Journal of Diabetes最新文献

Highlights

Diabetes mellitus, predominantly type 2, is a growing epidemic with nearly 90% of the cases reported worldwide.¹ In China, community health management is pivotal for the vast number of chronic diabetes patients, directly influencing their health outcomes. Despite the importance of blood glucose control in preventing diabetes complications, many community health service centers have yet to implement effective management programs.

This study conducted a follow-up investigation on 359 patients with type 2 diabetes managed by the Songyuan Community Health Center in Shenzhen. Data on medication, blood glucose monitoring, glycated hemoglobin, body mass index, diet, and exercise habits were collected over 6 months. Standardized management was defined by the establishment of health records and quarterly interviews, with follow-up visits and an annual physical examination.

The study found that 62.70% of patients met the standard for blood glucose control. Univariate Chi-square analysis identified standardized management, disease duration, and record-keeping duration as significantly associated with blood glucose compliance rates. Multivariate logistic regression analysis, after adjusting for disease duration, record-keeping duration, sulfonylurea therapy, and moderate exercise, revealed standardized management, medication selection, dietary patterns, and metformin dosage as significantly correlated with blood glucose control as shown in Figure 1.

The findings emphasize the importance of standardized management, sensible diet, and reasonable medication in improving blood glucose control among community diabetic patients. The study also highlights the need for individualized treatment strategies, particularly with metformin dosage, to achieve better glycemic management. Community health education and personalized strategies can effectively improve blood glucose control among diabetic patients. The role of standardized file management in patient management is introduced, emphasizing the need for community management systems to improve patients' blood glucose compliance rates.

This study presents novel insights into the low blood glucose compliance rate among community diabetic patients in Shenzhen, identifying standardized management, sensible diet, and reasonable medication as the primary factors influencing blood glucose control. It underscores the critical role of community health management centers in chronic disease management and the need for interventions targeting the improvement of diabetes management practices.

The authors have no financial or proprietary interests in any material discussed in this article.

The theme of growing numbers of persons with diabetes in relation to the aging of the population and to worsening obesity are factors brought up by Ellliott Joslin more than six decades ago in an article entitled “Diabetes in the Future”¹—but it remains daunting to face the reality of a progressive threefold increase from approximately 150 million in 2000 to more than 500 million cases today, with projections of a total of 700–800 million persons with diabetes by 2045.² The greatest increases will be in South-East Asia, from 90 to over 150 million, and in the Middle East and North Africa, from approximately 70 to 140 million, albeit with the Western Pacific countries increasing from 200 million to 260 million persons to remain the largest region of persons with diabetes.³

Diabetes prevalence increases with increasing age and increasing degrees of obesity, with both of these factors projected to play important roles in the growth of diabetes over the coming decades. The prevalence of diabetes increases from <5% before the age of 35 to 5%–10% from age 35–50 and to nearly 15% in middle-income countries, remaining around 10% from age 50–80 in low-income countries but increasing to >20% in middle-income countries and to >25% in high-income countries at ages 65 and over.² This becomes particularly important when we consider world population trends. The United Nations' projection of World Population Prospects showed that in 1950, there were fewer than 200 million persons aged 65 and over; this number began to increase gradually and by 2000, reached approximately 500 million, with projections that in the year 2100, there will be approximately 2.5 billion persons in this age group, equaling the number of persons aged less than 20 and 45–64, with the number of persons aged 20–44 being relatively static at an additional 3.5 billion.⁴ The same dataset shows that in China, the largest part of the Western Pacific region, the number of persons aged 20–44 is likely to have peaked around 2010, with projections of a decline in this age group from nearly 600 billion to approximately 300 billion in the year 2100, equaling the number of persons aged 65 and over and exceeding that in the 45–65-year-old and <20-year-old age groups.⁴ Taken together, the higher prevalence of diabetes with increasing age along with the increasing numbers of persons at greater ages implies that older persons contribute disproportionately to the population with diabetes, comprising a proportion increasing from 30% to 40% of persons with diabetes in the United States from 1980 to 2010.⁵

In addition to the aging of the population, the growth in numbers of persons with increasing degrees of obesity is an evident and worrisome characteristic; virtually every high-income country is seeing increases in pr

Type 2 diabetes mellitus (T2DM) is a complicated disease related to metabolism that results from resistance to insulin and sustained hyperglycemia. Traditional antidiabetic drugs cannot meet the demand of different diabetes patients for reaching the glycemic targets; thus, the identification of new antidiabetic drugs is urgently needed for the treatment of T2DM to enhance glycemic control and the prognosis of patients suffering from T2DM. Recently, glucokinase (GK) has attracted much attention and is considered to be an effective antidiabetic agent. Glucokinase activators (GKA) represented by dorzagliatin could activate GK and mimic its function that triggers a counter-regulatory response to blood glucose changes. Dorzagliatin has shown great potential for glycemic control in diabetic patients in a randomized, double-blind, placebo-controlled Phase 3 trial (SEED study) and had a favorable safety profile and was well tolerated (DAWN study). In the SEED study, dorzagliatin significantly reduced glycosylated hemoglobin (HbA1c) by 1.07% and postprandial blood glucose by 2.83 mol/L, showing the great potential of this drug to control blood glucose in diabetic patients, with good safety and good tolerance. An extension of the SEED study, the DREAM study, confirmed that dorzagliatin monotherapy significantly improved 24-h glucose variability and increased time in range (TIR) to 83.7% over 46 weeks. Finally, the clinical study of dorzagliatin combined with metformin (DAWN study) confirmed that dorzagliatin could significantly reduce HbA1c by 1.02% and postprandial blood glucose by 5.45 mol/L. The current review summarizes the development of GK and GKA, as well as the prospects, trends, applications, and shortcomings of these treatments, especially future directions of clinical studies of dorzagliatin.