4 | Future prospects
It can be easily found that this comprehensive program will help to
translate new technologies and research into clinical practice and
reverse T2D due to strengthening prevention and management or
self-management as well as personalized services. It will meet not only
Healthy China 2030 Plan but also updated the National Health Service
(NHS) Long Term Plan in the UK [90]. In short, this program can help
to achieve global health goals.
In fact, this program has already been used for CVD and cancer in daily
clinical practice, but there are more detailed on changing unhealthy
lifestyle for T2D (Table 1). If there is a national registered centre
for T2D which just likes major virus-communicable diseases, e.g. SARS
and COVID-19 [17,91], more satisfactory effects will be got after
reliable national clinical trials with this innovative classical
comprehensive program, since it combines anti-diabetic agents, insulin
use, metabolic surgery with mental health screenings and healthy
E(e)SEEDi lifestyle [27,92,93], which includes plant-based dietary
patterns, and will get better control of population-level HbA1c and
cardiovascular risk among individuals with T2D.
With a better understanding in the pathophysiological mechanisms at the
molecular level and the discovery of new targets for
metabolism[94,95], the implications for existing guidelines and
therapeutic options, as well combination with this iRT-ABCDEFG program
and effective lifestyle interventions for T2D, for example, a precision
dietary management and scientific dietary recommendations with respect
to carbohydrate, fat and dietary fibre, and increases in physical
activity and fitness, calorie restriction and weight loss [96,97],
these individuals will improve greatly glycaemic control and better
prevent its complications [98], such as CVD and neurodegenarative
diseases (Alzheimer’s disease and Parkinson’s disease) [99]. In
addition, the prevalence of both depression and thyroid abnormalities is
high among individuals with T2D [100,101]. and coronary plaques
[102], abnormal gene expression and serum biomarker levels in these
patients mean higher risk and adverse clinical outcomes [103-105],
hence, we should control and prevent these risk factors so as to reduce
cardiovascular mortality.
Theoretically, this iRT-ABCDEFG program is more plausible for better
management and self-management of T2D due to truly individualized
glycaemic goals. It is helpful to individuals with T2D for early
detection of ischemic heart disease, unrecognized CHF, and early statins
and SGLT2 inhibitors treatment safely for improvement of lipids and
endothelial function and lowering MACCE [106]. In fact, a biomarker
score is helpful to stratify T2D and pre-diabetes related CHF risks
[107]. Healthy E(e)SEEDi lifestyle may help to reduce these risks
and improve clinical outcomes [108]. In addition, clinical trials
already confirmed benefits of selective nonsteroidal MRA eplerenone
[109] and finerenone [110] in CHF prevention and cardiovascular
outcomes improvement. Obviously, a combination of these strategies in
this novel comprehensive program is helpful to healthcare of individuals
with T2D. Of course, both drug and non-drug management of T2D require
more solid evidence-based studies [111].
Since there are more cardiovascular benefits in SGLT2 inhibitors, such
as dapagliflozin [112], and new animal models and clinical trials
had already confirmed the glucose-lowering potential of glucokinase
activators [113], and there are more and better choices for T2D
treatment, but we should pay more attention to both safety and efficacy
of these novel hypoglycaemic drugs [114]. Because T2D links to
significant abnormalities in cardiocerebrovascular system [115],
such as atherosclerotic CVD, diabetic cardiomyopathy, CHF, stroke, CKD,
peripheral neuropathy [116], our program may have a role of
risk-reduction of MACCE and improvement of clinical outcomes. Herein,
this program can be adopted as “a concise guideline” in clinical
practice due to OMT and healthy E(e)SEEDi lifestyle.
Both T2D (diagnosed and undiagnosed) and IGT are important CVD risk
factors [117] and have higher risk of coronary stenosis and coronary
atherosclerotic plaques burden [118]. When there is fragmented QRS,
it may predict complex VAs and the risk of sudden cardiac death
[119], and LVDD is common [120] in T2D patients, it may also be
detected by 3D speckle tracking echocardiography [121]. However,
current SGLT2-inhibition remains to be at an underused status in these
HF-population [122]. A combination of agents high-intensity statins
(rosuvastatin) and more often with ezetimibe [123] and intensifying
lifestyle measures is needed for stricter LDL-C and non-HDL-C targets.
Because good clinical investigations or programs could inform future
diagnostic and therapeutic strategies, and enhance the understanding of
a disease, just like myocardial infarction with nonobstructive coronary
arteries (MINOCA) [124] and this iRT-ABCDEFG program. When combined
with novel tools [125], new agents [126], fresh preventive and
interventional strategies [127,128], it will help us to get better
effects on management or self-management of T2D. However, “advances in
science are not linear, they are zigzag”
[129].129 Thus, we should keep enough patience and
confidence from papers publication to practical application and try to
expand related clinical coverage.
In fact, during the pandemic and post-COVID-19 era [130], as major
OMT and particularly when combined with healthy E(e)SEEDi lifestyle,
both GLP-1 receptor agonists and SGLT2 inhibitors are good choices for
prevention of related complications in T2D (CHF, CKD, and
AF/AFL-reduction benefit) and MACCE due to direct and favorable
cardioprotective and nephroprotective effects [131-134], even if
SGLT2 inhibitors have no significant effects on ischemic events stemming
from atherosclerotic CVD in T2D [135]. With the development of new
drug delivery systems [136-138] and novel technologies
[139,140], it’s promising in applications for T2D and its
complications.