type 2 diabetes management. ASCVD is also an important consideration in the guideline. In this talk, I will introduce the content of the ADA/EASD consensus and the AACE guideline first. Then, I will also discuss the pros and cons of the two international guidelines.
SD7-2
CHIH-HSUN CHU
Chief, Division of Endocrinology and Metabolism, Department of Medicine, Kaohsiung Veterans General Hospital
T2DM is a complex chronic disease. It requires continuous medical care with multifactorial risk reduction strategies. The goals of treatment for diabetes are to prevent or delay complications and maintain quality of life. The cornerstone of treatment of T2DM is the adoption of a healthy diet, increased physical activity and maintenance of a normal body weight. A number of oral and injectable medications are available to help control blood glucose levels. Metformin is well-established and one of the most effective antidiabetic drugs. Sulfonylureas, which increases insulin secretion in T2DM, is also an essential medicine for diabetes. In recent decades, there has been an increasing complexity of medical treatments for diabetes, mostly due to the availability of new drugs and therapeutic classes. drugs have come into the market: these comprise alpha-glucosidase inhibitors, thiazolidinediones, the non-sulfonylurea insulin secretagogues glinides, dipeptidyl peptidease-4 inhibitors, and sodiumglucose cotransporter 2 inhibitors. Meanwhile, rapid-acting insulin analogues and long-acting insulin analogues have also become widely used due to their improved pharmacokinetic and pharmacodynamic properties. Except for insulin, GLP-1 receptors agonists, an injectable agent also came into Taiwan. These antidiabetic drugs act on different pharmacological mechanisms and have completely different safety pro les, although clinical trials suggest that they have comparable ef cacy in terms of their overall glucose lowering effect. The ADA “Standards of Medical Care in Diabetes” recommends a patient-centered approach should be used to guide the choice of pharmacologic agents. Considerations include comorbidities (atherosclerotic cardiovascular disease, heart failure, chronic kidney disease), hypoglycemia risk, impact on weight, cost, risk for side effects, and patient preferences. The updated “DAROC Clinical Practice Guidelines for Diabetes Care” in 2019 provides considerations of several factors for the choice of antidiabetic drugs.
