Clinical Story | Professor Junhang Tian: The "Truth, Goodness, and Beauty" of Clinical Trials

Editor's Note:

At the Third People's Hospital of Luoyang, treatment and research on endocrine and metabolic diseases are in full swing. As an expert in this field, Professor Tian Junhang boasts extensive experience in clinical drug studies focused on metabolic disorders. Recently, the Clinical Research Promotion Public Welfare Fund was honored to conduct an exclusive interview with Professor Tian. He shares his unique perspective on the "truth, goodness, and beauty" principles guiding clinical trials, while also emphasizing that the nation should take a top-down approach to further refine its healthcare system.

Written by | Mao Donglei

The Current Status and Challenges of Metabolic Diseases in Luoyang

Professor Tian Junhang first presented an overview of the current status of metabolic diseases in Luoyang. As a city representing China’s moderate level of development, Luoyang currently sees diabetes and obesity as the primary endocrine and metabolic disorders. These conditions are chronic epidemics that continue to show a growing trend.
 

Professor Tian Junhang, Director of the Department of Endocrinology at Luoyang City Third People's Hospital.

Served as a committee member of the Henan Provincial Endocrinology Society, standing committee member of the Endocrinology Group of the Henan Provincial Hypertension Research Association, committee member of the Henan Provincial Society for Integrated Traditional Chinese and Western Medicine in Endocrinology, vice chairman of the Luoyang City Endocrinology Society, and member of the Luoyang City Medical Technology and Medical Malpractice Expert Panel.

The incidence of diabetes continues to remain at alarming levels, with obesity serving as a critical underlying factor. In recent years, the prevalence of obesity among adults has surged to as high as 30% to 50%. Obesity is now officially recognized as a medical condition, as it not only triggers diabetes but also increases the risk of cardiovascular and cerebrovascular diseases, osteoporosis, and even impacts reproductive health—leading to issues such as premature ovarian failure, reduced libido, menstrual irregularities, and diminished sperm quality. Moreover, obesity can make it challenging for individuals to find partners, adding significant psychological and social burdens.

The obesity issue is not only a challenge for individuals but also a major problem for society and the nation. Currently, effective treatments for obesity remain limited, and the corresponding medications have yet to be covered by health insurance. This leaves families with obese members deeply concerned, making it a headache for society as a whole.

Medical and societal joint efforts

Professor Tian Junhang believes that preventing obesity—thus averting diabetes—is the most critical strategy. However, addressing this issue solely from a medical perspective is insufficient; instead, it requires a collective effort from both the nation and society, involving the integrated impact of factors such as healthcare and education. By improving environmental conditions, we can help slow down the progression of these chronic, widespread diseases. Beyond pharmaceuticals and medical interventions, societal-level approaches remain relatively underdeveloped. Professor Tian emphasizes the importance of educating patients to adopt healthier lifestyles and break harmful habits. Relying exclusively on medication while neglecting psychological support and lifestyle adjustments often proves ineffective and futile.

When it comes to drugs for blood sugar control and weight management, metformin has been hailed as a "miracle drug" over the past decade. It modestly improves appetite and aids in weight loss. Additionally, metformin helps enhance insulin sensitivity and alleviate symptoms of polycystic ovary syndrome. As a result, major global guidelines recommend metformin as the first-line treatment option.

However, metformin has not been definitively proven to prevent the onset of diabetes. The pathogenesis of diabetes is complex, and given the rapid advancements in biomedicine—particularly in molecular biology—insulin has evolved from human insulin to insulin analogs. These cutting-edge technologies also encompass the biosynthesis of anti-lipid-metabolism drugs such as GLP-1, GIP, and GCG. Notably, GLP-1 receptor agonists, including both single- and dual-target therapies (like those targeting insulin receptors), have already been extensively synthesized and developed.

Since the advent of insulin-based blood sugar-lowering technology, the most significant adverse effect has been hypoglycemia—a challenge that all insulin formulations struggle to avoid. Developing a technology that can effectively reduce blood glucose levels without triggering resistance would be profoundly impactful. Currently, emerging approaches such as small-molecule peptides, including GIP, are attracting considerable attention.

These technologies have been clearly shown to improve glucose and lipid metabolism, as well as promote weight loss. They stimulate insulin secretion when blood sugar levels are high, helping to lower blood glucose; however, in situations where blood sugar is normal or even slightly low, they do not trigger insulin release. At the same time, these compounds can also correct other metabolic abnormalities—for instance, by acting on the gastrointestinal tract to enhance feelings of fullness, boost lipid metabolism, and reduce appetite, ultimately aiding in weight management. Importantly, this mechanism remains effective for healthy individuals without disrupting their blood sugar levels. Semaglutide, a leading drug representing this class of technology, remains in high demand despite its relatively expensive price.

Among antidiabetic drugs, Professor Tian specifically highlighted the DPP-4 target; sitagliptin, originally developed by Merck, is a prime example of this class. DPP-4 inhibitors work by enhancing the body’s natural GLP-1 levels, thereby helping to regulate insulin secretion. Naturally occurring GLP-1 levels in the body are very low and have an extremely short half-life—no more than 10 minutes. By inhibiting the enzyme that breaks down GLP-1, DPP-4 inhibitors extend the active duration of the body’s naturally produced GLP-1. These medications stimulate insulin release when blood sugar levels are high, effectively lowering glucose, while simultaneously reducing insulin secretion—or even boosting glucagon production—when blood sugar dips, ensuring blood glucose remains stable.

The new generation of DPP-4 inhibitors, represented domestically by Senglitin from Shengshitaike, has been developed by improving Merck’s sitagliptin and has undergone rigorous, high-quality clinical trials—resulting in its recent approval for market launch. As one of the nationwide multi-center participating institutions, Luoyang City Third People’s Hospital also took part in the drug’s Phase III clinical trial.

Professor Tian commented that sengliptin exhibits a stable and gentle blood sugar-lowering effect, making it a neutral antidiabetic drug. Its most notable feature is that it does not cause hypoglycemia, making it particularly suitable for elderly patients, as well as individuals with pre-existing risk factors for cardiovascular and cerebrovascular diseases.

During the clinical trial, researchers built strong, friendly relationships with patients and their families, offering them every possible convenience. After the trial concluded, some participants even presented CRC staff with flowers and a beautifully crafted banner to express their heartfelt gratitude. Throughout the study, CRC staff played a vital role, forging close bonds with patients and their families—and, in many cases, becoming trusted friends who earned deep appreciation from those they supported.

The "Truth, Goodness, and Beauty" of Clinical Trials

Professor Tian believes that clinical trials not only provide numerous medical benefits to participants but also ensure their rights are fully protected. Luoyang City Third People's Hospital has always prioritized the protection of participants' rights, as mandated by GCP standards.

He further elaborated on the "truth, goodness, and beauty" principles in clinical trials. "Truth" refers to the authenticity of the clinical trial itself. Researchers must ensure the accuracy and quality of all data, adhering rigorously to inclusion/exclusion criteria and GCP guidelines—from the enrollment of participants through the entire trial period—all data remain fully traceable. The institute has undergone multiple inspections by the national authority, and every piece of verified data has proven to be authentic and reliable, thereby upholding the integrity of the trial.

Good practice means treating subjects with kindness. They always prioritize the principle of subject protection, strictly adhering to GCP guidelines, and building rapport with patients and participants—actions that are crucial for enhancing subject compliance and preventing dropout.

Beauty lies in the heart of the physician. Guided by the principle that "sometimes to cure, often to help, always to comfort," researchers treat patients as if they were their own loved ones. Inspired by this famous quote from American physician Dr. Trudeau, they are committed to meticulously conducting clinical trials while ensuring the highest level of care and support for all participants.

Recommendations and Prospects for Drug Development

Finally, Professor Tian offered pharmaceutical companies several recommendations from a drug-development perspective on how to enhance the safety and efficacy of medications—and even eliminate certain complications.

First, in the early stages of drug development, it’s essential to thoroughly investigate and identify promising target candidates—this is key to enhancing drug efficacy. At the same time, selecting appropriate trial endpoints is critical, as it ensures that the treatment effects of the drug are accurately reflected.

Secondly, they anticipate that in the future, AI will play an even greater role in areas such as target selection for new drug development and drug discovery. With the aid of AI technology, it will be possible to more efficiently screen and identify potential drug candidates, thereby accelerating the pace of new drug research and development.

Once again, precision medicine is a crucial pathway toward highly personalized treatments. For instance, the concept of a smart insulin capsule—equipped with an implanted chip to precisely regulate insulin release—holds promise in addressing the treatment challenges faced by patients with type 1 diabetes. Moreover, precision medicine also encompasses accurate genetic diagnostics, and in the future, it may enable gene-based therapies that fine-tune gene expression, ultimately offering new hope for treating diseases caused by abnormal gene activity.

During the drug development process, it’s important to focus on a drug's bidirectional regulatory effects to avoid serious adverse reactions, such as hypoglycemia. By precisely controlling the drug's mechanism of action, we can achieve safer and more effective therapeutic outcomes.

Professor Tian stated that drug development is a complex and lengthy process, requiring careful consideration of factors such as target selection, clinical endpoints for trials, intelligent technologies, and personalized medicine. He expressed confidence that in the future, more innovative, safe, and effective drugs will emerge.
 

A message to young doctors on improving the healthcare environment

Having practiced as a clinician for many years, Professor Tian has gained profound insights into how young doctors can steadily advance and thrive in this field. He believes that, as they embrace modern medical principles, knowledge, and technologies, young physicians should actively cultivate their expertise through hands-on clinical practice. Above all, they must treat patients with the same care and compassion they would show to family members—and never view medicine merely as a means to pursue personal gain. If financial interests take precedence over patient well-being, reputations will suffer, ultimately leading to greater losses than gains. Moreover, such an approach will inevitably hinder the continuous refinement and mastery of one’s medical skills.

As a clinical physician rehired after retirement, Professor Tian feels deeply fulfilled, yet he also believes that both the advancement of medicine and personal growth require a stronger overall environment—and the support of robust national policies.

Currently, doctors are under pressure to meet various performance metrics, forcing them to spend significant time and energy just to fulfill these targets. As a result, they hope the government will address the broader healthcare environment at a macro level, allowing doctors to focus solely on treating patients and saving lives—without being distracted by unnecessary administrative tasks. At the same time, they believe doctors' incomes should be decoupled from their workload to prevent over-treatment and help conserve healthcare system resources. Reasonable subsidies could still be provided to doctors, but their earnings shouldn't directly depend on the number of surgeries performed or outpatient visits.

As a veteran physician, Professor Tian sincerely hopes that the country will improve the medical environment and system, providing healthcare professionals with research funding and adequate subsidies to ease their burdens. "The nation needs to take a top-down approach, establishing comprehensive systems that offer robust support for the healthy development of the medical sector," he concluded. (Article sourced from: Clinical Research Promotion Public Welfare Fund)