The reality and ideal of diabetes treatment

  Diabetes has become a worldwide epidemic in the 21st century. It is the third most serious threat to human health after tumor and vascular disease, chronic non-communicable diseases, with high death rate, high disability rate and high medical costs, and has become a common public health problem faced by all countries in the world. The growth rate is 46%. It is estimated that the number of people with diabetes will reach 221 million by 2010 and will increase to 300 million by 2025, with a growth rate of 46%. The serious situation of diabetes in China is even more sobering. As of 2003, the number of people with diabetes in China was 23.8 million, the second highest in the world after India. According to official statistics, the Chinese government spends 80 billion yuan on treating type 2 diabetes and its complications. Even so, there is still a big gap between the reality and the ideal of diabetes treatment in China. The current status of diabetes control is still not optimistic.  1. Glycemic control.  The Diabetes Control and Complications Trial (DCCT) and the Epidemiological Study of Diabetes Interventions for Complications (EDIC) have shown that intensive treatment with strict glycemic control can significantly reduce the risk of complications in patients with type 1 diabetes by 60% to 80%. The UK Prospective Diabetes Study (UKPDS) also showed that patients with type 2 diabetes had a significant reduction in complications after strict glycemic control, including a 25% reduction in microvascular complications, a 16% reduction in myocardial infarction, and a 10% reduction in diabetes-related deaths. For type 2 diabetes, improved glycemic control can significantly improve the occurrence and development of complications, but few people can achieve the control goals recommended by the guidelines. Currently, all major diabetes authorities advocate glycosylated hemoglobin (HbA1C) as the “golden indicator” for evaluating glycemic control, and different organizations, such as the American Diabetes Association (ADA) and the International Diabetes Federation (IDF), have proposed their own indicators for glycemic control. China adopts the standard of diabetes treatment guideline of Asia-Pacific region, namely glycosylated hemoglobin HbA1C<6.5%. According to the latest results of the Asian Diabetes Treatment Status Survey 2003 in China, the average HbA1C of Chinese diabetic patients is 7.5% to 11.6%. Only 11.5% of the patients had ideal glycemic control, while the majority (88.5%) of the patients failed to meet the standard (HbA1C>6.5%), among which 38.6% of the patients had HbA1C>7.5%. It suggests that the current treatment for diabetic patients is still inadequate.  2. Blood glucose monitoring.  For diabetic patients, the purpose of diabetes treatment is to reduce complications, and it can be said that the good or bad treatment will affect the development of several years in the future. However, diabetes is also known as a silent killer, because high blood sugar is harmful to the human body, but often not felt, so timely and accurate blood glucose monitoring is an important means to ensure that the treatment is up to standard. However, the current status of blood glucose monitoring is still very unsatisfactory. In the United States, 15% to 20% of diabetic patients perform self-monitoring of blood glucose, about 10% in Hong Kong, and only 1% in mainland China. The average monitoring frequency of each diabetic patient in the United States is 30.1 times/month, 8-10 times/month in Hong Kong, and only 2.5 times/month in mainland China.  3.Insulin application.  At present, more than 50% of type 2 diabetes patients in developed countries are receiving insulin therapy, while the proportion in China is 11.1%. In a global survey, although the HbA1c control in China gradually improved from 1998 to 2003, according to the ideal standard of the Asia-Pacific region that HbA1c