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More than 50% of Chinese adults have diabetes or are in the pre-disease stage. See here for diagnostic criteria.

Release time:

2023-04-28 14:06

According to a recent report released by the World Health Organization, non-communicable diseases (NCDs) such as heart disease, cancer and diabetes have surpassed infectious diseases as the leading cause of death in the global population.As one of the most important non-communicable diseases that threaten the health of the global population, the number of patients with diabetes is increasing rapidly and the incidence is showing a steady upward trend.

In December 2021, the authoritative international medical journal JAMA published a study on the prevalence and treatment of diabetes in China from 2013 to 2018, which showed that the prevalence of diabetes in China increased from 10.9 percent to 12.4 percent from 2013 to 2018, and the prevalence of pre-diabetes was also increasing, reaching 38.1 percent in 2018,The total prevalence of diabetes and pre-diabetes has reached 50.5 per cent, and the prevalence of diabetes and pre-diabetes in Chinese adults has risen by about 4 percentage points in five years.

Photo by: JAMA

What is diabetes?

Diabetes is a common chronic metabolic disease causedThe body does not produce enough insulin or the body cannot effectively use the insulin produced.A syndrome that appears.

High blood sugar, or elevated blood sugar, is a common consequence of uncontrolled diabetes, which over time can cause serious damage to many systems of the body, especially nerves and blood vessels. Therefore, diabetes is closely related to various diseases.

Classification of diabetes mellitus

Type 2 diabetes mellitus

Type 2 diabetes (the main type of diabetes, accounting for more than 95% of patients with diabetes) is caused by the body's inability to effectively use insulin.

Type 2 diabetes is more common after puberty, most patients are obese, and symptoms may be similar to type 1 diabetes, but often not obvious. Therefore,The diagnosis may be made years after the onset and complications.

Type 1 diabetes mellitus

Type 1 diabetes (juvenile or childhood-onset diabetes) is characterized:

Insufficient insulin secretion
Age is usually less than 30 years old
"Three more and one less" symptoms are obvious
Often onset with ketosis or ketoacidosis
non-obese body type
Significantly lower fasting or postprandial serum C- peptide concentrations
The emergence of islet autoimmune markers

Gestational diabetes mellitus

During pregnancy, the placenta produces a variety of hormones for fetal development and growth. These hormones are very important for the healthy growth of the fetus, but they can block the insulin action in the mother's body, thus causing diabetes.

Etiology of Diabetes

genetic factors

Type 1 or type 2 diabetes has a racial and familial genetic predisposition. Diabetes has a family incidence tendency, and 1/4~1/2 patients have a family history of diabetes,However, it is not diabetes itself that is inherited, but the susceptibility to diabetes, and diabetes will only be induced under the combined action of external factors and the internal environment.

There are multiple DNA sites involved in the pathogenesis of type 1 diabetes, of which the DQ site polymorphism in the leukocyte antigen gene is the most closely related.

Type 2 diabetes has been found to be associated with a variety of gene mutations, such as insulin gene, insulin receptor gene and so on.

Environmental factors

Obesity caused by eating too much and exercising too littleIt is the most important environmental factor of type 2 diabetes, which makes individuals with genetic susceptibility to type 2 diabetes more likely to develop the disease.

Patients with type 1 diabetes have immune system abnormalities that lead to autoimmune reactions that destroy insulin beta cells after certain viral infections.

The dangers of diabetes

Long-term high blood sugar will affect the body's blood vessels and nerve disease, damage the heart, blood vessels, eyes, kidneys, etc.
Adult diabetics face two to three times the risk of heart attack and stroke
Neuropathy (nerve damage) in the feet, combined with reduced blood flow, increases the likelihood of foot ulcers, infections, and eventual amputation
Diabetic retinopathy is an important cause of blindness and is the result of long-term cumulative damage to small retinal vessels. Nearly 1 million people have gone blind because of diabetes.
Diabetes is one of the leading causes of kidney failure

Diagnosis of Diabetes

HbA1c is the internationally recognized gold standard for diabetes diagnosis:

Although the WHO recommended the useHbA1c diagnosis of diabetesHowever, due to the large difference in the standardization of HbA1c determination in different regions of China, the diagnostic criteria have not yet been unified.

In the 2020 version of the guide, after the three diagnostic criteria, addedHbA1c ≥ 6.5%The criteria are consistent with WHO recommendations.

Diabetes Intervention and Treatment

lifestyle intervention

Maintaining ideal body weight, proper exercise, changing diet to reduce calorie intake, limiting salt, reducing intake of sugar-containing or sugar-substitute beverages, quitting smoking, not excessive drinking and maintaining a good mood can not only reduce insulin resistance and hyperinsulinemia, but also improve glucose tolerance and other cardiovascular disease risk factors.

Treatment of Diabetes

Patients with type 1 diabetes need to inject insulin, patients with type 2 diabetes can be treated with oral drugs, but may also need to use insulin therapy according to the severity; and for each component such as impaired glucose regulation, high blood pressure, blood lipid disorders and obesity and other appropriate drug treatment.

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References:

[1] Prevalence and Treatment of Diabetes in China, 2013-2018. JAMA. 2021 Dec 28;326(24):2498-2506. DOI: 10.1001/jama.2021.22208.

[2] WHO. Diabetes. 2022

[3] Guidelines for prevention and treatment of type 2 diabetes in China (2020 edition)

[4] Chen Xiaoli, Ji Renjun. Etiology and pathogenesis of diabetes mellitus [J]. China Modern Drug Application, 2008(24):189-190.

[5] Zhang Ya, Xu Xianming. Etiology of gestational diabetes mellitus [J]. Chinese Journal of Practical Gynecology and Obstetrics, 2013,29(04):299-302.