The prevention of diabetes should be under the leadership of governments and health departments at all levels to mobilize social support and jointly participate in the prevention, treatment, education and health care programs. Comprehensive programmes are designed, implemented and evaluated with self-care and community support as the main components. Prevention is divided into three levels: primary prevention is to avoid the onset of diabetes; secondary prevention is early detection and effective treatment of diabetes; and tertiary prevention is to delay and/or prevent diabetes complications. Promote a reasonable diet, regular exercise, to prevent obesity. The key to prevent T2DM is to screen IGT population and intervene it in IGT stage, which may make IGT remain in IGT or change into normal glucose tolerance state. In recent years, a series of large-scale clinical intervention trials of IGT have been carried out, which indicated that it is possible to reduce or delay the incidence of FMD by means of lifestyle or drug intervention.
1. Primary prevention refers to the non-selective prevention for individuals or the whole population susceptible to diabetes, mainly refers to changes in environmental factors and lifestyle, to prevent or reduce the occurrence of diabetes all activities. Such as appropriate restriction of energy intake, to avoid obesity, promote normal weight and encourage more physical activity. The implementation of this preventive measure generally requires a high degree of attention by the state, the government and the health sector as a state policy to mobilize a wide range of health-care personnel and to use the mass media for extensive and thorough social information and education, to improve people’s basic knowledge about diabetes and understand the harmfulness and severity of diabetes and its complications, so as to achieve the desired results.
In addition, type 2 diabetes is a polygenic genetic disease, more than 20 candidate genes such as insulin gene, INSR gene, INSR 1 gene, glucose transporter gene, glucokinase gene, glycogen synthase gene, Β3 receptor gene and mitochondrial gene have been found to be associated with type 2 diabetes, the study of the association between these candidate genes and type 2 diabetes provides us with molecular biological basis for disease risk prediction in the population, which is currently being studied in many countries around the world, it is believed that in the near future, better conditions will be created for us to prevent, treat or delay the onset and development of type 2 diabetes.
For primary prevention of type 1 diabetes it is recommended that first-degree relatives of type 1 diabetes with islet cell antibody positive and/or Glutamate decarboxylase antibody positive be treated with immunotherapy (such as cyclosporine and mercaptopurine) and free radical scavengers (such as nicotinamide) to prevent or delay type 1 diabetes, it is currently in the early stage of exploration and research, but this marks the beginning of a new era in the prevention of type 1 diabetes.
2. For secondary prevention, the population at high risk of type 2 diabetes (including family history of diabetes, hypertension, hyperlipidemia, obesity or overweight over 40 years of age and gestational diabetes, etc.) is targeted, to prevent or reduce the occurrence of diabetic complications, early intervention and management should be carried out in people with latent type 2 diabetes and impaired glucose metabolism (IGT) or impaired fasting glucose (IFG) or IGT, particular emphasis is placed on preventing or delaying progression to type 2 diabetes in people with pre-diabetes, including IGT or IFG or IGT IFG. IGT is now widely recognized as a transitional stage in the development of type 2 diabetes, sometimes referred to as the “Pre-diabetes phase”. Almost all people with type 2 diabetes go through the IGT stage before the onset of the disease, according to a report by the International Diabetes Federation. The prevalence of IGT varies greatly among different races in the world, ranging from 3% to 20% . Like type 2 diabetes, IGT is associated with weight gain or obesity and physical inactivity. A positive family history of type 2 diabetes is a strong risk factor for IGT, low birth weight infants, low birth weight infants and those with low birth weight 1 year after birth also predicted an increased risk of IGT in the 40 to 60 years of age. In addition, it was suggested that elevated triglyceride was associated with IGT, but the cause-and-effect relationship has yet to be established. The prevalence of IGT in China is 2.5% ~ 4.2% . 2% ~ 14% of IGT patients in different countries may become type 2 diabetes every year. General literature reports that 19% ~ 60% of IGT patients will become type 2 diabetes in 5 ~ 10 years. It was reported that the annual change rate of IGT to type 2 diabetes was 7.7% ~ 8.95% . On the other hand, the study also found that IGT patients have abnormal glucose metabolism, it is often accompanied by hyperinsulinemia, dyslipidemia (a decrease in high triglycerides, HDL-cholesterol, an increase in LDL-cholesterol) , Hyperuricemia, hyperfibrinogenemia, and dysfunction of the fibrinolytic system (such as an increase in plasminogen activator inhibitor-1 activity and a decrease in tissue-type plasminogen activity) , thus lead to hypertension, cardiovascular and cerebrovascular arteriosclerosis disease risk significantly increased. In view of this, the intervention treatment of IGT population has been raised to an important position, the main objective is to reduce the risk of type 2 diabetes and cardiovascular diseases. At present, many diabetes research centers at home and abroad have made the intervention and treatment of IGT population as the main topic of multi-center collaborative research. Intervention therapy mainly includes behavioral intervention and drug intervention.
Behavioral interventions include limiting total calorie intake, reducing dietary fat (< 30%) , especially fatty acid (< 10 > 5%) , or maintaining normal body weight. The more successful the intervention, the lower the conversion rate to diabetes. Increasing physical activity is obviously beneficial to IGT patients, such as advocating cycling or commuting one stop earlier, increasing walking distance and taking less elevators. Eriksson et al. observed 181 IGT men prospectively for 6 years. The results showed that the incidence of diabetes was 10.6% in the group encouraged with regular exercise, compared with 28.6% in the non-intervention group, and the relative risk was 0.37. In general, dietary and exercise interventions are often carried out simultaneously. Tuomilhto et al. , Finland, 522 IGT patients were randomly divided into a diet-and-exercise intervention group (individually guided, reduced total and saturated fat intake, increased fiber intake and exercise volume, with the goal of weight loss) and a control group, followed up for an average of 3.2 years, after 4 years, the cumulative incidence of diabetes was 11% in the intervention group and 23% in the control group. Data from the domestic survey in Daqing showed that diet and exercise can reduce the rate of IGT to type 2 diabetes by 50% .
Behavioral intervention is the basis, safe and effective, but there are some defects in its long-term implementation, which affect its long-term intervention effect. Can be shown as follows:
I did, but I didn’t hear it.
Yes, but I don’t understand.
Understood, but not accepted.
Accepted, but not acted upon.
It did, but it didn’t last long.
(2) drug intervention: in recent years, IGT has been paid more and more attention to because of the difficulty of patients’persistence and poor compliance due to diet and exercise intervention, and the limited effect of long-term intervention, these include biguanides (metformin) , alpha-glucosidase inhibitors and insulin sensitizers, 1,3-thiazolidine-2,4-dione derivatives. The premise of drug intervention is that the drug itself is non-toxic, can improve insulin resistance and protection
3. Tertiary prevention
That has been diagnosed with diabetes, through various means of comprehensive treatment to prevent or delay its complications, mainly for the occurrence and development of chronic complications. The occurrence of chronic complications of diabetes is influenced by many factors. Comprehensive and reasonable measures should be taken to reduce or delay the occurrence and development of chronic complications of diabetes.
1 active control or elimination of risk factors associated with complications:
A. Optimal control of hyperglycemia, to eliminate or reduce the toxic effect of chronic hyperglycemia: diabetes education, diet therapy, exercise therapy, drug therapy and blood glucose monitoring can be used to make blood glucose as close to normal as possible (fasting blood glucose < 6.0 mmol/L, 2 hours postprandial blood glucose < 8.0 mmol/L, hba1c < 6.5%) , this is the basis of prevention and treatment of chronic complications of diabetes. Studies from the diabetes control and complications trial (DCCT) in North America and the prospective diabetes study (UKPDS) in the United Kingdom have confirmed that good glycemic control significantly reduces the incidence and progression of chronic complications in patients with type 1 and type 2 diabetes. Recently, many scholars have paid attention to the fact that in the long-term treatment of diabetes, not only blood sugar should be well controlled, but also obvious fluctuation of blood sugar should be avoided as far as possible, it also had a significant negative effect on the formation of arteriosclerosis.
B. Rational use of Antihypertensive drug, ideal control of blood pressure: hypertension is often associated with diabetes, and accelerates the occurrence and development of many chronic complications of diabetes, ideal control of blood pressure can significantly reduce or delay the occurrence and development of diabetic macrovascular and microvascular complications. Currently, there are 6 types of first-line Antihypertensive drug in clinical use, such as diuretics, beta-blockers, alpha-blockers, calcium antagonists, ACE inhibitor and Angiotensinogen II blockers. The latter two have no adverse effects on glucose and lipid metabolism, and can be used as the first choice of drugs. In particular, ACE inhibitor is widely recognized as having the potential to reduce blood pressure while providing a relatively more effective prevention and treatment for a variety of chronic complications of diabetes. For diabetic patients with hypertension, the blood pressure should be controlled at about 130/80 mmhg or even lower, and the blood pressure should be controlled below 125/75 mmhg in patients with proteinuria.
C. Correction of lipid metabolism disorders: diabetes is often associated with abnormal lipid metabolism (such as hypertriglyceridemia, hyperldl-cholesterol and HDL-cholesterol decrease and oxidative-LDL and glycation levels increase) , which can promote the occurrence of vascular complications. According to the different types of hyperlipidemia, different drugs should be taken according to different types of hyperlipidemia. [ currently, there are five kinds of commonly used hypolipidemic drugs at home and abroad: bile acid isolators, nicotinic acid derivatives, fibrate derivatives and HMG-CoA reductase inhibitors, etc. ] and diet therapy, promote normal control of blood lipids. Multi-center Collaborative Studies from abroad have reported that HMG-CoA reductase inhibitors can significantly reduce blood cholesterol and triglyceride in patients with diabetes, raise HDL, significantly reduce the incidence of coronary heart disease (including myocardial infarction) and mortality, it also significantly reduced the rate of decline in urinary protein excretion and renal function in patients with diabetic nephropathy, reduced diabetic retinopathy exudation, delayed progression, and reduced the risk of vision loss and loss.
D. Improvement of insulin resistance and reduction of hyperinsulinemia: patients with diabetes often develop hyperinsulinemia due to the presence of insulin resistance and improper treatment. Prolonged hyperinsulinemia can stimulate arterial wall smooth muscle and endothelial cell proliferation, increase the production of VLDL in liver, promote the lipid deposition of arterial wall, damage the endogenous fibrinolytic system, such as stimulate endothelial cells to produce plasminogen activator inhibitor-1(Pai-1) , promote the formation of thrombus; Long-term hyperinsulinemia also raises blood pressure and leads to weight gain through a variety of mechanisms, all of which can accelerate the occurrence and progression of diabetes vasculopathy. Therefore, taking appropriate measures to improve insulin sensitivity, reduce or avoid hyperinsulinemia is helpful to prevent and treat diabetic vascular complications. Currently commonly used drugs that have been clinically proven to improve insulin resistance to varying degrees are biguanides, 1,3-thiazolidine-2,4-dione derivatives, and alpha glucosidase inhibitors, other ACE inhibitor, micronutrient such as trivalent chromium and vanadium, some lipid-lowering drugs such as fibrate derivatives and 3-hydroxy-3-methylglutaryl-coa (HMG-COA) reductase inhibitors and β3 receptor agonists. Proper diet and exercise are also beneficial in increasing insulin sensitivity.
E. Hemorheology: in diabetic patients, high blood viscosity, aggregation, and coagulation are often due to endothelial cell damage, increased platelet function, increased erythrocyte adhesion and deformability, and decreased fibrinolytic system function, therefore, Cilostazol (Peta) , Pancreatic Kallikrein (Yikai) , ticlopidine (ticlopidine) , 2, 5-dihydroxybenzenesulfonic acid (Dao Shengming) , low-dose aspirin, dipyridamole and Chinese medicines such as Salvia Miltiorrhiza and ligusticum chuanxiong.
F. Antioxidant supplementation: in patients with diabetes, free radicals accumulate in the body due to increased production of free radicals in the body, and on the other hand, the function of the body’s free radical scavenging system is weakened, therefore, appropriate antioxidant supplements such as vitamin C, vitamin E, beta carotene and Superoxide dismutase can reduce the body’s increased free radical damage to tissue.
G. Other: in diabetes, the reduction of inositol in cells, especially in nerve cells, is more obvious, and thus participates in the development of chronic complications of diabetes, according to the inositol depletion theory, appropriate inositol supplementation for diabetic patients may be beneficial in the prevention and treatment of chronic complications, especially neuropathy Aldose reductase inhibitors (which inhibit the activation of the TRIPITOL pathway in hyperglycemia in diabetes) and aminoguanidine compounds (which inhibit the formation of nonenzymatic glycation end products of proteins) , animal experiments and small-scale clinical studies have confirmed that it has a good effect on the prevention and treatment of chronic complications of diabetes, pending further large-scale clinical research to evaluate; Animal studies have shown that specific protein kinase C-Β inhibitors (LY333531) reduce diabetic nephropathy and retinal development and inhibit intimal hyperplasia and hypertrophy, preliminary clinical studies have shown a role in the prevention and treatment of diabetic angiopathy and neuropathy.
2 early diagnosis, early treatment
The onset of chronic complications of diabetes is hidden, the progress is slow, the early stage often lack of obvious clinical manifestations, patients do not pay attention to, but once the chronic complications progress to the clinical stage, the clinical manifestations, the disease is often difficult to reverse, therefore, to strengthen the monitoring of chronic complications of diabetes, early diagnosis is very important.
Pay attention to the people who are susceptible to the chronic complications of diabetes
Recently, many basic and clinical studies have found that the occurrence and development of chronic complications of diabetes are often Genetic predisposition. Clinical observation of the occurrence and development of chronic complications of diabetes is not completely consistent with the control of diabetes, in clinical practice, 20% to 30% of patients with diabetes have no serious chronic complications despite good or bad blood glucose control for many years, while about 5% of patients with diabetes have serious chronic complications in the short term even though blood glucose is well controlled, this is especially true in diabetic nephropathy, where only 30% to 40% of patients with type 1 diabetes ultimately develop end stage renal dysfunction, and the peak is between 15 and 20 years of diabetes, the risk of diabetic nephropathy was significantly reduced later, and only 5% to 10% of patients with type 2 diabetes died from kidney disease, and clinical observation showed that diabetic nephropathy patients had familial aggregation. The exact mechanism is unclear, some studies suggest that it may be related to genetic tendency of essential hypertension, Single-nucleotide polymorphism of enzymes related to heparan sulfate proteoglycan (such as N deacetylase) , polymorphism of Angiotensinogen I converting enzyme, INSR gene mutation and individual differences in Aldose reductase activity. The role of genetic predisposing factors in chronic complications of diabetes seems to be fully established, but the exact molecular biological mechanism needs to be further elucidated in order to provide a powerful tool for clinical prediction of the risk of chronic complications of diabetes, it is advantageous to carry on the intensive treatment to the above susceptible crowd.
CARRY OUT epidemiological investigation and general survey of high-risk population
Diabetes, especially type 2 diabetes, early often because of the lack of obvious clinical manifestations and people on the lack of diabetes-related knowledge, so that most (1/3 ~ 2/3) long-term? They are the most powerful force in the world, the most powerful in the world? At the time of definite diagnosis of type 2 diabetes, the average duration of the disease has been 3 ~ 7 years. Therefore, the epidemiological investigation of diabetes and the general survey of the high-risk population of diabetes have been actively carried out, it is very important to detect the recessive diabetes and impaired glucose tolerance patients in hyperglycemia state at early stage, and to intervene and treat them in time.
To strengthen the knowledge education of diabetic patients and their families about diabetes
To educate the diabetic patients and their families on the basic knowledge of diabetes and its complications, so that they understand the importance of controlling diabetes and the harm of its complications, so as to actively cooperate with the treatment and follow-up, it is also important to control the condition of diabetes.
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