With the rapid development of China’s productivity level, people’s living standards have undergone radical changes. Even in rural areas, most areas of crop cultivation has been largely automated. Three out of ten people in China are overweight or obese, and the current level of urbanization has reached 43%, with some areas of aging reaching more than 20%. Accordingly, the prevalence of diabetes has increased from less than one diabetic in 100 people in the 1980s to nearly ten in 100 in 2007-2008 (nearly 100 million people have diabetes), and with the addition of individuals with pre-diabetes (abnormal glucose tolerance), 25 out of 100 people have different degrees of blood sugar abnormalities. This is such a large group of people that at this rate almost exhausts the poor health resources of the country and is a huge burden to the families of diabetics. Therefore, it is imperative to widely publicize the knowledge of diabetes prevention and treatment, to achieve early detection of high-risk groups and early prevention. Calling on governments, social groups, enterprises and the general public to act together to fight diabetes is an action that has been actively promoted by the International Diabetes Federation and the World Health Organization in recent years. Reduced physical labor, urbanization, and increased intake of high-fat, refined and processed foods are the primary causes of overweight or obesity in the population. Obesity is closely related to hypertension, dyslipidemia, fatty liver, diabetes and tumor development. 80% of patients with type 2 diabetes (previously called non-insulin-dependent) are overweight or obese. Therefore, changing poor lifestyle habits is crucial to the prevention and treatment of diabetes. Weight loss is far more effective for those at risk and for those with diabetes than the use of any diabetes treatment medication. Weight loss can also be more effective in reducing cardiovascular disease and prolonging life. Type 2 diabetes accounts for more than 90% of the diabetic population, and the number of adolescents is also increasing significantly. Unlike a person with type 1 diabetes (insulin-dependent), a person with type 2 diabetes has increased blood glucose as only one of many metabolic abnormalities that he/she has. The main cause of death in type 1 diabetes is diabetic nephropathy, which is directly related to poor glycemic control. In contrast, 70% of the major causes of short life expectancy in type 2 diabetes are related to cardiovascular death, and more than 10% are related to tumor death. This shows that it is more important for patients with type 2 diabetes to prevent the development of cardiovascular and cerebrovascular disease. In addition to overweight and obesity, 60% of type 2 diabetic patients have dyslipidemia and 70% have hypertension. The most direct chronic complications of poor blood glucose control are diabetic nephropathy, retinopathy and neuropathy and other microvascular diseases, and often accompanied by type 2 is atherosclerosis (coronary heart disease, cerebral infarction), which is more related to hypertension and dyslipidemia. Although strict glycemic control is essential to prevent diabetic microangiopathy, control of diabetic coronary heart disease and cerebral infarction by lowering blood pressure and regulating lipids is more effective and cost-effective, and it is easier to achieve blood pressure and lipid control standards. Therefore, it is important to treat blood pressure and lipids at the same time as hyperglycemia in diabetes. Like hyperglycemia, hypertension and dyslipidemia in diabetic patients can be controlled medically but cannot be cured and require long-term use to maintain compliance. The study of intensive glycemic control in type 1 diabetes proves that intensive glycemic control and efforts to achieve glycemic standards (glycosylated hemoglobin <7%) are certainly effective in preventing chronic complications of diabetes, while the use of insulin is life-saving for patients with type 1 diabetes. However, the results of studies of intensive glycemic control (efforts to "normalize" blood glucose) in patients with type 2 diabetes, both new onset and those with 8-10 years of disease, are unfortunate. In a study of type 2 diabetes of about 10 years' duration aimed at "normalization (glycosylated hemoglobin <6.0%)" of blood glucose, although it took a lot of effort, blood glucose did not achieve "normalization (only 6.4% glycosylated hemoglobin control was finally achieved)". Although the intensive glycemic control did not achieve "normalization" (eventually only 6.4% glycated hemoglobin control was achieved), the number of deaths in the intensive group did not decrease, but increased, compared to those in the slightly more lenient glycemic control. This suggests that intensive glycemic control alone for type 2 diabetes does not really extend the life expectancy of diabetic patients. But the effect of strict glycemia is as effective as type 1 diabetes in preventing microvascular complications (diabetic nephropathy, retinopathy and neuropathy), and intensive glycemic control is certainly very useful. Why is intensive glycemic control effective in preventing atherosclerosis in patients with type 1 diabetes but not significant in type 2 diabetes? First of all, type 1 diabetes generally has no other risk factors for atherosclerosis other than elevated blood glucose. The use of insulin to control blood glucose is the only means. type 2 diabetes is often accompanied by a variety of other metabolic abnormalities, and patients often neglect the control of blood pressure and blood lipids when treating diabetes. the onset of type 2 diabetes is closely related to poor lifestyle habits, and patients often do not pay attention to or are unwilling to change such poor habits. As a result, high-fat diet and lack of exercise lead to obesity, and obesity leads to a decrease in the hypoglycemic effect of insulin. Even with high-dose insulin, it is difficult to achieve glycemic control, and there are many patients who believe that they can not control their diet after trying insulin. Therefore, insulin injections, increased eating, and further weight gain further reduce the glucose-lowering effect of insulin, and blood glucose gradually rises again, and a vicious cycle of increasing insulin dose and more weight gain is formed. Subcutaneous injection of large doses of insulin also leads to hyperinsulinemia, which promotes the development of atherosclerosis and tumor growth. Clinically, we also often encounter situations in which insulin-treated patients often do not control their diet, gain weight significantly, and once one day forget to eat or delay eating after insulin injection, leading to the occurrence of severe hypoglycemia. In the case of a patient with coronary heart disease (often unknown to the patient himself), a single hypoglycemia can potentially be life-threatening because of a severe lack of sugar in the heart and sympathetic excitation to cardiac arrest or myocardial infarction. Other patients are treated with insulin and have average blood glucose control, but their blood pressure increases with weight gain, and eventually brain hemorrhage and cerebral thrombosis occur. Weight loss treatment is currently the most effective means of improving insulin sensitivity, which can significantly reduce the dose of oral hypoglycemic drugs and insulin, making it easier to meet the blood pressure and lipid standards, and reduce the occurrence of hypoglycemia, which can be said to be the treatment of the root cause of diabetes. This is the only way to extend the life of type 2 diabetes in the true sense. Therefore, most international and national diabetes academic groups emphasize that once type 2 diabetes has been diagnosed, efforts should be made to reduce body weight by 5-10%. The ideal weight should be height - 100 = weight in kilograms or body mass index (weight/height squared) < 24. Dietary control is the key to diabetes treatment. It is common to hear patients say I have stopped eating sugar, why is my blood sugar still not under control. If you are not fat (body mass index < 24), eating sugar will not cause diabetes. The reason why patients often drink a lot of drinks at the onset of the disease is because they are already obese, insulin resistant, pre-diabetic or diabetic, except that their blood sugar does not exceed 10 mmol per liter, and they usually have no symptoms of thirst, polyuria or weight loss, but they drink a lot of sugary drinks in the summer when they sweat or at a wine dinner, resulting in a sharp rise in blood sugar. A long time will lead to poisoning of the insulin-secreting cells that are already nearly exhausted, and severe hyperglycemia will occur. In fact, obesity is associated with a high-calorie diet of large amounts of staple foods and fats (oils), combined with a lack of exercise, on a regular basis. Diabetes, including its accompanying atherosclerosis such as coronary heart disease and cerebrovascular disease, is like a frog boiled in warm water. Once it appears, it cannot be cured. It can only be slowed down by changing bad habits and medication, and even good control can be achieved without medication. But if you go back to your old bad habits and gain weight again, your diabetes will get worse again. I have at least ten or more diabetic friends who were obese at diagnosis, lost more than 10 kg through diet control plus physical exercise, and maintained a controlled diet. Currently either without any medication, or taking only a simple medication, blood sugar control is very satisfactory, in the absence of colds and fevers is no different from those who do not have diabetes. Dietary control should be controlled in a degree, and its basic principle is to reduce the total calorie intake without controlling the type. Overweight or obese people have stricter control over the amount of food they eat. It is often said to eat a little bit of everything (including potatoes, groundnuts, rice, all can eat), seven points full as the degree. Never ask what is good to eat more with diabetes. However, there are patients who suffer from malnutrition due to over-controlled diet. This is not desirable. Seven minutes full, eat more vegetables (less oil), exercise more and lose weight. If the blood sugar is still not up to standard, it suggests the need to supplement with medication. There are many diabetic patients who often ask me what kind of glucose-lowering medication is good. My answer is that a drug that is effective in lowering your blood sugar and is safe (less frequent or does not cause hypoglycemia) is a good drug. There are several ways to classify diabetes medications. I am more used to classifying them for patients by whether they are prone to hypoglycemia and whether they have proven to be safe for long-term use. But whether or not it is really right for you is best based on what your doctor has tailored for you. One category is prone to hypoglycemia drugs: drugs that promote insulin secretion (sulfonylureas and glinides) and insulin. Of these, insulin causes the most hypoglycemia, with long-acting sulfonylureas such as glibenclamide being the most severe, especially when taken by patients with newly diagnosed type 2 diabetes. The symptoms of hypoglycemia are varied. Common ones are severe hunger, panic, weakness, cold sweats, and in older people, dizziness. Severe hypoglycemia can lead to coma and often requires help from others to feed some sugar water or intravenous glucose before it can be corrected. If the consultation is not timely, it may lead to a vegetative state. A more reasonable classification of oral hypoglycemic drugs is: a class of drugs that generally do not cause hypoglycemia when taken alone and have good safety in long-term clinical application, such as metformin and acarbose. I often hear patients say "people say that metformin damages the kidneys". In fact, metformin is the only drug that has been shown to extend the life of type 2 diabetes, and the drug has a therapeutic effect on fatty liver. Some are even now watching its attempts to treat breast cancer. Of course if your kidney function (blood creatinine >125 micromol per liter) is up, then you may need to reduce or stop taking the drug. In other cases such as severe heart failure, pulmonary failure hypoxic state, the drug must be discontinued before surgery and iodine oil angiography. It will be taken again a week after the procedure or imaging is completed. There is another category of drugs that do not cause hypoglycemia when used alone, but their long-term safety needs further observation due to the short time on the market, such as sitagliptin, saxagliptin and vildagliptin, etc. The last category is drugs that do not cause hypoglycemia when used alone, but have safety warnings in previous treatments, such as insulin sensitizers rosiglitazone and pioglitazone. The second category is the drugs that promote insulin release, such as the sulfonylurea hypoglycemic drugs used (glibenclamide (the main ingredient in abstinence pills), glimepiride, glipizide (glucophage), glipizide (Ruiyin), glipizide (Damacell), etc.), and glinides (Reglanet, Miglitazone, etc.). These drugs are more effective in lowering blood sugar, but they also tend to cause hypoglycemia. The glinides cause less hypoglycemia than the sulfonylureas, and among the flavoureas, Damectin controlled-release tablets cause less hypoglycemia than the other sulfonylureas. Among the injectable drugs that can stimulate the release of endogenous insulin, suppress appetite and lose weight are exenatide (Bemidji) and liraglutide (Novalur), which are recently marketed. These drugs are basically free of hypoglycemia when administered alone, but they require sufficient insulin secretion capacity of the pancreas. Theoretically, the earlier these drugs are used, the better the effect, and in most cases, the better the effect when combined with other types of oral hypoglycemic drugs. The last category is insulin. The glucose-lowering effect of insulin is unquestionable, but it requires proper application and diet to achieve its excellent glucose-lowering effect. The initial use of insulin requires frequent guidance from doctors or nurses, and patients need to think about their own situation. Whether an insulin is suitable for you needs to be adjusted continuously to achieve rational use of medication and smooth sugar reduction. During this period, blood glucose testing is very important, not only fasting blood glucose, but also postprandial blood glucose. Regular follow-up is very important. For patients with type 2 diabetes, the general principles and order of treatment selection are: strict control of diet, increased exercise, efforts to reduce body weight by 5%-10%, if the diagnosis of high blood glucose at the time of diagnosis, may need short-term combined oral hypoglycemic drugs, if there is ketosis, then may need insulin short-term treatment, blood glucose stabilization and then adjust the appropriate medication according to the actual situation. First, use drugs that have been on the market for a long time and have good safety, and if they still do not meet the standard then you should choose newer drugs. In conclusion, we should follow up the treatment effect and adjust the appropriate medication in a timely manner. Metabolic monitoring of diabetic patients is very important and cannot rely on self-conscious symptoms alone. Frequent self-monitoring of blood glucose is needed (prepare a quality assurance blood glucose meter) and frequent testing of fingertip blood glucose. Some patients often say that fingertip glucose is not as accurate as intravenous glucose, but it is not. For patients with diagnosed diabetes, it is very convenient to test fingertip blood glucose, and as long as the quality of the blood glucose meter chosen is guaranteed and the blood glucose test strips are well preserved, its accuracy is sufficient to guide blood glucose treatment. There is no need to frequently go to the hospital to draw venous blood for blood glucose testing. The frequency of testing is still based on the advice provided by your doctor according to your blood glucose control situation. Another very important indicator is glycosylated hemoglobin. This parameter can reflect the blood sugar control within 3 months, and it is usually measured every 3 months before the blood sugar standard is reached, and after the standard is reached and continues to be reached several times, it is tested once every six months or once a year. In addition to blood glucose index, blood lipids need to be tested every 3 months. Blood pressure should be measured for you by your doctor at each visit and treated accordingly. Screening and follow-up for chronic complications and concomitant diseases (coronary artery disease, etc.) is also very important. Screening for microvascular complications (retinopathy, proteinuria, and neuropathy) is usually required right after type 2 diabetes is diagnosed. Depending on the presence of complications and then your treating physician, you will decide how often to follow up. In conclusion, poor lifestyle habits are the main cause of the current high prevalence of diabetes. Correcting poor lifestyle habits is the key to preventing and treating diabetes and its complications, as well as correcting other metabolic disorders other than blood glucose, which can truly prolong the life of type 2 diabetes; medication should not only target blood glucose, but blood pressure and lipid control are also important; choosing sugar control treatment is safe first; early screening, early diagnosis, early prevention and early Early screening, early diagnosis, early prevention and early achievement of the standard are very important. Finally, I wish all diabetic patients a long and healthy life!