2016 CDS:梅斯医学专访纪立农教授:我们需要“中国原创”的临床证据

2016-11-22 MedSci MedSci原创

2016年11月16日~19日,由中华医学会、中华医学会糖尿病学分会(CDS)主办,厦门市医学会承办的中华医学会糖尿病学分会第二十次全国学术会议(CDS 2016)在福建厦门召开。中华医学会糖尿病分会(CDS)自2014年开始设立科学贡献奖,是CDS的最高学术奖项,旨在对国内从事糖尿病研究的杰出科研工作者进行表彰,从而鼓励和引导更多同道投身糖尿病科研,促进我国糖尿病防治工作的进步。今年科学贡献奖颁

2016年11月16日~19日,由中华医学会、中华医学会糖尿病学分会(CDS)主办,厦门市医学会承办的中华医学会糖尿病学分会第二十次全国学术会议(CDS 2016)在福建厦门召开。
 
中华医学会糖尿病分会(CDS)自2014年开始设立科学贡献奖,是CDS的最高学术奖项,旨在对国内从事糖尿病研究的杰出科研工作者进行表彰,从而鼓励和引导更多同道投身糖尿病科研,促进我国糖尿病防治工作的进步。今年CDS科学贡献奖颁给了北京大学人民医院的纪立农教授。
▲大会主席贾伟平教授为纪立农教授颁奖
 
纪立农教授现任北京大学人民医院内分泌科主任,北京大学国际医院内分泌科主任,北京大学糖尿病中心主任,兼任国际糖尿病联盟西太平洋区(IDF-WPR)候任主席,曾于2010-2012年任CDS主任委员,于2012-2015年任国际糖尿病联盟(IDF)副主席,去年12月当选为IDF西太平洋区候任主席。
 
纪立农教授应邀接受了梅斯医学(MedSci)的专访,就如何基于真实世界的研究探索糖尿病防控方向以及糖尿病自我管理的发展壁垒阐述了自己的见解。
 
梅斯医学:纪教授,您好,感谢您接受我们的采访。首先恭喜您获得今年CDS的最高学术奖项“科学贡献奖”,请您跟我们分享一下在糖尿病防控方面,我们取得了哪些成就?当前面临的最大困难是什么?
 
纪立农教授:在2007-2008年全国糖尿病流行病学调查发布之后,糖尿病患病率比之前明显升高,糖尿病患者未诊断高达60%,这些患者如何被早期发现和早期治疗,以及那些已经被诊断的糖尿病患者,如何按照国际上循证医学验证有效的防治方法控制血糖和减少并发症,是中国当前面临的大问题。
 
针对于糖尿病防控,我们开展了一系列的研究。在3B研究中,我们探讨了已就诊糖尿病患者的血糖,血压,血脂的控制情况。结果显示受试者血糖,血压,血脂综合达标率不到6%,在阿司匹林作为主要抗血小板药物使用与指南相差甚远。
 
在国际糖尿病诊断标准中国人群适应证的验证研究证实,空腹血糖和糖化血红蛋白诊断糖尿病的切点同样适用于中国人群。NEW2D研究结果显示,应加强从体检和机会性筛查路径发现糖尿病并重视早期诊断(由此催生了中国糖尿病风险评分),同时进行心血管危险因素的综合管理,这一结论也得到了3B研究的支持。脂肪肝与糖代谢状态研究的科学意义是,要把糖尿病和脂肪肝作为共同研究对象;对早发2型糖尿病患者的心血管风险研究提示,对这类患者应及早诊断、严格控制,加强糖尿病足和外周血管病变的预防和早期诊断。此外,我们还开展了新型降糖药物的有效性和安全性研究。
 
所以,无论在从提高医生诊疗能力,或者患者教育方面,都应该把真正的循证医学证据充分的利用。以基于真实世界的研究为改善糖尿病提供了有力的证据和改进的方向,如果将其得到使用,会对中国糖尿病防控产生很大的影响。
 
梅斯医学:现在很多人都在做真实世界的研究,但其实真实世界的研究并不是那么容易开展,那么真实世界研究的壁垒到底在哪里?
 
纪立农教授:科学研究是糖尿病防治的基石,转化医学提倡把基础转化成临床,而真实世界的研究是把基础研究转化成诊疗措施,进而评估在真实世界中的诊疗措施的效果。真实世界的研究关心的是整个系统,而不是小规模人群。
 
确实,做好真实世界研究非常不易。真实世界研究操作难度极大,研究设计需从临床问题出发,旨在服务患众,提高整体医疗质量,不仅仅从理论上,从各级医院医生投入到相应的研究工作中,也希望为患者医疗质量的改善提供帮助;不同于国外完善的医疗数据体系,国内需要投入大量的人力及临床资源去获取真实的诊疗数据,基于对大样本量大数据的分析,才能获得真实且具代表性的可反映临床实践的结果
 
梅斯医学:在糖尿病自我管理方面,我国糖尿病教育所面临的挑战有哪些?哪种模式最值得我们借鉴?
 
纪立农教授:第一,我们没有足够的教员,对患者进行教育辅导和个体化的互动。第二,国家在教育者教育认证和培训方面投入的资金非常有限,还未制定糖尿病教育者的专属岗位。第三,未形成可持续发展的教育体系。国外的糖尿病教育多为收费项目,医保也会为其买单,国内的多数糖尿病教育为免费提供,仅有少数医院还收取低廉的挂花费,在这种情况下,既不能体现教育者的价值,也未能在行为改变中形成有效的杠杆促进作用,仅仅靠教育者的热情来提供免费的糖尿病管理,很难持续。我认为最值得借鉴的糖尿病自我管理模式是台湾的模式,台湾的模式不仅实现了糖尿病教育支付的多重方式,而且形成了可持续发展的教育体系,也就是糖尿病教育者的资格认证。
 

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    2018-02-03 1e145228m78(暂无匿称)

    学习了.谢谢作者分享!

    0

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content=科学研究是糖尿病防治的基石,必须要提高医生的临床研究的能力,只有通过系统的交流培训,逐步让青年医生了解如何做科研,落实研究设计,如何开展临床试验,这也是发展糖尿病事业防控的重要任务。, beContent=null, objectType=article, channel=null, level=null, likeNumber=58, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/NUyjXTCJjo7s7ZCKOmmbBTD6nE7gcd5OZpvyGEzkxBP3S275k5ZJVrsPkotZhBglRHM9rKvcj1OgkssqhcnoPw8zIaMZTF8c/0, createdBy=4c441942088, createdName=ylzr123, createdTime=Tue Nov 22 14:29:11 CST 2016, time=2016-11-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=157453, encodeId=19b415e4535d, content=学习啦,谢谢分享, beContent=null, objectType=article, channel=null, level=null, likeNumber=43, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mStl88fu4NfdY7yem1P7bRvOP6z0jKsBoYR8ezfAricY7meQWcte7LRJsWHVn0CnPJg2JuQmevR0DoFmmEib5QLD2kNESBESQT/0, createdBy=59191706502, createdName=医路开来, createdTime=Tue Nov 22 13:46:46 CST 2016, time=2016-11-22, status=1, ipAttribution=)]
    2017-11-05 bshuang
  4. 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createdName=医路开来, createdTime=Tue Nov 22 13:46:46 CST 2016, time=2016-11-22, status=1, ipAttribution=)]
  5. 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content=科学研究是糖尿病防治的基石,必须要提高医生的临床研究的能力,只有通过系统的交流培训,逐步让青年医生了解如何做科研,落实研究设计,如何开展临床试验,这也是发展糖尿病事业防控的重要任务。, beContent=null, objectType=article, channel=null, level=null, likeNumber=58, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/NUyjXTCJjo7s7ZCKOmmbBTD6nE7gcd5OZpvyGEzkxBP3S275k5ZJVrsPkotZhBglRHM9rKvcj1OgkssqhcnoPw8zIaMZTF8c/0, createdBy=4c441942088, createdName=ylzr123, createdTime=Tue Nov 22 14:29:11 CST 2016, time=2016-11-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=157453, encodeId=19b415e4535d, content=学习啦,谢谢分享, beContent=null, objectType=article, channel=null, level=null, likeNumber=43, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mStl88fu4NfdY7yem1P7bRvOP6z0jKsBoYR8ezfAricY7meQWcte7LRJsWHVn0CnPJg2JuQmevR0DoFmmEib5QLD2kNESBESQT/0, createdBy=59191706502, createdName=医路开来, createdTime=Tue Nov 22 13:46:46 CST 2016, time=2016-11-22, status=1, ipAttribution=)]
    2016-11-25 脱因不花

    探讨一种适合中国国情的糖尿病模式

    0

  6. 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content=科学研究是糖尿病防治的基石,必须要提高医生的临床研究的能力,只有通过系统的交流培训,逐步让青年医生了解如何做科研,落实研究设计,如何开展临床试验,这也是发展糖尿病事业防控的重要任务。, beContent=null, objectType=article, channel=null, level=null, likeNumber=58, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/NUyjXTCJjo7s7ZCKOmmbBTD6nE7gcd5OZpvyGEzkxBP3S275k5ZJVrsPkotZhBglRHM9rKvcj1OgkssqhcnoPw8zIaMZTF8c/0, createdBy=4c441942088, createdName=ylzr123, createdTime=Tue Nov 22 14:29:11 CST 2016, time=2016-11-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=157453, encodeId=19b415e4535d, content=学习啦,谢谢分享, beContent=null, objectType=article, channel=null, level=null, likeNumber=43, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mStl88fu4NfdY7yem1P7bRvOP6z0jKsBoYR8ezfAricY7meQWcte7LRJsWHVn0CnPJg2JuQmevR0DoFmmEib5QLD2kNESBESQT/0, createdBy=59191706502, createdName=医路开来, createdTime=Tue Nov 22 13:46:46 CST 2016, time=2016-11-22, status=1, ipAttribution=)]
    2016-11-24 一闲
  7. 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createdName=医路开来, createdTime=Tue Nov 22 13:46:46 CST 2016, time=2016-11-22, status=1, ipAttribution=)]
    2016-11-24 yangpeizhi
  8. 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createdName=医路开来, createdTime=Tue Nov 22 13:46:46 CST 2016, time=2016-11-22, status=1, ipAttribution=)]
    2016-11-22 ylzr123

    科学研究是糖尿病防治的基石,必须要提高医生的临床研究的能力,只有通过系统的交流培训,逐步让青年医生了解如何做科研,落实研究设计,如何开展临床试验,这也是发展糖尿病事业防控的重要任务。

    0

  9. 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content=科学研究是糖尿病防治的基石,必须要提高医生的临床研究的能力,只有通过系统的交流培训,逐步让青年医生了解如何做科研,落实研究设计,如何开展临床试验,这也是发展糖尿病事业防控的重要任务。, beContent=null, objectType=article, channel=null, level=null, likeNumber=58, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/NUyjXTCJjo7s7ZCKOmmbBTD6nE7gcd5OZpvyGEzkxBP3S275k5ZJVrsPkotZhBglRHM9rKvcj1OgkssqhcnoPw8zIaMZTF8c/0, createdBy=4c441942088, createdName=ylzr123, createdTime=Tue Nov 22 14:29:11 CST 2016, time=2016-11-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=157453, encodeId=19b415e4535d, content=学习啦,谢谢分享, beContent=null, objectType=article, channel=null, level=null, likeNumber=43, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mStl88fu4NfdY7yem1P7bRvOP6z0jKsBoYR8ezfAricY7meQWcte7LRJsWHVn0CnPJg2JuQmevR0DoFmmEib5QLD2kNESBESQT/0, createdBy=59191706502, createdName=医路开来, createdTime=Tue Nov 22 13:46:46 CST 2016, time=2016-11-22, status=1, ipAttribution=)]
    2016-11-22 医路开来

    学习啦,谢谢分享

    0

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