For thousands of years, medicine has been exploring and searching for a cure for human diseases, and the search has never stopped. Improving people’s quality of life and prolonging their lives has always been the sacred mission of our medical practitioners.
With the accelerated economic development and industrialization, lifestyle changes and population aging process, the prevalence of diabetes in China is on a rapid rise, becoming another important chronic non-communicable disease that seriously endangers people’s health after cardiovascular diseases and tumors. According to the World Health Organization, the economic loss due to diabetes and related cardiovascular diseases in China reached 557.7 billion USD between 2005 and 2015. A number of surveys in recent years have shown that the status of diabetes control is not optimistic in both developed and developing countries such as China.
Diabetes is currently one of the most important non-communicable diseases threatening human health worldwide. According to the International Diabetes Federation (IDF), the number of people with diabetes reached 370 million in 2011, 80% of whom are in developing countries, and it is estimated that by 2030 there will be nearly 550 million people with diabetes worldwide. 4.6 million people died from diabetes worldwide in 2011, and the global medical cost of diabetes reached $465 billion that year.
Among them, the rapid growth of diabetes in China has brought a heavy burden to the social and economic development of the country. a diabetes epidemiological survey conducted by the Chinese Medical Association Diabetes Society (CDS) in some areas of China from 2007 to 2008 showed that the prevalence of diabetes among people over 20 years old was 9.7%, the proportion of pre-diabetes was 15.5%, and only Only 40% of diabetic patients are diagnosed.
The CDS survey on the economic burden of diabetes conducted in 2007-2008 found that compared to normoglycemic individuals, patients with diabetes had one times more days in the hospital, 2.5 times more visits, and 2.4 times more medical expenses. Patients with more than 10 years of diabetes had nearly 3 times more medical costs compared to those with less than 5 years of disease.
If we do not take measures to prevent the transformation of pre-diabetes into diabetes, the number of people with diabetes in China will further increase, which will undoubtedly add to the already overburdened health care system in China. If the diagnosed patients are not well treated and managed, the heavy mental and economic burden of diabetes complications on individuals, families and the country will seriously affect the healthy development of our society and economy.
As an endocrinologist and a member of the Changzhou Science Lecturer Group, I have the responsibility and obligation to promote the scientific knowledge of diabetes and its related complications for the general public and to teach and explain to them.
Diabetes is a group of metabolic diseases characterized by elevated levels of plasma glucose (referred to as blood glucose). In addition to causing elevated blood glucose, diabetes can also cause disorders of protein and fat metabolism. It is well known that the common symptoms of diabetes are three more and one less: drinking more, eating more, urinating more and losing weight. However, there are four major types of diabetes according to etiology: type 1 diabetes, type 2 diabetes, gestational diabetes and special types of diabetes.
Among the four types of diabetes, only type 1 diabetic patients have three symptoms that are typical. Relying on symptoms to confirm a diagnosis of diabetes often misses many diabetics. Diabetes has many predisposing factors, and some high-risk groups, such as mothers aged ≥40 years, mothers who have given birth to huge children (weighing ≥8 pounds), obese people, people who usually lack exercise, and people with diabetes in their first-degree relatives (genetic factors) are susceptible to diabetes.
People are aware of cancer and often talk about “cancer”, but they do not know the danger of diabetes. Diabetes is a common disease, the third most common disease after cardiovascular disease and tumor. Once you have “diabetes”, you will have a feeling that life is worse than death, not to mention the quality of life. Why is it nicknamed “the silent killer” abroad? Because its insidiousness is so high that when patients are diagnosed with diabetes, many of them have actually had the disease for a long time.
Initially, it will not easily let you notice the discomfort, and then let you be gradually influx of physical fatigue, drinking, eating, urinating, losing weight, obesity and other symptoms troubled, once suffering from “diabetes”, will reduce life expectancy by as much as ten years, with the progress of the disease, complications throughout the body, death from complications is sooner or later. According to the World Health Organization, one person dies from diabetes every 10 seconds, and one person has a limb amputated every 30 seconds due to diabetes. The risk of not meeting blood glucose standards is the loss of health and even life.
The Chinese Medical Association Diabetes Society (CDS) and the International Diabetes Federation (IDF) jointly released data (2010.11.14)
Each year, China spends 13% of the total national medical expenditure on diabetes, amounting to RMB 173.4 billion (US$25 billion), of which the costs associated with treating diabetes complications account for more than 80%. The average annual treatment cost per case with complications is nearly 20,000 RMB, which is 5.1 times higher than that of patients without complications. In summary, we can see that diabetes is incredibly expensive to treat and requires lifelong treatment.
The real danger of diabetes – is its acute and chronic complications , 80% of patients die from diabetic complications.
Type 2 diabetes accounts for about 90% of the total number of diabetics. Insulin resistance exists prior to diagnosis, with insulin secretion showing a compensatory increase in the early stages and a progressive decline beginning later; microvascular complications such as macrovascular complications and neuropathy in diabetes can exist and progress gradually when the incidence has increased in the early stages before diabetes occurs; microvascular complications are more correlated with blood glucose and therefore often appear and progress gradually after diagnosis. As the disease progresses, complications spread throughout the body.
Complications of diabetes include two major categories: acute and chronic. Acute complications include diabetic ketoacidosis, diabetic non-ketotic hyperosmolar coma, diabetic lactic acidosis, and hypoglycemia.
With the clinical application of insulin, the prognosis of acute complications of diabetes has been greatly improved. As long as patients do not stop using insulin or reduce the dose of insulin at will, and seek timely medical treatment after the onset, most patients can be cured. Chronic complications, on the other hand, can occur unknowingly because they are more insidious.
Chronic complications of diabetes often involve the whole body. These include retinopathy, blurred vision and even blindness; cerebrovascular disease, vascular embolism and even paralysis; renal disease, which can lead to renal failure and uremia in severe cases; cardiovascular disease, coronary artery disease; neurological disease, abnormal sensation; vascular system disease, which can lead to foot gangrene and even amputation in severe cases. Diabetic cardiovascular disease, often with chest tightness, chest pain symptoms, but there are some patients without typical chest pain symptoms but myocardial infarction.
Diabetic cerebrovascular disease often has symptoms of dizziness and numbness of the limbs, which can lead to paralysis or even death in severe cases. Diabetic hypertension, about 1/3 of diabetic patients will be combined with hypertension. type 2 diabetic patients are at high risk of developing retinopathy. Diabetic retinopathy is the leading cause of blindness in the adult population, and its major risk factors include the duration of diabetes, poor glycemic control, hypertension and dyslipidemia.
There are 6 stages of diabetic retinopathy, 3 each in the non-proliferative and proliferative forms. In adult patients with type 2 diabetes, approximately 20-40% develop retinopathy and 8% have severe vision loss. For patients with a 15-year history of diabetes, more than 98% have retinopathy. In diabetic nephropathy, early kidney damage is manifested by trace amounts of proteinuria, in the middle stage it is manifested by large amounts of proteinuria, and in the later stage the kidney damage gradually increases until renal failure.
Diabetic neuropathy, which has the highest incidence and is the most complex, is often clinically evident within 10 years of diabetes diagnosis, according to the 2010 CDS guidelines, and its incidence correlates with the duration of the disease. Neurological function tests reveal that 60% to 90% of patients have varying degrees of neuropathy, of which 30% to 40% are asymptomatic. 2001 domestic inpatient survey found that 61.8% of type 2 diabetic patients had coexisting neuropathy. The prevalence of neuropathy is higher in diabetic patients who smoke, are over 40 years of age, and have poor glycemic control.
It is difficult to accurately estimate the true prevalence of diabetic neuropathy because the clinical presentation and complaints vary greatly from patient to patient due to the different nerves involved and the degree of nerve damage in diabetes. If the prevalence of diabetic neuropathy diagnosed by the patient’s own complaints (such as limb numbness, pain, etc.) is 25%, but examined by the doctor through the tuning fork vibration sensory test, the prevalence of diabetic neuropathy rises to 50%, and if more complex peripheral sensory nerve or autonomic nerve function tests are performed on each diabetic patient, the prevalence of diabetic neuropathy is as high as 90%.
What are the manifestations and dangers of diabetic neuropathy? Early positive symptoms of diabetic peripheral neuropathy include: numbness, pain, ankylosis, burning sensation, pins and needles, etc. Numbness pain and other sensory abnormalities should never be ignored. This is the case of a diabetic foot patient who already had two toes amputated, and this time a peg was stuck in the bottom of the foot, which was only discovered a week later. Why? Diabetic peripheral neuropathy caused him to lose sensation in his lower extremities. Let’s look at what happened to the next patient. There are patients who have lost sensation and had their foot skin burned during electrotherapy, and there are patients who could not sense the lighter in the shoe and continued to walk, resulting in the loss of the big toe; the same case is a 67-year-old woman who walked in a shoe with porcelain tiles, causing a large ulcer on the bottom of the foot.
These aforementioned conditions are one of the main causes of diabetic foot. Once the diabetic foot is secondary, the treatment is very difficult, so the International Diabetic Foot Working Group also actively advocates that prevention is important in diabetic foot. Neuropathy can manifest itself in a variety of ways, but the most important neuropathy associated with the development of the diabetic foot is the peripheral neuropathy of hyperalgesia. The lack of sensation makes the foot vulnerable to injury as diabetics lose the self-protection of the foot.
Dry, cracked skin and localized arteriovenous short circuits caused by diabetic autonomic neuropathy can also contribute to or exacerbate the development of the diabetic foot. Peripheral arteriopathy is another important factor in the development of the diabetic foot. Patients with severe peripheral arterial disease can present with the classic symptoms of intermittent claudication. However, more patients with severe peripheral arterial disease may develop foot ulcers without symptoms, or the ischemic lesions may exacerbate the foot disease after damage to the insensitive foot.
The underlying pathogenic factors of the unforgiving diabetic foot are neuropathy, vasculopathy and infection. The combination of these pathogenic mechanisms leads to ulceration and gangrene of the tissue and, in severe cases, even amputation. Diabetic gastrointestinal neuropathy includes hypogastric motility: nausea, vomiting, anorexia, belching, etc. There are also cardiac autonomic neuropathy, painless myocardial ischemia, painless myocardial infarction, and even induced sudden death.
High blood sugar has a metabolic memory effect, just like the annual cycle, which notes the wind, rain and snow during the growth of trees; just like the beach, which leaves every wave lapping. The long-term effect of previous glycemic control on complications is called the metabolic memory effect. The effect of early intensive treatment on the condition: 72.6% remission rate with intensive treatment at 3 months of onset; 67% remission rate with intensive treatment at 6 months of onset; 47.1% remission rate with intensive treatment at 12 months of onset; 42.3% remission rate with intensive treatment at 24 months of onset.
The main risk factors affecting chronic complications are the degree of hyperglycemia, duration of diabetes, blood pressure, obesity, genetic susceptibility factors, and smoking. Because of the absence of symptoms, many people delay for many years. type 2 diabetes starts insidiously, and most patients find that fasting blood glucose is significantly elevated before they are diagnosed; long-term “treatment is not up to standard” makes patients never get rid of the shadow of hyperglycemia; fluctuating high and low hyperglycemia aggravates vascular nerve damage. For patients with diabetic neuropathy, they must strengthen their belief in overcoming the disease, know more about diabetes, eat less, be more diligent, and relax a little, so they can definitely overcome diabetes. In fact, there is no better treatment than prevention.
The integrated treatment approach proposed by the IDF is imaginatively called the “five horses” of diabetes management by Chinese scholars. It includes diabetes education, blood glucose monitoring, medication, diet therapy, and exercise therapy. There are three levels of prevention in the treatment of diabetes. Primary prevention, also known as premorbid prevention, is to take various measures to prevent healthy people, high-risk people and people in pre-diabetes from getting diabetes. Secondary prevention, also known as treatment, is the early diagnosis and standardized treatment of diabetes to control the disease and keep it stable and not to develop too fast. Tertiary prevention, also known as post-illness management, is to control diabetes and its complications through disease management, avoid, delay, and treat diabetes complications, and prevent disability or death caused by them.
The fundamental measure of prevention is to drive the “five horses” of diabetes. How to prevent and delay the onset of neuropathy? Meeting the standards is the first step! This means good control of blood glucose, correction of dyslipidemia, and control of hypertension. In order to reduce the occurrence and development of chronic complications, strict control of blood glucose to the standard is essential. Control fasting blood glucose to 4.4-7.0 mmol/L, non-fasting blood glucose <10 mmol/L, glycated hemoglobin <7, and actively control blood pressure to the target range <140/80 mmHg.
Prevention of diabetic neuropathy – regular screening and evaluation of the condition. All patients should be screened for diabetic peripheral neuropathy at least once a year after diagnosis of diabetes.
Prevention of diabetic neuropathy – Enhance foot care. Wash your feet daily with warm water and neutral soap, paying attention to the toe seam; cut your toenails short, but not too short, and gently smooth the edges; pay attention to foot insulation and anti-cracking in winter; wear shoes and socks that fit your feet and are clean and soft, with thread socks that are breathable; do not overheat the water when washing your feet to avoid burns.
Prevention of diabetic neuropathy – foot self-examination.
1.Take off your shoes
2.Determine the inspection site
3.Use 10g nylon wire perpendicular to the skin, make contact between the nylon wire and the inspection site for 1-2 seconds, add force just to make the nylon wire bend, any place without feeling should be regarded as positive, repeat the inspection to further determine, it should be noted that do not do the inspection at the callus and foot ulcer.
Prevention of diabetic neuropathy – avoiding risk factors . Risk factors associated with the development and progression of diabetic neuropathy include smoking, alcohol abuse, high blood pressure, and high cholesterol.
Prevention of diabetic neuropathy – choosing the right type of rehabilitation exercise . Minimum intensity exercise: 90 kilocalories for 30 minutes; medium intensity exercise: 90 kilocalories for 10 minutes; high intensity exercise: 90 kilocalories for 5 minutes; prevent the occurrence of hypoglycemia.
Prevention of diabetic neuropathy – regular self-testing: 1.
1, usually pay attention to the observation of weight changes, regular monitoring of blood sugar, blood pressure.
2, change bad habits, stop smoking and limit alcohol, pay attention to personal hygiene, keep the skin clean, to prevent complications.
3, maintain a good psychological quality, lift the burden of thought, establish a long-term struggle with diabetes and confidence to overcome the disease.
4. Carry identification cards with you when you go out so that you can deal with emergencies in time.
The treatment of diabetic neuropathy includes moderate relief of symptoms, affecting the underlying pathological basis, repairing damaged nerves, slowing down the development of the disease process and the occurrence of other complications. Specific measures are
1.Strict control of blood sugar
2.Improve microcirculation 3.Repair the damaged nerves
4, symptomatic treatment. The drugs used in the treatment of diabetic neuropathy include epalrestat tablets, alpha lipoic acid, methylcobalamin, calcium hydroxybenzenesulfonate, and prostaglandin. Among them, intravenous medications include methylcobalamin, kaishi, lipoic acid, and traditional Chinese medicine to activate blood circulation and remove blood stasis, such as Danshen injection, etc. The best combination of oral medications is methylcobalamin and epalrestat.
Diabetes cannot be cured yet, but it can be completely controlled. With firm confidence, perseverance and scientific treatment, you will surely win your health!