Academician Ning Guang: Lifestyle Modification Outperforms Medication in Managing Metabolic Diseases

Currently, the incidence of metabolic diseases, such as obesity, hyperlipidemia, and non-alcoholic fatty liver disease (NAFLD), has risen significantly, becoming a major public health concern. Similar to anti-aging research, the study and management of metabolic diseases constitute a critical area of focus. One of the most significant challenges in managing these conditions is meeting the diverse and rapidly evolving needs of patients.

In May, at the Sequoia Global Healthcare Industry Summit, Academician Ning Guang, an academician of the Chinese Academy of Engineering and President of Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, shared his insights on “How Metabolic Disease Management Can Meet Patients’ Emerging Needs.” VCBeat has compiled and edited the highlights of his presentation.

Metabolic diseases are primarily manifested as diabetes and obesity. Currently, there are nearly 600 million people with diabetes worldwide, including approximately 140 million in China. The treatment and management of such a large population of patients with diabetes is a systematic and complex issue. Meanwhile, the problem of obesity cannot be overlooked. The current Body Mass Index (BMI) of the Chinese population has increased from around 22 in the past to approximately 25. BMI is a commonly used international indicator for assessing body fatness and health status; the normal range is between 20 and 25, with values above 25 classified as overweight and those above 30 as obese. A BMI of 25 has reached the critical threshold for health indicators.

To verify the authenticity of this upward trend, we conducted a dedicated study on diabetes and obesity in China in 2010. The results showed that 11.6% of the 150,000 participants included in the study were diabetic patients. Subsequent studies by many other researchers have yielded data consistently within the range of 11.6% to 12%. Furthermore, the research indicated that 20% to 25% of these diabetic patients were obese, reflecting the current status of metabolic diseases.

In light of this current situation, we need to consider several questions: What are the consequences of obesity and other metabolic diseases in China? Can these conditions be prevented and controlled? How can their prevalence be reduced?

To comprehensively analyze the risk factors for diabetes and its complications, explore the pathogenesis of diabetes, and provide new evidence to support the diagnosis, treatment, and management of diabetes in China, we launched the “4C” Study (the China Cardiometabolic Disease and Cancer Cohort Study) in China. The following are some of the study results:

First, can the prevalence of diabetes in China be reduced?

Many people hope that the prevalence of diabetes in China will further decline from over 10%, but the reality is quite the opposite. Currently, the prevalence of diabetes in China is still increasing at an annual rate of 2%. If newly diagnosed patients with prediabetes are included, this growth rate will triple. A nationwide epidemiological survey conducted in 2010 showed that among adults aged 18 and above in China, individuals with prediabetes accounted for 50.1% of the total population, representing a large base and a rapidly growing group.

Second, how to get 50% of the Chinese population to seek medical care at hospitals?

The risk of cancer in patients with diabetes is 2–3 times that of the general population. Currently, the leading causes of mortality in China are primarily cardiovascular and cerebrovascular diseases and tumors. Although many enterprises have focused their R&D efforts on these two areas and developed a large number of innovative products, thereby reducing mortality rates for these conditions, deaths from cardiovascular and cerebrovascular diseases still account for 38% of all deaths, while tumors account for 33%. This issue is highlighted because, in most cases, diabetes serves as a precursor to both cardiovascular/cerebrovascular diseases and tumors.

Based on this premise, if 50% of patients with prediabetes were to seek medical attention at hospitals, the existing healthcare resources might be unable to bear the resulting burden. The current approach being explored is to establish a platform or network that matches doctors with patients, akin to how ride-hailing services address transportation needs. The platform could be developed by individual physicians, medical teams, or even providers of medical methodologies.

To achieve substantial results, this platform must address two key issues: first, how to guide and correct patients’ lifestyle behaviors in their daily lives; and second, how to obtain continuous clinical data from patients within the hospital setting.

Third, can a truly regional or national network be established?

The primary objective of this network is to resolve the patient-physician matching problem, achieving “vertical integration”—linking upward with tertiary Grade A hospitals and reaching downward to patients and primary healthcare institutions. The platform is analogous to existing models such as “Medical Consortia” and “Medical Communities.” Furthermore, the network should be led by top-tier hospitals, which facilitates standardized treatment protocols for all patients—unified methodology, centralized management, and consistent care approaches—thereby reducing costs while managing chronic diseases. In the realm of diabetes management, we aim to establish such a network across 1,000 hospitals, simultaneously caring for 10 million patients.

Ride-hailing platforms address transportation challenges not only by establishing the platform itself but, more importantly, by increasing supply and improving vehicle operational efficiency. In the healthcare sector, however, expanding supply is a slow process, making it paramount to enhance the efficiency of in-hospital consultations. Therefore, from an implementation perspective, the primary issue that any newly established platform must resolve is how to improve hospital consultation efficiency while ensuring adequate consultation duration. In other words, the goal is to reduce non-essential time spent during medical visits while simultaneously increasing the time available for doctor-patient communication. Currently, most doctor-patient interactions last only 3–5 minutes. How can this be extended to 15 minutes? There are two key considerations: 1. How can patients and doctors make effective use of this time for meaningful communication? 2. What technologies can be employed to facilitate effective communication and extend the duration of these interactions?

Secondly, patient visit data in hospitals needs to be recorded to facilitate subsequent patient management. Currently, some independently developed technologies in China, such as TiDB, can truly address this issue. When patients seek medical care at hospitals today, their medical history cards can record up to 2,000 entries of medical history data, whereas previously they could only accommodate 5 to 15 entries.

“National Center for Standardized Management of Metabolic Diseases” (MMC) is an innovative model that enables patients to address all diabetes-related issues through a “one-stop” service. Its core philosophy is to establish a new paradigm for diabetes diagnosis and treatment characterized by “one center, one-stop service, and one standard,” with the ultimate goal of reducing the prevalence of diabetes and its various complications in China.

Currently, MMC manages approximately 2 million patients, with 1,600 participating hospitals, including 21% of China’s Grade III Class A hospitals, and has attracted approximately 7,000 to 30,000 physicians.

Everyone is exploring approaches to pharmacological treatment, with physicians predominantly relying on medications to manage patients. However, doctors do not simply recommend a specific drug; rather, they advocate for a therapeutic approach. By adopting this recommended strategy, the diabetes control rate can increase from approximately 15% to around 45%. This effect is sustainable because it stems from lifestyle modifications rather than sole reliance on medication. These findings demonstrate that diabetes and many other metabolic disorders are fundamentally lifestyle-related diseases; therefore, implementing lifestyle changes represents the most effective treatment for such conditions.

I believe that relying on pharmaceuticals or unnatural methods to address the challenges facing humanity is certainly not the optimal approach; only by employing natural solutions can humankind truly move forward.

We have conducted research using existing data, such as AI-assisted diagnosis and treatment of retinopathy. In a study comparing the prevalence of COVID-19 infection between patients with diabetes and the general population, the results showed a higher prevalence among diabetic patients. However, diabetic patients who received MMC treatment exhibited a lower prevalence, demonstrating that lifestyle modifications are also an important approach to preventing COVID-19.

Currently, in addition to our academic advancements, we have also engaged several enterprises, fostering robust collaboration between businesses and hospitals and thereby cultivating a thriving ecosystem. We refer to this ecosystem as “M-Campus,” with its hub located in Wuxi. M-Campus has integrated companies that provide technical support for the MMC (Metabolic Management Center) model; three such companies have already joined, primarily addressing issues related to blood glucose monitoring and urine testing. These partnerships enable the MMC model to achieve genuine self-evolution and establish a symbiotic ecosystem. Looking ahead, we aim to attract more startups to join us in tackling chronic diseases through comprehensive management strategies.