[CSD2015访谈] 礼来糖尿病部医疗事务副总裁David Kendall:糖尿病新医学未来发展的两大方向
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专家访谈 综合领域  作者:D.Kendall 来源:国际糖尿病 2015/12/14 16:46:00    加入收藏

内容概要:2015年12月10日下午,在中华医学会糖尿病学分会第十九次全国学术会议上,现任美国礼来糖尿病部医疗事务副总裁David Kendall 教授受邀发表了题为“我们需要新药吗?

——礼来糖尿病部医疗事务副总裁David Kendall 教授访谈

  编者按:2015年12月10日下午,在中华医学会糖尿病学分会第十九次全国学术会议上,现任美国礼来糖尿病部医疗事务副总裁David Kendall 教授受邀发表了题为“我们需要新药吗?-糖尿病管理中的临床需求和新医学的定位(Do we need a new medicine?- the clinical needs and positioning of new medicine in Diabetes management)”的专题报告。David Kendall 教授曾担任美国糖尿病协会(ADA)首席医疗官,有丰富的临床研究经验,参与了包括DCCT研究及ACCORD研究在内的很多大型临床试验。David Kendall 教授在接受我刊现场采访中谈到,仅简单引入越来越多种类的药物会使糖尿病管理变得更复杂,而在应用现有药物的基础上对患者进行教育,帮助他们更好地了解这些药物可改善糖尿病管理。此外,他还指出了糖尿病新医学未来发展的两大方向。

  《国际糖尿病》:您是一名资深的糖尿病学家、临床研究者,并曾担任美国糖尿病协会(ADA)首席医疗官。请您向中国糖尿病医生介绍一下糖尿病患者管理方面的经验?医生如何更好地管理患者,使患者更好地遵从医嘱长期治疗,从而改善糖尿病预后?

  Kendall教授:我非常高兴能够参加本届中华医学会糖尿病学分会(CDS)年会,这已经是我职业生涯中第二次参会。2012年,在中国成都我第一次参加了CDS年会,并与很多作为CDS活跃委员的同道进行了交流。在加入美国糖尿病协会担任首席科学家及医学执行官前很多年,我一直是一名学术及临床研究者。在我的临床生涯中,我不仅有机会开展了药物研发研究,还参与了包括DCCT研究及ACCORD研究在内的很多大型临床试验。在美国糖尿病协会中,我与很多专家一起参与了既适用于美国,也适用于全世界糖尿病治疗指南的编写。我非常高兴也感到无比荣幸,自己能出席本次大会并对我的临床经验和临床实践与中国及世界各地医生的临床经验与实践进行对比,分享我们所面临的患者类型及其临床治疗方面的差异。美国已经积累了很多1型糖尿病与2型糖尿病管理经验,但是,与美国相比,中国等很多世界其他地区的2型糖尿病治疗存在一定差距。此外,近年来人们越来越重视和关注1型糖尿病。我过去作为临床医生、大型专业学会代表的经验以及现在作为企业研究者及医生的经验,使我能够将各种知识整合到CDS年会这样的精彩学术会议中。

  《国际糖尿病》:近十几年来糖尿病领域出现许多新治疗策略和药物,您在本次会议上也谈到“我们是否需要新医学”的问题,请您介绍一下能够更好地满足临床需求的新医学有何特点?

  Kendall教授:1921年人们发现胰岛素,1923年胰岛素开始作为糖尿病治疗药物被应用于临床,从那时起直至上世纪90年代人们管理1型糖尿病及2型糖尿病的选择非常有限。自上世纪80年代开始,尤其是过去十年间,我们拥有了多种专门治疗2型糖尿病的方法,同时胰岛素治疗在1型糖尿病及2型糖尿病的应用也发生了一定修订与改变。很多人会问,现在我们是否已经拥有了有效管理糖尿病所需的大多数药物。之前我曾详细讨论过,实际上在应用现有药物的基础上对患者进一步进行教育,帮助患者更好地了解这些药物,并确保患者了解对糖尿病进行持续主动管理的重要性可改善糖尿病患者的管理。相反,若仅是简单的引入越来越多种类的药物,则会使糖尿病管理变得更复杂。至于“我们是否需要更多药物?”,我认为答案既是肯定的,又是否定的。

  正如Buse教授在本次大会上所讨论的那样,新型药物让我们知道了更多管理糖尿病的替代选择,了解了这些药物的潜在安全性及其他效应(包括其对心脏疾病、癌症风险的影响),了解患者对这些药物的耐受性。不过,我想强调的是,应用现有药物并对患者及医务人员进行相关教育也可使糖尿病治疗更有效,这种策略对糖尿病管理而言仍然具有非常重要的意义。实际上,新药本身以及有效性较差的老药均不能解决糖尿病患者所面临的问题。

  《国际糖尿病》:您认为糖尿病新医学未来发展的方向是什么?未来哪些药物或治疗方法对于2型糖尿病是更有前景的?

  Kendall教授:就糖尿病新医学的未来发展方向,过去几十年间以及本次大会上均强调要更好地了解糖尿病个体患者的需求。实际上,没有一种治疗或是联合治疗方案适用于所有患者,尤其是2型糖尿病患者。了解对个体患者而言,哪些药物联合方案耐受性最好、哪些方案最容易接受、哪些方案最有效,是实施个体化医疗或精准医疗的基础。我认为,糖尿病医学未来有两大发展方向。其一,改善我们为患者进行药物选择的精确度。其二,需要寻找能具有附加效果的新型降糖药物。我们已经认识到,就糖尿病患者的管理而言,仅降低血糖、降低眼/肾脏及神经并发症以及改善高血糖症状是不够的。新型降糖药物可以独特方式改善血压、体重、胆固醇,保护其他器官降低心脏疾病、肝脏疾病及高血糖传统并发症风险。展望未来,研发既能实现血糖控制又能带来其他获益的新药,以及探寻更有效的新老药物组合方案均是未来糖尿病医学领域的重中之重。

  International Diabetes: You are a famous diabetic doctor, clinical researcher, and used to be the Chief Scientific and Medical Officer at the American Diabetes Association. So can you introduce your experience of diabetes patients management to Chinese diabetic doctors? How to manage patients better, making them follow doctors’ advice, and improving their diabetic outcome?

  Dr Kendall: Thank you for the opportunity to join you and it is a pleasure to be here with the Chinese Diabetes Society for the second time in my career. I first visited Chengdu in 2012 and have worked with many of my colleagues who are active members of the Chinese Diabetes Society. My history is as an academic and clinical investigator for many years prior to joining the American Diabetes Association where I served as the Chief Scientific and Medical Officer. In my clinical career I have had the opportunity not only to do drug discovery studies but large clinical trials such as the Diabetes Control and Complications Trial (DCCT) and the ACCORD trial. In my role at the American Diabetes Association, I worked with many professionals on treatment guidelines that are applicable both in the United States and indeed worldwide. The opportunity to be present here and to make comparisons between my clinical experience and clinical practice and those of the physicians in China as well as worldwide, and to help share information on our differences in clinical treatment and also the differences in the types of patients we see, is an honor and privilege. In the US, we have had many years of experience with the management of both type 1 and type 2 diabetes, and there is much greater emphasis on the treatment gaps that occur in favor of type 2 diabetes in many parts of the word including China and parts of the US, and an emerging interest in the treatment of type 1 diabetes. My past experience as a clinician, as a representative of a large professional society and now as an industry researcher and physician have allowed me to tie all of that information together in wonderful settings like this Chinese Diabetes Society meeting.

  International Diabetes: In resent ten years, many new therapies and drugs are appears in diabetes area, your lecture also refers to the question that “if we need new medicine”, so please introduce what is the characteristic of new medicine that can meet clinical need better?

  Dr Kendall: The opportunity I have to discuss the history of medications and medication discovery in diabetes really follows two paths. Firstly, for many years since the discovery of insulin in 1921 and its use as treatment beginning in 1923 through to the late 1990s, we had very limited choices for the management of type 1 and type 2 diabetes. Beginning in the 1980s and much moreso in the past decade, we have seen the introduction of multiple classes of therapies specifically to treat type 2 diabetes but also modifications and changes as to how insulin therapy is applied in both type 1 and type2 diabetes. Many have asked whether we are now in a position where we have most of the medicines we need to effectively manage diabetes. What I have discussed in detail, is the option of using the current medicines as well as possible as one approach to improving care in conjunction with further patient education, helping physicians better understand these medications and ensuring that patients understand the importance of continued active management of their diabetes. The contrast is simply introducing more and more types of medicines, which may make the management of diabetes not simpler but more complicated because of the choices. I think the answer to “Do we need more medicines?” is both yes and no. As was discussed by Dr Buse at this meeting, new medicines have taught us a great deal about alternative ways to manage diabetes but also about the potential safety and other effects of these medicines including their effects on heart disease, cancer risk and the ability of patients to tolerate those. But I would emphasize that using many of the existing medications more effectively through patient and provider education remains a very important part of management. New medicines alone will not solve the problem and using old medicines ineffectively will not solve the problems that face patients who hope to live much better lives with diabetes.

  International Diabetes: In your opinion, what is the direction of future diabetes new medicine? Which kind of diabetes drugs or therapies are more promising in the future?

  Dr Kendall: What we have heard here at this meeting and what we have learned over the past several years about future directions is understanding better the needs of individual patients with diabetes. No one therapy or combination of treatments is likely going to be best for all patients. This is particularly true in patients with type 2 diabetes. Understanding which drug combinations are best tolerated, are most well accepted and are most effective for an individual patient is the basis of personalized or precision medicine. I think the future direction has two very important components. One is understanding how we can improve the precision of the choices of medicines used for patients. And we have come to understand that going beyond just the lowering of blood glucose to reduce the risk of eye, kidney and nerve problems as well as the symptoms of high blood glucose is not enough. That we need to be looking for additional effects of medications that may improve blood pressure, body weight, cholesterol and protect other organs in unique ways with the knowledge that problems of heart disease, liver disease as well as the classic complications of high blood glucose (eye, nerve and kidney disease) all need to be addressed with new medications. Having glucose control plus other benefits will be an important focus in the development of new medications as well as understanding the appropriate combinations of both new and old medicines much more effectively.

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