Expert Consensus on Clinical Management of T2DM Combined with Obesity Reversal Treatment in China(2023 Edition)

With lifestyle changes,the incidence of type 2 diabetes(T2DM)and obesity has significantly increased,becoming major chronic diseases that seriously threaten the health of China’s residents.Both domestic and international guidelines and consensus exist regarding the diagnosis and management of this disease.In recent years,T2DM treatment has focused more on new tactics that lean towards a patient-centered comprehensive management approach,replacing the traditional glucose-centered approach.Additionally,an increasing amount of evidence in medicine suggests that the reversal of diabetes is possible.However,there is currently no expert consensus on the clinical management of T2DM combined with obesity reversal treatment.Therefore,experts and scholars in China with extensive experience in T2DM combined with obesity reversal treatment have been invited to develop this consensus.The content includes early identification and diagnosis of T2DM combined with obesity,definition and mechanisms of diabetes reversal,disease assessment and grading,staging of diabetes and goals of reversal,the 2+N reversal strategy,inpatient system treatment combined with comprehensive outpatient management(including weight control,precise nutrition,scientific exercise,glucose-lowering medication,psychological intervention,rehabilitation therapy,and remote follow-up through online platforms),and evaluation of post-reversal efficacy.The aim is to further improve the level of T2DM combined with obesity reversal diagnosis,treatment,and management in China,and to implement the Healthy China strategy.

Experimental and Clinical Study on Inhibition and Reversion of Liver Fibrosis with Integrated Chinese and Western Medicine

Objective: To explore the possibility of reverting HBV-related hepatic fibrosis and cirrhosiswith traditional Chinese medicine (TCM). Methods: A herbal recipe (861 ), comprising of 10 herbs includingSalvia miltiorrhiza, Astragalus membranaceus and SPatholobus saberectus were used as the antifibrotic agents. Three controlled clinical trials of treating HBV-related fibrosis and early cirrhosis were carried out. A total of 107 patients were assessed clinically and pathologically with double liver biopsies before and after treatmentby means of modified Scheuer and Chevallier scoring system. Rat model of hepatic fibrosis induced by CCI. andhuman albumin immune injury, culture of separated hepatic stellate cells (HSC) were established. Total collagen content of the liver was determined by detection of hydroxyproline, amount of type Ⅰ, Ⅲ Ⅳ collagens byhistoimmunochemistry, quantitative measurement of mRNA for collagen Ⅰ, Ⅲ, Ⅳ, transforming growth factor-3 (TGF-3), matrix metalloproteinase (MMPI ), MMP2, tissue inhibitor of metalloproteinase (TIMP) inliver tissue by dot blot hybridization. Serum and liver tissue collagenase activity was detected by method of Rajabi M and Emonard H. Histopathological study of liver specimen was done with H. E., Masson and sirius redstain as well as histoimmunochemistry. Results: (1 ) In HBV-related patients, after six months treatment with861, the reversion rate was as high as 78% in S2, 82 % in S3 (precirrhotic stage) and 75 % in S4 (cirrhosis).These results corresPOnd well with that obtained in animal experiment. (2) Total and type i, m, V collagencontent in animal model liver were significantly reduced in amount after 861 treatment, whereas quantitation ofmRNA for collagen Ⅰ, Ⅲ, Ⅳ and TGF-β were also markedly suppressed either in liver tissue or cultured HSC,suggesting the suppression by 861 on fibrogenesis. At the same time, serum and liver tissue collagenase activity(latent and active) were enhanced significantly by administration of 861, while mRNA for MMPI (interstitialcollagenase) in cultured HSC and collagenase activity in the supernatant of the HSC culture were both increased,and meantime, mRNA for TIMPI was significantly suppressed in quantity, indicating the enhancement of excessive extracellular matrix (ECM) degradation after 861 treatment. Conclusions: (l ) Contrary to the conventional concept, the liver fibrosis and early cirrhosis due to HBV infection in man could be definitely reversed byTCM treatment of 861. This was also verified in CC14 and immune injury models. (2) The mechanism leadingto the reversal of fibrosis was due to suppression of fibrogenesis, and the concurrent enhancement of ECM degradation. In the latter, suppression of TIMP also plays an imPOrtant role. (3) Both initiation by imflammationand perpetuation of the activation of HSC were suppressed by the 861.