In order to gain a deeper understanding of the current situation we have acquired knowledge regarding the primary treatment methods for diabetes, hypertension, and colitis. Our plan entails conducting street random interviews with chronic disease patients from various regions in Hubei Province to ascertain their present primary treatment methods and attitudes towards existing medications. Our objective is to identify areas that require improvement. During these interviews, it came to our attention that some patients express concerns about polypharmacy, while others mentioned inconveniences associated with injection-based administration in their daily lives. Towards the conclusion of the interviews, we briefly introduced our preliminary concept of synbiotic therapy and assessed patients' receptiveness towards this novel medication approach(Figure 1,2,3,4).
Conventional treatment
Diabetes
1.Biguanides, such as metformin, primarily reduce hepatic glucose output and enhance peripheral tissue utilization of glucose to effectively lower blood glucose levels. Currently, metformin is considered a first-line medication for the treatment of type 2 diabetes.
2.Sulfonylureas stimulate pancreatic β-cells to secrete insulin in order to achieve glycemic control. Examples include glimepiride, glipizide, glyburide, etc.
3.α-glucosidase inhibitors like acarbose and voglibose exert their hypoglycemic effects by inhibiting intestinal α-glucosidase enzymes and reducing glucose absorption.
4.Thiazolidinediones such as pioglitazone and rosiglitazone are also utilized for lowering blood sugar levels.
5.Additionally, there are newer classes of antidiabetic drugs available including GLP-1 receptor agonists, DPP-IV inhibitors, SGLT-2 inhibitors.
Hypertension
1.Calcium channel blockers (CCBs) exert their antihypertensive effects by vasodilating blood vessels. Commonly used drugs include short-acting dihydropyridines such as nifedipine, long-acting dihydropyridines like amlodipine, and non-dihydropyridines such as diltiazem and verapamil.
2.Angiotensin-converting enzyme inhibitors (ACEis) inhibit the production of angiotensin II, thereby reducing blood pressure. Commonly prescribed ACEis include captopril, enalapril, benazepril, lisinopril, and fosinopril.
3.Angiotensin receptor blockers (ARBs) block type 1 receptors for angiotensin II. Frequently used ARBs consist of losartan, valsartan, irbesartan, olmesartan medoxomil, candesartan cilexetil, telmisartan, and azilsartan medoxomil.
4.Diuretics primarily lower blood pressure by promoting sodium excretion and reducing volume load.Thiazide diuretics are the main class of diuretics and can be further categorized into thiazide-type diuretics (such as hydrochlorothiazide and bendroflumethiazide)and thiazide-like diuretics(such as chlorthalidone and indapamide).
Beta-blockers are highly selective beta1 receptor blockers that have fewer adverse reactions due to their limited blockade of beta2 receptors. They effectively reduce blood pressure while also providing protection to target organs and decreasing the risk of cardiovascular events. Commonly prescribed beta-blockers include metoprolol tartrate/succinate(Lopressor/Toprol-XL), atenolol,bisoprolol , acebutolol , propranolol( Inderal ) etc.
Colitis
1.Aminosalicylate drugs, such as sulfasalazine (SASP), balsalazide, olsalazine, and mesalamine, primarily exert localized anti-inflammatory effects by targeting the intestinal mucosa. Unlike most medications, they do not elicit systemic responses upon entering the bloodstream and demonstrate favorable safety profiles.
2.Corticosteroids may be employed for patients who exhibit inadequate response to aminosalicylate drugs or encounter relapse during treatment. Prednisone and methylprednisolone are commonly prescribed corticosteroids in such cases. However, prolonged usage of corticosteroids can give rise to various adverse reactions and is unsuitable for maintenance therapy.
3.Immunosuppressants like azathioprine, 6-mercaptopurine, and methotrexate are predominantly utilized for maintenance therapy in patients with steroid intolerance or after tapering off steroids. The primary side effects associated with immunosuppressants encompass bone marrow suppression, hepatic and renal impairment, as well as an increased risk of neoplastic growths; hence vigilant monitoring is imperative when employing these medications.
Interview findings
In order to gain a deeper understanding of patients' concerns and enhance our project's capacity to cater to the target group, we conducted random interviews with patients suffering from colitis, diabetes, hypertension, etc. Through these interviews, it was discovered that some diabetic patients who rely on insulin injections still encounter inconveniences in their daily lives due to this method of administration. Moreover, they often have to take numerous medications for various chronic diseases which leads to anxiety. Mitigating some of this anxiety could be achieved by reducing dosage or increasing the interval between medication intake. The specific interview results encompassed patients' attitudes and suggestions pertaining to current medication practices. With regards to novel drugs, safety and price emerge as primary concerns for patients followed by efficacy. Some patients expressed willingness to experiment with new drugs but have certain prerequisites such as affordability and safety.
Patient A: Male, aged 34, diagnosed with ulcerative colitis. Currently undergoing treatment primarily with aminosalicylic acid inhibitors and hormones, experiencing periodic recurrences of the condition. He expressed interest in living synbiotic therapy but has concerns regarding its safety and efficacy. His main hope is that this novel therapy can reduce his reliance on hormones and minimize the risk of side effects.
Patient B: Female, aged 42, suffering from chronic colitis for an extended period. She has displayed a strong inclination towards living synbiotic therapy. She mentioned her willingness to try it if it could improve her symptoms by adjusting her intestinal flora. However, she also worries about the potential cost of treatment and hopes it will not be excessively high or can be covered by medical insurance reimbursement.
Patient C: Male, aged 58, possesses some knowledge about probiotic products. He believes that living synbiotic therapy may serve as an effective treatment option. He desires more clinical data supporting its effectiveness and stated that if proven accurate, he would recommend it to other patients.
Patient D: Female, aged 65 approaches any new treatment cautiously due to concerns about potential unknown side effects associated with living synbiotic therapy; therefore she prefers traditional treatments that have stood the test of time. She mentioned not considering trying it unless there is substantial evidence proving its safety and effectiveness.
Patient E: Male, aged 28 recently diagnosed with mild colitis holds an optimistic view towards living synbiotic therapy and hopes for complete recovery through this approach while avoiding long-term medication use. He expressed concerns about the long-term effects of the therapy as well as possible recurrence; thus he desires more information about this treatment along with guidance for patients.
Patient F: A 72-year-old male currently undergoing thrice-daily insulin injections, which pose significant inconvenience. It would be highly desirable to have an oral medication alternative available. “I am open to considering it provided that it is certified by a reputable institution for safety. Anticipating its availability eagerly.”
Patient G is a 67-year-old male who currently finds the oral administration of his medication convenient, taking one tablet per night. However, the cost of this medication for both diabetes and hypertension treatments amounts to approximately 4-5 thousand yuan per year. The patient expresses that if our new drug can effectively regulate blood sugar levels and is economically accessible, with minimal or even reduced expenses compared to the existing synbioitic therapy, they would be open to trying it. Nevertheless, if the price exceeds their budgetary constraints, they will not consider adopting the new drug.
Patient H is a 68-year-old female with multiple underlying conditions, requiring the administration of nearly ten pills at once. The convenient once-daily dosing method is compromised due to the need to take blood pressure and blood sugar medications concurrently with other medications. Although there are concerns about polypharmacy, if safety can be ensured, it would be worthwhile to consider trying the new medication for its potential effectiveness.
Patient I is a 20-year-old male who has recently been diagnosed with hypertension and started taking medication. However, the effectiveness of the medication is currently unstable. He aims to control his blood pressure within normal range or even cure it completely so that he can avoid long-term medication use. The patient is open to synbiotic therapy and hopes it can regulate his overall body function by actively cooperating with dietary adjustments, addressing the root cause of high blood pressure rather than just treating symptoms. While controlling blood pressure may seem effective on the surface, preventing underlying factors from worsening is crucial in managing chronic diseases. Although difficult to cure, prolonging drug treatment duration and reducing frequency of intake are possible solutions. Additionally, he hopes not to experience sudden spikes in blood pressure after discontinuing medication like some other patients do. Furthermore, he prefers probiotics used in therapy that are easily stored as their efficacy may be compromised if they become inactive too quickly during daily life.
Certain patients exhibit ambiguous attitudes and are currently in a state of cautious observation. Conversely, some patients explicitly articulate concerns regarding the elevated risks associated with novel medications, apprehensive about potential complications, and expressly assert their unwillingness to be part of the initial cohort for experimental drugs. This further underscores the imperative need for heightened emphasis on safety.
Patient J: Male, 53 years old. The patient reported that the current antihypertensive medication he is taking is not covered by national medical insurance, resulting in high costs. He mentioned that if it were available over-the-counter, the price requirement for medication would be more affordable. Moreover, he expressed willingness to try the new drug if it effectively controls blood pressure; however, he will adhere to doctor's orders and only use the new drug if prescribed by the hospital.
Patient K: Female, 55 years old with hypertension. The patient currently does not take any medication and exhibits some reluctance towards pharmaceutical treatment. Regarding synbiotic therapy, she did not express a definitive stance but mentioned her desire for fast and stable efficacy without requiring long-term continuous use of drugs when necessary.
Patient L: Male, 68 years old with diabetes who currently manages his condition through diet control alone. In relation to synbiotic therapy, he stated "If it proves effective then certainly," but also voiced concerns about being an experimental subject and prefers observing others' responses before trying it himself.
Patient M: Female, 81 years old. The patient believes that her current medication is reasonably priced as it is covered by medical insurance and does not impose significant financial burden. She expresses unwillingness to accept new drugs due to concerns about potential side effects and instability compared to conventional antihypertensive medications which have undergone extensive clinical studies. She fears developing health issues from unnecessary medications unless her existing treatment fails or until there are confirmed safety records and a substantial population using the new drug; only then would she consider trying it out.
Patient N: A 70-year-old female patient. The patient does not perceive the medication as being costly, with a price of approximately twenty yuan per box. Moreover, the patient declines synbiotic therapy due to concerns regarding potential inferiority of the new medication's effectiveness. She firmly believes that the current treatment is both efficacious and affordable, thus rendering any switch to an alternative treatment method unnecessary.
Figure 1 patients’ satisfaction with the current medication method
Figure 2 Patients' Acceptance of the Project and the New Drug
Figure 3 patients’ potential concerns about new drugs