July 27, 2022 12:45
Currently, there are about 700,000 people with diabetes (diabetics) in Hong Kong, that is, 1 in every 10 Hong Kong people.2% of Hong Kong people under the age of 35 have diabetes; among those over the age of 65, more than 20% are diabetic1.The International Diabetes Federation estimates that by 2030, the number of people with diabetes in Hong Kong will surge to 920,0002。
The scariest thing about diabetes is that most people with type 2 diabetes eventually die from serious complications, such as cardiovascular disease and kidney disease. In order to understand the current situation of risk assessment and management of complications in people with type 2 diabetes in Hong Kong, the Hong Kong Medical Care Alliance has recruited 196 people with type 2 diabetes who are receiving treatment in the HA or private institutions since the middle of last year. Complications Clinical Data Survey”, and commissioned the “Hong Kong Diabetes Specialist Center” to assist in the assessment and examination of complications for the participants, and be responsible for data collation and analysis.
Annual complication assessments are recommended
The Hong Kong Medical Care Alliance held a press conference today to announce the findings. At the press conference, Dr. Chow Chun-chung, a specialist in endocrinology and diabetes at the Hong Kong Diabetes Specialist Center, focused on the main complication of diabetes, “diabetic heart”, explaining that heart failure is the invisible killer of diabetes, and how to prevent complications. He said that the common complications of diabetes can be roughly divided into small vessel disease (diabetic kidney, diabetic eye, diabetic foot) and macrovascular disease (diabetic heart, ischemic stroke). In order to prevent complications, doctors will recommend that patients undergo a comprehensive complication assessment examination every year, including blood, urine, foot and eye examinations. Once problems are found, early treatment can be performed to reduce damage and fatal risks, and cure the disease. . However, this test can only effectively determine the risk of small-vessel complications, but it is helpless for large-vessel disease. “People with diabetes are two to four times more likely to suffer from various cardiovascular diseases than the general population, and heart failure is the most common. A study found that 30% of people with type 2 diabetes will eventually develop heart failure.” Dr. Zhou Zhenzhong pointed out that heart failure It is a chronic disease, the initial symptoms are not obvious, but it is a deadly invisible killer.
Dr. Zhou Zhenzhong
According to the American Heart Association’s heart failure classification guidelines, heart failure can be divided into 4 grades. The first grade is high-risk people such as diabetics; the second grade is the early stage of the disease, with no obvious symptoms; the third grade begins to show symptoms, the structure of the heart Abnormal functioning; Grade 4 severe condition requiring frequent hospital admissions 3. Dr. Zhou Zhenzhong said that people with diabetes have a 33% higher chance of being admitted to the hospital due to heart failure than the general population; if people with diabetes suffer from heart failure at the same time, the mortality rate will be 4 to 8 times higher than that of the average diabetic.
NT–proBNPTesting helps preventheart failure
Dr. Zhou Zhenzhong continued that since there are no symptoms in the early stage of heart failure, regular cardiovascular disease risk examinations are the best prevention method. The examinations include medical imaging examinations such as computed tomography coronary angiography (CTCA) and cardiac magnetic resonance imaging (Cardiac MRI). and echocardiogram, and blood tests such as NT-proBNP, BNP, hs-cTn, etc., among which NT-proBNP has been regarded as the gold indicator for diagnosis and monitoring of heart failure in the past 5 years. NT-proBNP is a hormone made and secreted by cells in the ventricle, which is released into the blood when the ventricle undergoes structural changes such as dilation, hypertrophy, or compression.Normal NT-proBNP values range from 50pg/mL to 125pg/mL, and those exceeding the standard are at risk of heart failure, and the chance of hospitalization or death due to cardiovascular disease in the next 12 months is higher than that of low-risk patients (values below 125pg/mL) nearly 3 times 4. Some studies have pointed out that people with no history of heart disease but with excessive NT-proBNP values should consider prescribing heart-protecting drugs hypoglycemic agents to reduce hospital admissions or death rates.
Among the existing hypoglycemic drugs in Hong Kong, oral SGLT2 inhibitors and subcutaneous injection of GLP-1 receptor agonists have empirical support, which can effectively reduce the risk of diabetic heart disease in patients with type 2 diabetes. Once heart failure is diagnosed in diabetic patients, 4 drugs that have been shown to be effective in the treatment of systolic heart failure can also be prescribed to improve symptoms and cardiac function, including ACE inhibitors/ARNIs, Beta Blockers, aldosterone receptors MRA, and SGLT2 inhibitors, which also help reduce the risk of hospitalization and death in patients with diastolic heart failure.
appear healthy or have heart problems
After a clear explanation by Dr. Zhou Zhenzhong, the results of the “Clinical Data Survey on Complications of Diabetics” were announced by Ms. Wong Min-er, a registered social worker of the Hong Kong Medical Care Alliance. The average age of the people with diabetes (hereinafter referred to as the participants) who participated in the survey was about 61 years old, 112 were male; 84 were female, 26 and 23 were smoking and drinking habit. In terms of physical condition, the average weight is about 67 kg, the average BMI is 25.1, and the systolic and diastolic blood pressures are 127.1 and 73.7 respectively. All participants had normal and acceptable HbA1c values (<7%); most had normal blood lipids; most (93%) had normal renal function, but some participants ( 33%) had different degrees of albuminuria; most had normal levels of NT-proBNP (65.9 pg/mL), but nearly 10% had abnormal NT-proBNP levels.
It can be seen that the participants in this survey are younger diabetic patients, the proportion of smokers or drinkers is low, and most of them are in good physical condition, with normal levels of blood pressure, blood sugar and other indicators. Participants underwent a series of tests, including a comprehensive blood test, NT-proBNP cardiovascular disease risk detection, as well as urine, foot, vision and fundus examinations, as well as electrocardiogram, blood pressure and obesity index. The survey found that even with better diabetes management, about 10% of participants had abnormal NT-proBNP tests, requiring improved treatment options or further cardiac testing.
NT-proBNP compensates for the lack of complication detection
In terms of medical records, most of the participants had no record of cardiovascular disease or kidney disease except hypertension; after examination, it was found that only a few people had diabetic retinopathy or kidney disease. On the participants’ traditional cardiovascular risk factors, the average number of risk factors among all participants was found to be 2.3, and the proportion defined as higher risk (ie, with 3 or more risk factors) was 40%. However, the study found that about 10% of the participants had NT-proBNP higher than 125pg/ml. The data is consistent with international research experience, reflecting some apparently healthy diabetics, or with varying degrees of heart health problems.
In-depth comparison of 19 participants with abnormal NT-proBNP found that their mean NT-proBNP level was 371.8 pg/mL, of which 11 were slightly above the standard (<300 pg/mL), but 8 had NT -proBNP greatly exceeds the standard, and some even reach as high as nearly 2000pg/ml. Compared with the other participants, the 19 had a younger mean age (72.4 years), longer diabetes history (more than 15 years), lower weight/BMI, and more traditional cardiac risk factors. They have significantly more medical records of cardiovascular disease (32%), and the overall proportion of abnormal renal function and albuminuria is also significantly higher, which is consistent with international research data, reflecting that cardiovascular disease and renal function abnormalities are related to NT-proBNP abnormality. closely related. However, according to clinical data, the blood sugar, blood pressure and blood lipids of the 19 patients were controlled at normal levels, and there was no significant difference between the general patients in the use of cardiac drugs and sugar control drugs. The results reflect the uniqueness of NT-proBNP in assessing cardiac function in diabetic patients, and the addition of NT-proBNP detection can make up for the lack of cardiac function assessment in existing diabetic complications.
(From left) Ms. Wong Min-yee, a registered social worker of the Hong Kong Medical Care Alliance, Dr. Chow Chun-chung, a specialist in endocrinology and diabetes, two type 2 diabetic patients, Mr. Lei, and Mrs. Wong