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[ADA2015]宏观视角:携手ADA,防控全球糖尿病
——ADA主席Samuel Dagogo-Jack教授专访
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作者:Dagogo-Jack 2015/6/10 15:55:00    加入收藏
内容概要:波士顿当地时间2015年6月7日,今年ADA主席Samuel Dagogo-Jack教授作了题为“抗击糖尿病75年——我们全球的挑战”主席报告。昨日,Dagogo-Jack教授接受《国际糖尿病》记者现场专访,他不仅总结了本届会议包括Banting科学成就奖在内的亮点内容,而且从宏观视角谈及跨文化背景的全球糖尿病前期营养干预计划、过去ADA在糖尿病防控史上的贡献以及ADA作为全球性组织为缩短不同地区及种族人群糖尿病管理差距的合作发展之路。

  <International Diabetes>: Dr. Dagogo-Jack, as the president of the ADA, are there any features of this scientific meeting this year you would comment to compared with the previous ADA meetings?

  Dr. Dagogo-Jack: Oh, thank you very much. The ADA’s scientific sessions this year have followed the general content areas as in previous years. We make sure that we cover a broad range of topics so that everybody who comes to these meetings will have something in their interest area. We have complications, we have type 1, type 2, we have behavioral meta, we have basic sciences, genomic, proteomic, clinicals – we have clinical trials – late breaking abstracts – we have more 3,500 abstracts communicated, hundreds of sessions, so I would say that compared to previous years, every year we make a little more progress and since I’m the president for this year I will proudly claim that this is the best scientific sessions ever. But somebody may argue with that but I think I feel very good about these meetings when I move around and see the number of people, the audio tours of the posters – the guided tours? Very popular. So whether you’re working in the field or not, you stop by the poster and you don’t have to know all of the science there, somebody guides you through, gives you the background, and the key results. It’s a fantastic idea.

   作为ADA的主席,请您介绍一下与往届ADA年会相比,本届ADA科学年会有何特色?

 
  与往年一样,今年的ADA科学年会仍然关注糖尿病领域的基本内容。我们确保大会涉及较为广泛的主题,从而能够让每位参会者都能够找到自己感兴趣的领域。大会设立糖尿病并发症、1型糖尿病、2型糖尿病、行为医学、基础科学、基因组学、蛋白组学、临床试验等各个方面。其中,就临床试验而言,大会期间会将有3500余篇最新摘要参加交流,涉及数百场会议。作为今年ADA年会主席,我可以非常自豪地说,今年的年会是有史以来最好的一次科学会议。我们今年设立的有声壁报非常受欢迎。不论是否来自壁报所涉及领域,参会者都会被壁报所吸引。参会者并不需要知道壁报所涉及的所有科学内容,因为有人会引导你了解壁报所展示研究的背景及主要结果。

  <International Diabetes>: Thank you very much. So, let’s talking about the Banting Award lecture. So what’s your comment on Dr. Scherer?

  Dr. Dagogo-Jack:Great selection of Dr. Phillip Scherer. He is a professor at the University of Texas Southwestern Medical Center in Dallas. He is one of the discoverers of adiponectin – a new hormone secreted by fat cells and the American Diabetes Association awarded him the Banting Medal for Scientific Achievement, which is the highest scientific honor we give to any scientist and he gave a fantastic lecture at the Banting Award lecture. He basically chronicled the discovery of adiponectin after giving a background of the diabetes and obesity connection and then he walked us through adiponectin signaling, the molecular pathways and then the genomic downstream effectors of adiponectin then he brought us right back to potential drug-able targets and the discovery of drugs and how potentially new chemicals can be discovered that can combine efficacies for obesity and also protect diabetes. It’s very good work.

  您对Banting奖获奖者Scherer教授作何评价?
 
  选择将Banting奖颁发给Phillip Scherer教授是个非常伟大的决定。Phillip Scherer教授来自德克萨斯大学西南医学中心,是由脂肪细胞分泌的新激素——脂联素的发现者之一。因此,ADA决定将Banting科学成就奖这一对科学家而言最高级别的科学荣誉颁发给他。Phillip Scherer教授在大会期间作了非常精彩的Banting奖获奖讲座,在介绍糖尿病及肥胖相关联的背景后,介绍了脂联素的发现史,然后进一步向参会者介绍了脂联素信号通路(分子通路)及脂联素的下游效应器及其作为潜在药物研发靶标的价值,探讨了应如何发现对肥胖及糖尿病均具有效应的新化学物质。这些都是非常好的工作。

  <International Diabetes>: Thank you very much. So, your Presidential Address is “75 Years of Battling Diabetes--Our Global Challenge”so please talk about the great changes of stop diabetes in the last 75 years – give a little review.

  Dr. Dagogo-Jack: Yes, quickly, so 75 years ago, 1940, when we were founded, there was a world war – the Second World War was actually going on. Started in 1939. And so physicians in America were very bold to focus on diabetes when the whole world is burning, okay? But it shows how important diabetes is. In 1940, we have only one drug for that diabetes treatment: insulin – discovered in 1922 – old insulin, extracted from pigs and animals, often not clean enough, with local infections. 16 different types of syringes were available with different markings. Families were confused how to use the insulin. People were making mistakes with the insulin and getting reactions, had low blood sugar. The ADA standardized the syringes. Told the Food and Drug Administration that we want uniform syringe and the FDA said you had the idea, go on, create. So the ADA drafted and drew out what should be the U40 and U80, then later U100. All of those are ADA’s contributions. Once the Food and Drug Administration announced that all syringe makers must follow the ADA pattern, mistakes, harm and side effects, and mistaken insulin doses, overdose and death from blood – dramatically decreased. The ADA also basically has been funding, through research, researchers that has discovered most of what we know about diabetes today, about the physiology of diabetes, best management approaches, team care, all of that is ADA’s – ADA can claim. We have a vigorous research program. Since 1952, ADA has spent more than 700 million dollars on research projects. Then since 2010 to now, we spent 70 million dollars, 70 on training grants, on like other agencies. ADA’s training grants can be awarded to anybody in the world. There is no requirement for American citizenship. So ADA believes that any important discovery in the field of diabetes made by anybody anywhere will benefit everybody everywhere.

  请您简要概述过去75年间抗击糖尿病方面发生了哪些巨大变化?
 
  早在75年前第二次世界大战期间的1940年,ADA就成立了。实际上,从1939年始,ADA成立的相关工作就已经开始了。因此,在全世界仍处于战争硝烟中的时候,美国的临床医生就已经意识到了糖尿病是多么重要,非常关注糖尿病。1940年,我们只有一种治疗糖尿病的药物,那就是1922年发现的胰岛素。那时的胰岛素非常老,主要从猪等动物体内提取而来,并不是太纯,常常会导致局部感染。当时,共计有不同厂家生产的16种不同类型注射器,人们对如何使用胰岛素感到困惑,应用胰岛素时常会发生错误而导致不良反应,很多患者会出现低血糖。后来,ADA对注射器进行了标准化,告知美国FDA我们需要统一的注射器。FDA当时回复称,既然有这种想法你们就争取创造出统一的注射器。后来,ADA起草了相关文件,并先后推出了40 U、80U以及后来的100U型号的注射器。ADA在这其中作出了非常大的贡献。在FDA宣布所有注射器制造商必须遵循ADA模式后,胰岛素剂量应用错误、过量应用及死亡等的发生率显著降低。
 
  此外,ADA还一直向糖尿病研究及研究者提供有关糖尿病病理生理学、最佳管理方法、团队管理等方面研究的资助。ADA资助开展了很多具有竞争力的研究项目。自1952年开始,ADA在研究项目方面的投资已经超过7亿美金。从2010年至今,ADA还在对培训项目及其他机构投入了7000万美金。其中,ADA的培训基金可颁发给世界上的任何研究者,并不一定只颁发给美国国籍者。ADA认为,任何地区、任何人所获得的糖尿病领域的任何重大发现都能使全世界的患者得到获益。

  <International Diabetes>: So then we go to the next question. You have given a speech about, famous, talk about transcultural Diabetes Nutrition Algorithm program, so can you please introduce us this program and what is the significance meaning, you know, to the diabetes prevention in different cultures?

  Dr. Dagogo-Jack:Good. So, as you know, the World Health Organization has estimated that there are more than 300 million people worldwide with pre-diabetes and the number will double by the year 2035. So while we are focusing on diabetes we should not forget pre-diabetes. Pre-diabetes can be prevented from progressing to diabetes. And the best prevention strategy does not even require a drug. It is diet and physical activity. But when you say diet in North America, it has relatively little meaning in Africa, or China, or parts of China, or Japan. So the multicultural nutrition initiative, which I am involved with a sister organization, the AACE, is working on harmonizing and regionally customizing a core set of nutritional principles that will be flexible region to region. Each region will adapt the template to their specific needs and focus on caloric restriction, macro-nutrient modification – those are the broad outlines. But the specific macro-nutrient would be unique to the geographical environment. So we need partners, so we are forming partnerships with the local experts who are more knowledgeable with local nutrition to say

  if you want an individual who is overweight, has a family history of diabetes, who is currently pre-diabetic, you want to prevent diabetes in him and need him to go on 1400 calorie diet – what does 1400 calorie diet mean in Tanzania? In Chicago? In Shanghai? In New Delhi? It won’t be the same food. Up till now, people don’t have that transcultural dimension. They think you can just use the same dietary plan. That is a farce. It’s not going to work. So we need this transcultural coalition in order to better translate the science of diabetes prevention in all global communities.

  您曾作了一个非常著名的有关跨文化糖尿病营养方案项目的演讲。其对不同文化背景下糖尿病的预后有何重要意义?
 
  据世界卫生组织估计,目前全世界糖尿病前期患者一超过3亿,到2035年数量还将翻番。因此,我们在关注糖尿病的同时不能忽视糖尿病前期。糖尿病前期向糖尿病的进展过程是可以预防的,其最好的预防策略甚至并不需要应用药物,仅进行饮食干预及体力活动即可。但是,就饮食而言,适合北美人群糖尿病预防的饮食可能对非洲、中国或中国部分地区或日本却相对并无太大意义。因此,我们与美国临床内分泌医师协会(AACE)正在共同协调和制定非常灵活的具有地域特征的营养原则,倡导跨文化的营养计划。每个地区可在营养方案模板的基础上根据其特定需求,关注热量限制及常量营养物质调整,但膳食中具体的常量营养物质则需要根据患者所处的地理环境不同而有所不同。所以,我们需要合作伙伴,现在我们正在与对当地营养情况更了解的当地专家进行合作。
 
  对有糖尿病家族史、伴有超重的糖尿病前期患者而言,为预防其糖尿病发生,我们需要采用含有1400卡路里的饮食对其进行干预。但我们需要知道在坦桑尼亚、芝加哥、上海、新德里等不同地区,1400卡路里的热量到底意味着什么?在上述不同地区1400卡路里热量所对应的食物可能并不相同。到目前为止,人们通常认为只需要采取相同的膳食计划就行,还没有认识到跨文化营养方案的重要性。这实际上非常荒谬,无法达到真正预防糖尿病的目的。因此,我们需要跨文化的联盟来更好地将糖尿病预防的科学成果转化应用至全球所有社区的糖尿病预防中。

  <International Diabetes>: Great, thank you very much. So the last one: in order to narrow the gap between different areas and different races of population in stopping, in, you know, the best diabetes management,so what plan does ADA have right now in the future?

  Dr. Dagogo-Jack:Well the ADA has been a global – has had a global perspective since it was founded. People often hear – they hear the name American Diabetes Association, they think it’s only American. These meetings, everybody on the planet, every country, there is a member here, every continent has sent a member. And going back to our beginning, way back 1940s, we’ve been giving awards to people from any country where outstanding – they didn’t have to be American. So we are forming stronger and stronger collaborations with the International Diabetes Federation. In these meetings I have met with the presidents and chief executive officers of the European Association for the Study of Diabetes, met with the IDF, International Diabetes Federation. We held a joint conference – symposium, global diabetes symposium with speakers from India, Africa and Jamaica. And we have a session, joint symposium, with China Tribune, so there is a global realization that this problem is not for one country alone. The solution will not be for one country alone either. We are going to collaborate and continue to collaborate until we find a cure for diabetes and everybody can go home happy

  <International Diabetes>: Okay, thank you very much.

 
  缩短不同地区及种族人群糖尿病管理的差距,ADA有哪些计划?
 
  自成立开始,ADA一直是全球性的。人们通常听到ADA的名字时会认为ADA只是美国的。实际上ADA举行的会议面向地球上每个人和每个国家,每个洲都会派人来参会。追溯到ADA成立的上世纪40年代,ADA一直在为来自其他国家的人们颁发杰出成就奖,这些奖项的获得者并不都是美国人。所以,我们正在与国际糖尿病联盟(IDF)、欧洲糖尿病研究协会(EASD)开展越来越密切的合作。ADA今年举办了一场全球糖尿病研讨会,邀请来自印度、非洲及牙买加的讲者参加。此外,我们还与中国举办联合研讨会。
 
  因此,糖尿病防控是一个全球性问题,而绝不仅仅是某一个国家的问题。要想解决糖尿病防控问题绝非仅靠哪一个国家就能实现。我们需要不断进行合作,直至找到治愈糖尿病的方法,让每个人都能幸福生活。
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