What are the causes and diagnostic criteria of diabetes? How to avoid poor blood sugar control? Is just improving your diet effective?
What kind of disease is diabetes? What is the current prevalence rate in Taiwan?
Diabetes is one of the most important chronic diseases affecting the health of Taiwanese people. It is a hyperglycemic disease caused by the interaction between environmental factors and genes. The main characteristic is high blood glucose concentration. The body’s “insulin” is responsible for controlling the entry of blood sugar into tissue cells. When the amount of insulin is insufficient or the body does not respond well to insulin to lower blood sugar, diabetes may occur.
Once blood sugar is not properly controlled, the large blood vessels, small blood vessels, and nervous system of the body will gradually develop lesions, and even cause serious problems such as stroke, cardiovascular disease, and heart failure. In recent years, diabetes has been complicated by chronic kidney disease and chronic renal failure. The proportion of dialysis treatment is also increasing year by year.
According to the latest statistics in 2021, the prevalence of diabetes in Taiwan is about 11.1%, which means that one in 10 adults has diabetes. In the early years, when there was no health insurance data database, it was generally estimated that the prevalence of diabetes was about 4-6%. Complete statistical studies after 2000 have gradually confirmed that the prevalence of diabetes in Taiwan is approximately 9% to 11%, which is significantly higher than early estimates. In recent years, aging is one of the important factors responsible for the increase in the crude incidence of diabetes.
What are the diagnostic criteria for diabetes? Should we be careful when developing prediabetes?
According to the diagnostic criteria for diabetes defined by the World Health Organization, as long as:
fasting blood glucose is greater than 126 mg/dl,
oral glucose test is greater than or equal to 200 mg/dl 2 hours later,
random blood glucose is greater than or equal to 200 mg/dl dl combined with typical symptoms of diabetes (eating more, drinking more, urinating more) or ketoacidosis may be diagnosed as diabetes if 2 of the 3 criteria are met.
The diagnostic criteria of the American Diabetes Association and the European Diabetes Study Group add glycated hemoglobin (A1C) greater than 6.5%, as long as 2 of the above 4 criteria are established in the same blood test, or blood tests at different times meet 2 The above indicators belong to the scope of diabetes.
In addition, people whose blood sugar exceeds the normal range but has not yet reached diabetes are called “diabetes high-risk groups”, also known as “pre-diabetes”. They are an important risk factor for diabetes and cardiovascular disease, and are also related to obesity, hyperlipidemia, and high blood pressure. related to blood pressure. The main diagnostic criteria are:
oral glucose test between 140-199 mg/dl 2 hours later,
fasting blood glucose between 100-125 mg/dl;
glycated hemoglobin (A1C) between 5.7- 6.4%.
What are the main causes of diabetes in Taiwan? Which lifestyle habits are most relevant?
Whether in Taiwan or other countries around the world, the main cause of diabetes is related to two pathophysiological mechanisms. The first is “insulin resistance”, and the second is “insulin” deficiency or “incretin” deficiency. According to previous literature reports, there is a slight difference in the proportion of diabetes mellitus between Eastern and Western ethnic groups. Easterners are more likely to suffer from insulin deficiency, while Westerners are slightly more likely to have insulin resistance.
Although diabetes is influenced by genetic inheritance, the more important reasons are related to the obesity epidemic, reduced activity and other lifestyle factors. For example, if physical activity is reduced, excess calories will be stored in the body in the form of fat, and adipose tissue will increase insulin resistance. As we age, insufficiency of enterocrine function or reduced secretion can also cause an imbalance in insulin ratio and increase fasting and postprandial blood sugar.
A single bad living habit may not be the direct cause of the disease. However, common modern lifestyles such as staying up late, lack of exercise, and unbalanced diet are closely related to chronic diseases. Once diabetes occurs and the lifestyle is not adjusted, it is more likely to indirectly lead to poor blood sugar control. People with diabetes should receive correct health education and plan good living habits to help stabilize blood sugar and reduce the risk of various complications.
Is it possible to “reverse” prediabetes? Can it be cured by just improving your diet?
The “reversal” of diabetes promoted in the public is a commercial term and does not really mean “curing” the disease. Some studies have shown that through lifestyle and drug intervention, it is indeed possible to help patients return their blood sugar to the normal range, and maintain good blood sugar for a period of time after stopping medication, which is called diabetes “remission” - Remission. However, remission does not mean that blood sugar will remain normal throughout life, and patients should not assume that diabetes is cured and that blood sugar problems will no longer occur.
Diet and blood sugar control are closely related. People with diabetes should make appropriate nutritional adjustments under the complete health education of clinicians, health teachers and nutritionists. There are a few single health foods in the market that claim to have a therapeutic effect on diabetes. Most of them are exaggerated advertising, or the results of animal experiments and cell experiments are promoted as being effective on the human body, causing patients to mistakenly believe that as long as they consume healthy foods, they do not need to pay attention to their daily diet and Blood sugar control. You should carefully understand whether the relevant information is accurate and safe, and if you have any doubts, you should consult the correct health and education channels.
What are the current treatments for diabetes? What are the considerations in drug selection?
The two major goals of diabetes treatment are “blood sugar control” and “organ protection”. The two complement each other like the yin and yang theory. Clinicians will be patient-centered and consider comorbidities, age, cognition, weight, and risks of high and low blood sugar when selecting drugs. In addition to controlling blood sugar, current treatment drugs also have a protective effect on the heart and kidneys. Some antidiabetic drugs have been shown to help reduce retinopathy, proteinuria, and neuropathy.
Currently, there are two categories of diabetic injection drugs: insulin and incretin. When the pancreas secretes insulin, incretin stimulates insulin and inhibits glucagon, both of which are closely related to changes in blood sugar. Insulin has a stable effect on lowering blood sugar. Symptomatic hyperglycemia will give priority to insulin treatment. If the blood sugar is stable but the risk of hypoglycemia is considered, incretin therapy can be intervened.
The use of diabetes drugs must be selected based on the pathological mechanism and the patient’s lifestyle. Not all patients can be weighed on the same scale. In addition, the length of onset and the effectiveness of previous treatment will affect drug use and treatment patterns. People with diabetes should manage their lifestyle well to help the drugs exert their full therapeutic effect.
How to avoid worsening of diabetes after it occurs? Which therapeutic concepts are most important?
As the life span increases, Taiwanese people should pay attention to the risk of diabetes as early as possible. Diabetes is most common in people aged between 50 and 60, and the incidence of diabetes has shown a trend of getting younger in recent years. People aged 40 to 50 and those under 40 should pay attention to the rising risk of diabetes in the next 10 years and understand their blood sugar status as early as possible.
People who have developed diabetes should pay special attention to the stability of blood sugar control. Whether blood sugar is under stable control is closely related to the probability and speed of complications in the next 10 to 20 years. In addition to early control of blood sugar, when necessary, drugs with organ protection such as heart and kidney protection can be intervened to stabilize a good lifestyle. Healthy lifestyle is the foundation of blood sugar health. An unhealthy lifestyle will make the treatment effect half effective.
In view of unstable blood sugar control, it is easy for people with diabetes to undergo changes in renal function and even face the risk of dialysis at an early stage. Renal function indexes such as proteinuria and glomerular filtration rate (eGFR) should be checked regularly, and regular treatment should be followed according to the doctor’s advice, and at the same time, receive diabetes health teachers Guidance with a nutritionist. Complete diabetes care must be coordinated by clinicians, health teachers and family members. Patients and family members should learn correct blood sugar health education knowledge to help the elderly with diabetes in the family obtain the best control.
Further reading:
