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Guard Against Type 2 Diabetes

Xin YUE, Internal Medicine Physician, Associate Chief Physician

Diabetes mellitus is a chronic disease related to the hormone that regulates blood sugar in the body, insulin. When the pancreas does not produce enough insulin or the body cannot effectively use the insulin it produces, diabetes appears [1]. Diabetes is divided into type 1 diabetes (lack of insulin) and type 2 diabetes (ineffective use of insulin).

In recent decades, along with urbanization, aging and changes in the contemporary lifestyle, the prevalence of type 2 diabetes has seen a significant increase worldwide, becoming one of the main diseases endangering human health. In China, the prevalence of diabetes in people over the age of 20 has gone from 0.67% in 1980 to 9.7% in 2008 [2], with the total number of adults diagnosed with diabetes reaching 92.4 million. With the current growth rate, it is expected that by 2030, the world will have 500 million people with diabetes.

The dangers of diabetes

The major risks of diabetes are complications in small blood vessels (microvascular) and in large blood vessels (macrovascular). These can include complications that cause retinopathy (damage to the retina of the eye), diabetic nephropathy (a progressive kidney disease), diabetic neuropathy (affecting all peripheral nerves and organs), hypertension, cerebrovascular disease, cardiovascular disease and lower extremity disease. Diabetic retinopathy is the main cause of adult blindness; diabetic nephropathy is a common cause of chronic renal failure. The medical expenditures needed to combat these complications account for the most significant portion of the healthcare costs of diabetes.

Populations at risk for developing type 2 diabetes

Certain ethnic groups are genetically more predisposed to developing diabetes. People of African descent, Latinos, Native Americans, people of Asian descent, and Pacific Islanders are all at increased risk. Additionally, those with the following risk factors should regularly be screened for diabetes:

  •  Obesity and lack of exercise
  •  First-degree relatives (parents and siblings) with diabetes
  •  History of cardiovascular disease
  •  History of gestational diabetes
  •  History of delivering large for gestational age (LGA) babies
  •  Hypertension or dyslipidemia
  •  Impaired fasting glucose
  •  Suffering from polycystic ovarian syndrome (PCOS)
  •  Glycosylated hemoglobin (A1C) ≥ 5.7% or glucose intolerance
  •  People with insulin resistance-related diseases

In addition, even in the absence of risk factors, those 45 years or older should start having regular screenings for diabetes.

Diagnostic criteria for diabetes

The diagnostic criteria of the American Diabetes Association (ADA) in their 2012 guide are: glycosylated hemoglobin (A1C) ≥ 6.5% or fasting blood glucose (FBG) ≥ 7.0mmol / L, or glucose tolerance test postprandial blood glucose 2 hours (OGTT2hPG ) ≥ 11.1mmol / L, or typical symptoms of patients with unregulated blood glucose ≥ 11.1mmol / L. Of course, if the patient does not clearly present with hyperglycemia, the above results must be reviewed and repeated.

The treatment of diabetes

More and more treatment options for diabetes have become available in recent years, including new medications. The cornerstone of all treatment, however, is always a strict diet and appropriate exercise. Certain medications are also very effective, including six types of oral hypoglycemic agents, GLP-1 receptor agonists and a wide range of insulin injections. In addition, weight loss surgery can be effective in the treatment of obese patients with type 2 diabetes. Blood glucose monitoring is very important and serves as the basis for treatment options. Patients can collect blood glucose data through self-collected daily blood glucose monitoring or continuous glucose monitoring systems (CGMS), which patients can choose according to their own needs.

In summary, diabetes is an increasingly serious health and societal problem. Controlling risk factors, taking preventative measure as soon as possible, and vigilantly screening to enable early diagnosis and treatment have far-reaching significance for every patient and society as a whole. High-risk groups should take measures to actively prevent developing the disease and maintain a healthy weight. This can be achieved by getting regular exercise, controlling caloric intake with a good diet and quitting smoking.

Diabetes is a lifelong, chronic disease, and its treatment is complex. Successfully managing it means paying attention to many factors beyond merely controlling blood glucose levels. Overcoming diabetes requires a coordinated effort between patients and doctors to balance diet, exercise, diabetes education, medication and blood glucose monitoring.

For more information:
Glucose monitoring system (CGMS): http://datun.ufh.com.cn/en/medical-services/internal-medicine/CGMS/
United Family Bariatric Clinic: http://datun.ufh.com.cn/en/news/2012/11/14/Bariatric-Clinic/

[1] http://www.who.int/mediacentre/factsheets/fs312/zh/index.html
[2] The 2010 edition of Chinese type 2 diabetes prevention and treatment guidelines

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