Recently, no matter where they go, sugar patients are instilled with the treatment concept of “intensive glucose-lowering to meet the standard”, and both doctors and patients are working hard for “intensive glucose-lowering to meet the standard”, and intensive glucose-lowering is warmly sought after. The question is: What is the fundamental purpose of diabetes glucose-lowering treatment? The answer is to reduce the incidence of disabling and fatal cardiovascular complications associated with diabetes. So is lowering sugar really beneficial in reducing the risk of cardiovascular complications? “This seemingly simple proposition has consumed the lifelong efforts of countless diabetic workers and still has not been fully resolved.” Instead of reducing cardiovascular events, intensive glucose lowering significantly increased the rate of death in patients with diabetes. Although cardiovascular disease deaths were also increased in the intensive group, there was no statistically significant difference compared to the standard group. One of the cold thoughts: Why does intensive glucose lowering increase the death rate? After nearly a year of cold thinking and comparative analysis of several other large trials, the international diabetes, endocrinology, and cardiology community has reached a preliminary consensus on some of the emerging issues identified in these trials: the possibility that they are related to inappropriate and overly aggressive treatment strategies for a group of very high-risk diabetic patients. This group of patients is elderly, with long duration of disease, severe disease, atherosclerosis and cardiovascular complications; inappropriate and overly aggressive treatment strategies such as over-intensive glucose lowering, with rapid reduction of higher levels to <6% in a short period of time, resulting in a 16% incidence of severe hypoglycemia and weight gain; and a wide range of medications, with the potential for adverse drug interactions. Intensive glucose lowering is not beneficial to people with long duration of disease. Cold Thought No. 2: How to achieve intensive glucose lowering? Blood glucose control is still the foundation of diabetes treatment. The benefits of glucose lowering for microvascular and neurological complications of type 1 and type 2 diabetes are well established. The question is: Does everyone with diabetes need intensive glucose lowering? The answer is no. Intensive therapy is appropriate for patients with early, mild disease who have achieved intensive glucose lowering to reduce cardiovascular disease events. The goal should be at least <7% (Class A evidence-based) and may be <6.5%. In the absence of hypoglycemia, the target can be reduced to 6% or less. Intensive glucose lowering is not recommended for elderly patients with long disease duration or short life expectancy, patients with significant atherosclerosis and cardiovascular complications, patients with advanced diabetes with multiple co-morbidities, patients with severe disease with high HbA1c (>10%), patients who have difficulty achieving the target despite multiple therapies (including insulin application), and those at risk of severe hypoglycemia. Regarding the speed of reaching the standard: lessons learned show that it is important not to lower glucose too fast or too hard, but to reach the standard gradually and smoothly and safely. A good treatment plan requires a small impact on the body, no weight gain and less hypoglycemia. Cold Thought No. 3: The cardiovascular safety of sulfonylureas is good. Although the conclusions of the American University Joint Diabetes Study Program have long been overturned, the diabetes community has been more or less wary of the cardiovascular safety of sulfonylurea hypoglycemic agents. It is a large clinical trial with sulfonylureas as the basic therapeutic drug, more than 90% of its intensive group with gliclazide extended-release tablets, the average treatment of more than 5 years, no increase in cardiovascular disease death, and macrovascular disease began to reduce after 4.5 years, indicating that gliclazide extended-release tablets are safe for the heart, the American Diabetes Association and the European Diabetes Association consensus statement on the treatment of hyperglycemia also lists sulfonylureas as type 2 diabetes Preferred drugs. Cold Thinking #4: Prevention and treatment of diabetes, especially type 2 diabetes, requires a holistic approach. The prevention and treatment of diabetes, especially type 2 diabetes, is not a matter of lowering glucose, but rather a comprehensive approach to multiple cardiovascular risk factors, including management of obesity, hypertension, dyslipidemia, anticoagulation, improving insulin resistance, improving pancreatic B-cell function, and smoking cessation. Conclusion: Numerous clinical endpoint trials have demonstrated that it is unrealistic and risky to use aggressive intensive glucose lowering in patients with advanced, highly progressive diabetes in the expectation of a short-term “miracle”. Even in patients with early mild disease, intensive treatment for three to five years is unlikely to result in a significant reduction in cardiovascular disease complications. The main goal of blood glucose control is not to have hyperglycemic toxicity, not to aggravate organ function damage and not to increase the risk of death. Therefore, the most important point in the prevention and treatment of diabetes is that although it is said to lower the sugar standard, but must be people-oriented; must be a combination of Chinese and Western, aiming at both the symptoms and the root cause of the treatment; must be “prevention before the disease”, “health care” throughout the whole process of prevention and treatment of diabetes!