There are several clinical schemes to treat and relieve diabetes:
First, lifestyle intervention.
Lifestyle intervention is a lifelong task for diabetic patients. The results showed that obesity occurred within 6 years. After intensive lifestyle intervention, the remission rate of type 2 diabetes is 46%, and the more weight loss, the higher the remission rate of diabetes. When the weight loss is ≥ 15 kg, the remission rate of type 2 diabetes can reach 86%. So overweight/obese? Patients with type 2 diabetes should lose weight by lifestyle intervention ≥ 5%. The more you lose weight, the better you control metabolic diseases, and the greater the chance of diabetes relief.
Second, medication.
Patients who can't get at least 5% weight loss after 3 months of weight loss intervention need to adjust the intervention measures. If lifestyle intervention fails, drugs and surgery should be considered. The recommended diet drug is mainly orlistat (other drugs have not been approved for marketing in China). The US Food and Drug Administration (FDA) has approved the indications for reducing weight of liraglutide and Smegupeptide, which are glucagon-like peptide-1 receptor agonist (GLP- 1RA). Although it has not been approved for weight loss in China at present, 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. Many studies show that short-term intensive insulin therapy can improve the new diagnosis? Islet β cell function and insulin resistance in patients with type 2 diabetes mellitus. 2% was relieved. ? Therefore, for overweight/obesity? If patients with type 2 diabetes have severe hyperglycemia at the initial stage of diagnosis, accompanied by obvious symptoms of hyperglycemia or ketoacidosis, short-term insulin therapy is recommended.
Third, weight loss surgery
For body mass index ≥35 (body mass index = weight ÷ height? ) patients with type 2 diabetes (Asian ≥32. 5) Metabolic surgery can be considered to relieve type 2 diabetes. There are many methods of metabolic surgery, among which sleeve gastrectomy (LSG) and endoscopic Rouxen-Y gastric bypass (LRYGB) are the most commonly used. Compared with lifestyle intervention, combined medication can achieve glycosylated hemoglobin ≤ 6% in 3 years for patients with type 2 diabetes mellitus complicated with obesity who are not ideal in weight loss. Among them, the remission rate of glycosylated hemoglobin can reach 38% in patients undergoing gastric bypass, 24% in patients undergoing gastrectomy, and only 5% in patients undergoing drug treatment? .
Fourthly, endoscopic interventional therapy.
If the patient's body mass index is greater than or equal to 37, then obese patients need to achieve the weight loss goal of 10% before surgery because of the high risk of surgical complications, which also means that not everyone can do weight loss surgery and need to reach a certain body mass index value. It is necessary to meet its strict surgical indications and improve the safety of surgery.
Except for some patients who can't operate because they don't meet the surgical indications, many patients are not encouraged to change the organ structure during weight loss surgery. At present, there is an innovative endoscopic interventional therapy technology-"gastric bypass stent system" in China, which is different from surgery and will cause damage to human body. It can put the gastric bypass stent system into the membrane tube through painless gastroscope to isolate food from the intestinal wall, and the food passes through the membrane tube, thus reducing the absorption of the intestinal wall. Judging from the current clinical results, three months after removal, the indexes of metabolic diseases such as body weight, glycosylated hemoglobin and liver hardness have obviously decreased.
In short, the remission state of diabetes is not permanent, and patients in remission state of diabetes still need annual follow-up to determine the survival of remission state of diabetes. So far, there is no evidence that T2DM has been cured. After remission of T2DM, the blood sugar level of some patients can still rise to the level that needs to be controlled by hypoglycemic agents again, even if the measures of inducing remission are still maintained. Therefore, patients with type 2 diabetes in remission still need regular follow-up, and it is best to detect glycosylated hemoglobin 1 time every 3 months, the longest time 1 year.
References:
Liu Ye, Wang Haining. Interpretation of ADA/EASD "Knowledge of Diabetes Relief Experts" and "ADA Diabetes Guide 2022: Obesity and Weight Management in the Prevention and Treatment of Type 2 Diabetes" 202 1 —— Definition and Treatment Strategy of Diabetes Relief [J]. Journal of Clinical Internal Medicine, 2022,39 (5): 299-.