The prevalence of diabetes in my country is increasing year by year and is trending younger. Rapid changes in lifestyle and rapid growth in the prevalence of overweight/obesity are one of the main reasons for the surge in type 2 diabetes. Type 2 diabetes mellitus (T2DM) was previously considered a chronic progressive metabolic disease requiring long-term lifestyle and pharmacological intervention. However, with in-depth research on the pathogenesis of diabetes, new therapeutic targets and treatment methods continue to emerge, bringing more options for diabetes treatment.

The treatment path for treating diabetes and relieving it has the following clinical options:

1. Lifestyle intervention

Lifestyle intervention is what patients with diabetes need to maintain throughout their lives. The results show that among obese type 2 diabetes patients within 6 years of the disease, after intensive lifestyle intervention, the diabetes remission rate is 46%, and the more weight loss, the higher the diabetes remission rate. When the weight loss is ≥ 15 kg,? The remission rate for type 2 diabetes can reach 86%. Therefore, overweight/obese patients with type 2 diabetes should lose ≥5% of their weight through lifestyle intervention. The more weight lost, the better metabolic disease control can be achieved and the chance of diabetes remission increases.

2. Drug treatment

For patients who cannot achieve at least 5% weight loss after 3 months of weight loss intervention, intervention measures need to be adjusted. If lifestyle intervention fails, drug and drug treatment should be considered. Surgical treatment. The recommended weight loss drug is mainly orlistat (other drugs are not approved for marketing in my country). The U.S. Food and Drug Administration (FDA) approved the glucagon-like peptide-1 receptor agonist (GLP-1RA) drugs liraglutide and semaglutide for weight loss indications, although both are currently my country has not approved indications for weight loss, but it has been approved for hypoglycemic indications and is widely used.

For newly diagnosed diabetic patients with severe hyperglycemia, short-term (2 weeks) intensive insulin therapy can be used to achieve remission. Multiple studies have shown that short-term intensive insulin therapy can improve pancreatic beta cell function and insulin resistance in newly diagnosed patients with type 2 diabetes, with 66.2% of patients having diabetes remitted. ? Therefore, for overweight/obese patients with type 2 diabetes who have severe hyperglycemia at the early stage of diagnosis and are accompanied by obvious symptoms of hyperglycemia or ketoacidosis, short-term insulin treatment is recommended.

3. Bariatric surgery

For patients with type 2 diabetes (Asian ≥32.5) with BMI ≥ 35 (BMI = weight ÷ height?), metabolic surgery can be considered to alleviate type 2 diabetes. Metabolic surgery methods include a variety of methods, the most commonly used currently include sleeve gastrectomy (LSG) and laparoscopic Rouxen-Y gastric bypass (LRYGB). Compared with lifestyle intervention and combined drug treatment for obese patients with type 2 diabetes and unsatisfactory weight loss, surgical intervention combined with drug treatment can achieve glycated hemoglobin ≤6% within 3 years. Among them, the response rate of glycated hemoglobin in patients undergoing gastric bypass surgery can reach 38%, and the response rate of patients undergoing gastrectomy can reach 24%, while the response rate of drug therapy alone is only 5%.

IV. Endoscopic Interventional Therapy

If the patient’s BMI is ≥37, then due to the high risk of surgical complications in obese patients, a 10% weight loss target needs to be achieved before surgery can be performed Treatment, this also means that not everyone can do bariatric surgery. It needs to reach a certain BMI value, etc., and it needs to meet its strict surgical indications to improve the safety of the surgery.

Except for some patients who do not meet the surgical indications and are inoperable, there are also many patients who are daunted by the changes in organ structure required for bariatric surgery. At present, there is an innovative endoscopic interventional treatment technology in China - the "gastric bypass stent system". Unlike surgery, which can cause damage to the human body, the "gastric bypass stent system" can be inserted into the membrane tube through a painless gastroscope. , isolate food from the intestinal wall, and food passes through the membrane tube, thereby reducing intestinal wall absorption. According to current clinical results, after 3 months of removal, the patient's weight, glycosylated hemoglobin, liver stiffness and other metabolic disease indicators were significantly reduced.

In short, the diabetes remission state is not permanent. Patients in the diabetes remission state still need to be followed up every year to determine the persistence of the diabetes remission state. To date, there is no evidence of a cure for T2DM.

After remission of T2DM, even if measures to induce remission are maintained, some patients' blood glucose levels may rise again to a level that requires the use of antidiabetic drugs. Therefore, patients with type 2 diabetes in remission still need to be followed up regularly, preferably every 3 months and no more than 1 year at most, with glycated hemoglobin detected.

References:

Liu Ye, Wang Haining. 2021 ADA/EASD "Expert Knowledge on Diabetes Mitigation" and "2022 ADA Diabetes Guidelines: Prevention and Treatment of Type 2 Diabetes" Interpretation of Obesity and Weight Management in Treatment - Definition and Treatment Strategies of Diabetes Remission [J]. Journal of Clinical Internal Medicine, 2022, 39(5): 299-302. DOI: 10.3969/j.issn.1001-9057.2022.05.003.