[CDS2015]John Buse:互联网技术用于糖尿病管理已经到了激动人心的时刻
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专家访谈 临床科研  作者:J.Buse 来源:国际糖尿病 2015/12/11 15:13:00    加入收藏

内容概要:编者按:中华医学会糖尿病学分会(CDS)一贯注重与国际组织间的交流合作,CDS第十九次全国学术会议多次邀请著名糖尿病学家,ADA前任主席、美国北卡罗来纳大学医学院John Buse教授作为特邀嘉宾发表大会报告。2015年12月9日上午,John Buse教授发表了“糖尿病领域中心血管临床终点研究的利与弊(A review of CV outcome studies in diabetes)”的演讲。会后,John Buse教授就心血管结局试验的经验、精准医学与糖尿病防治、互联网技术与糖尿病管理等当前热点话题接受了我刊采访。

 
  <International Diabetes>:As we know, it was not the first time you come to China, what’s your impression of CDS meeting? And what’s your harvest from connecting with Chinese diabetes field?
 
 
  Dr Buse: I love coming to China and visiting with my colleagues at the Chinese Diabetes Society. Unfortunately, I don’t understand Chinese so most of the presentations just go past me, but in talking to my friends here in the hallways and at meetings, it seems that this meeting has a lot of emphasis on type 1 diabetes and that there is a growing population of type 1 diabetics in China, which is very interesting to me.
 
  CDS2015年会有感
 
  我非常喜欢来参加中国糖尿病学会的年会与中国同道进行交流。只可惜,我不懂中文。因此,大多数演讲的内容都听不太懂。但是,通过与本次大会上参会的一些朋友进行交谈,我发现本次大会似乎非常关注1型糖尿病,中国1型糖尿病患者数量在不断增加。我对此非常感兴趣。
 
 
  <International Diabetes>:Since FDA requires cardiovascular safety for new drugs in 2008, there are many cardiovascular study, such as SAVOR、EXAMINE、 TECOS、 ELIAX and EMPA, what can we learn from these studies?
 
  Dr Buse:I would characterize the cardiovascular outcomes trials that have been done up till now as falling into two categories. The first are the trials before the EMPA-REG trial, and the other category is the EMPA-REG trial. All the other trials failed to show any benefit for cardiovascular endpoints but were very useful in providing much better estimates of the other risks associated with these drugs. For instance, in the ORIGIN trial, we learned a lot about hypoglycemia and safety issues concerned with cancer, for example. In the DPP-4 inhibitor trials, we learned about the very low rates of pancreatitis and pancreatic cancer. On the other hand, with the EMPA-REG study, we learned the very exciting result of a reduction in cardiovascular endpoints, perhaps even an improvement in survival. That was very exciting and a new experience with a diabetes drug. We also learned a lot about the side effects of empagliflozin. These were concerns that had been raised with other drugs about bone health and diabetic ketoacidosis (DKA) and urinary tract infections and there seemed to be no imbalance in the EMPA-REG study. So the cardiovascular outcomes trials tell us a lot about safety beyond cardiovascular risk.
 
  心血管结局试验加深了我们对降糖药物整体安全性的认识
 
  目前心血管结局临床试验可分为两大类,一类是在EMPA-REG研究之前的临床试验,另一类是EMPA-REG研究之后的临床试验。除了EMPA-REG研究外,其他临床试验均未发现降糖药物具有心血管终点方面的获益。只是让我们更好地评估和了解了这些药物的其他风险。例如,ORIGIN研究使我们对胰岛素的低血糖及引发癌症的安全性问题有了更多认识。在有关DPP-4抑制剂的临床试验中,我们发现这类药物的胰腺炎及胰腺癌发生率非常低。与上述研究不同,EMPA-REG研究带来了非常令人兴奋的结果即降糖药物可降低心血管终点事件,甚至还能改善生存率。这无疑是非常令人兴奋的,是糖尿病药物的一种新体验,也让我们对降糖新药empagliflozin的不良反应有了更多认识。既往人们曾担心其他降糖药物会影响骨骼健康、导致糖尿病酮症酸中毒及泌尿道感染,但从EMPA-REG研究结果来看我们似乎没有必要担忧empagliflozin会存在上述问题。因此,心血管结局试验除了心血管风险外还加深了我们对降糖药物安全性的认识。
 
  <International Diabetes>:As we know, the prevention of diabetes is very important. Precision medicine emphasize to give specific lifestyle intervene to specific population. Can you show some successful practical experience or some studies on going about the individual intervention?
 
 
  Dr Buse: I think it is very early days with regard to precision medicine. We don’t have good studies to provide data around particular approaches in particular patients. The best we can do now on a practical basis in clinical practice, for instance: if it is a patient who does not respond well to oral agents, then we should think about LADA (latent autoimmune diabetes of adulthood) as a possibility; if it is a patient who presents with a strong family history earlier in life then we should be thinking about maturity-onset diabetes of the young (MODY); if it is a patient with adult onset diabetes who is not very heavy, to think more about insulin deficient phenotypes. There is great promise in precision medicine, but the practical applications today in clinical practice have been remitted.
 
  精准医学与糖尿病防治
 
  我认为目前精准医学尚处于早期发展阶段。我们尚未开展非常好的研究来提供针对特定患者采取特定方法的数据。现在,临床实践中我们所能做的就是当患者对口服药物反应不佳时,考虑其可能罹患的是成人隐匿性自身免疫糖尿病(LADA);若患者具有较强的早发糖尿病家族史,我们应考虑其可能存在年轻的成年发病型糖尿病(MODY);若患者为体重不是很重的成年发病糖尿病,则需要进一步考虑其是否依赖于胰岛素。虽然,现在精准医学给我们带来了巨大的希望,但其在临床实践中的应用尚非常有限。
 
 
  <International Diabetes>:With the development of internet, mobile medical, big data permeates to diabetes management more and more. What is your opinion and prospect on this aspect?
 
 
  Dr Buse: It is a very exciting time with regards to how to use these new communication technologies in diabetes. Supporting patients regarding lifestyle (diet and exercise) and how to respond to glucose values and self-monitoring (if the glucose values are higher than desired for several days, then a message can be sent the patient via the Cloud querying their diet, concurrent illnesses and so on) are things that are being tested in the United States now and I think it is very promising technology, but again, not quite ready for mass application yet. I think it is also very promising technology for China considering there are over 100 million patients with diabetes. Mass communication can hopefully help manage those numbers of patients.
 
 
  互联网技术与糖尿病管理
 
  现在已经到了非常激动人心的时刻,我们需要探讨如何在糖尿病领域中应用这些新的通信技术。现在美国已经采用上述技术帮助患者进行饮食及运动等生活方式干预,指导患者如何对血糖值及自我监测结果作出反应。例如,其可在患者血糖值连续数天高于预期时,通过云端查询饮食及并存疾病等情况并将信息发送给患者。我认为,这是非常有前途的技术,但同样这种技术目前还不能进行大规模临床应用。鉴于中国糖尿病患者数量已超过1亿人,我认为该技术对中国而言也是一项非常具有前景的技术。大众传播可能有助于我们对患者的上述数据进行管理。
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