余学峰：长期并发症的管理是中国T2DM的最大挑战

全球探索调查旨在调查临床医生（HCP）和2型糖尿病患者（PWD）对2型糖尿病（T2DM）管理的认知。这项调查以网络为基础，对来自13个国家的PWD（2100例）和HCPs（1400例）提出10项问卷调查。这项调查报道了来自中国226例PWD和100例HCPs的数据。±3%的差异有统计学意义，且±10%的差异为显著差异。

该调查结果表明，中国的数据和全球的数据有差异。中国（89%）与全球（96%）相比，较少的HCPs认为体重管理（wt）是最大的挑战，可能是因为中国的PWD与全球相比较少肥胖（以当地定义为基础）。中国HCPs认为大血管并发症（99%）和心血管（CV）风险（96%）管理是最大的挑战；中国PWD同样关心长期并发症。中国与全球相比（63 vs 33%），注射疗法（主要指胰岛素）更加普遍，且减少低血糖方面有更大的挑战（79% vs 66%）。

在PWD和HCPs的回答之间存在一些差异。仅有28%的PWD和46%的HCPs认为wt下降1-5%是有意义的，71%的PWD和54%的HCPs认为wt下降＞6%是有意义的。HCPs更加强调长期的wt下降，46%的HCPs（与26%的PWD相比）希望wt下降＞2年。PWD认为尿路感染（UTIs）和真菌感染是最难以接受的治疗副作用，然而，医生认为是低血糖。有趣的是，假如能伴有2.5%的的wt下降，相似数量的PWD（44%）和HCPs（40%）原意接受这些最难以接受的副作用（权衡风险/受益）。该研究同时还注意到情绪影响的认知差异，与PWD相比，多达两倍的HCPs认为CV事件（29 vs 15%）和血糖管理（31 vs 12%）有负面情绪影响。

该研究发现，这些数据突出，在中国长期并发症管理是T2DM问题的最大挑战。与全球的结果相比，在中国，wt管理没有被充分重视。PWD和HCPs在wt下降副作用和T2DM对情绪影响方面观点的差异需要解决。

The EXPLORE Global Survey examined the perceptions of clinicians (HCP) and people with Type 2 diabetes (PWD) on T2DM management. EXPLORE was an internet-based 10-item questionnaire for PWD (N=2100) and HCPs (N=1400) from 13 countries. Data from 226 PWD and 100 HCPs from China are reported here. Differences of ±3% are statistically significant and ±10% meaningfully different.

There were differences in the China and global data. Fewer HCPs in China (89%) vs globally (96%) found managing weight (wt) the biggest challenge perhaps because Chinese PWD were less obese (based on local definition) than global PWD. Chinese HCPs found managing microvascular complications (99%) and CV risk (96%) the biggest challenge; PWD were similarly concerned about long-term complications. Injectable therapy (mainly insulin) was more common in China vs globally (63 vs 33%) and minimizing hypoglycemia was a greater challenge (79 vs 66%).

Several disconnects exist between PWD and HCPs responses. Only 28% of PWD vs 46% of HCPs thought wt loss of 1-5 % as meaningful; 71% of PWD thought wt loss of >6% as meaningful vs 54% of HCPs. HCPs placed more emphasis on long-term wt loss; 47% (vs 26% of PWD) wanted loss for ≥2 yrs. PWD perceived UTIs and yeast infections as the least acceptable therapy side-effect while clinicians identified hypoglycemia. Interestingly a similar number of PWD (44%) and HCPs (40%) would willingly accept the least acceptable side-effect if accompanied by a 2.5% wt loss (risk/benefit trade-off). Disconnects were also noted in perceptions of emotional impact; twice as many HCPs vs PWD identified risk of CV events (29 vs 15%) and managing blood sugar (31 vs 12%) to have a negative emotional impact.

These data highlight that management of long-term complications is the most challenging T2DM issue in China. Wt management is not as highly regarded by HCPs and PWD in China compared with global results. The disconnect between PWD and HCPs views on wt loss side-effects and emotional impact of T2DM needs to be addressed.

编辑： 葛根    来源：丁香园