High-risk screening and warnings of complications for diabetes: Addressing the health crisis that could shorten lifespan by nine years.
Hyperglycemia
The Epidemiology of Diabetes Mellitus: Diabetes mellitus is a group of metabolic diseases characterized by chronic hyperglycemia. In 1980, the prevalence of diabetes in China (total population) was only 0.67%, reaching 1.04% by 1986. From 1994 to 1995, the prevalence was 2.5%, and in 2002, the prevalence in urban populations was 4.5%, while in rural populations it was 1.8%. A nationwide epidemiological survey of diabetes conducted by the Chinese Diabetes Society in 14 provinces and municipalities in 2007-2008 (using WHO diagnostic criteria) showed that the prevalence of diabetes in people aged 20 and above in my country was 9.7%. In 2010, another nationwide epidemiological survey (using combined diagnostic criteria for diabetes) showed that the prevalence of diabetes in adults aged 18 and above in my country was 11.6%. Therefore, the prevalence of diabetes in my country is very serious. Rapid economic growth, population aging, changes in lifestyle brought about by urbanization, Westernization of dietary structure, increased overweight and obesity rates, and improved medical conditions leading to longer patient survival may be the reasons for the dramatic increase in the prevalence of diabetes in my country.
Classification of Diabetes: Currently, China adopts the 1999 WHO classification system for diabetes etiology, classifying diabetes into type 1 diabetes mellitus (T1DM), type 2 diabetes mellitus (T2DM), and other special types of diabetes based on etiological evidence.
1. T1DM: The pathophysiological characteristics of T1DM are a significant reduction or disappearance of the number of insulin-secreting pancreatic islet cells, resulting in a severe decrease or absolute deficiency of insulin secretion. The age of onset is usually <30 years, with rapid onset, moderate to severe clinical symptoms, significant weight loss, emaciation, and often elevated urinary ketones.
2. T2DM: The significant pathophysiological characteristic of T2DM is a decreased insulin regulation of glucose metabolism (IR) accompanied by reduced or relatively reduced insulin secretion due to pancreatic islet cell dysfunction. It is more common in middle-aged and elderly people, with an insidious onset and often asymptomatic.
3. Special Types of Diabetes: Special types of diabetes are those with relatively clear etiologies. As research into the pathogenesis of diabetes deepens, the number of special types of diabetes will gradually increase. The main special types of diabetes include: hereditary defects in pancreatic islet cell function, such as adult-onset diabetes in young adults and mitochondrial gene mutation diabetes; hereditary defects in insulin action, such as insulin receptor mutations; pancreatic exocrine diseases, such as chronic pancreatitis, pancreatic cystic fibrosis, acromegaly, Cushing's syndrome, etc.; drug- and chemical-induced diabetes, such as glucocorticoids, alpha-interferon, diazoxide, etc.; cytomegalovirus infection; and anti-insulin receptor antibodies.
Screening of High-Risk Patients for Diabetes: Due to limitations in public health resources, diabetes prevention should prioritize high-risk groups, with targeted screening based on the degree of diabetes risk. Definition of high-risk individuals for diabetes in adults: Adults (>18 years) with any one or more of the following risk factors for diabetes:
① Age ≥ 40 years;
② History of impaired glucose regulation;
③ Overweight (BMI ≥ 24 kg/m²) or obesity (BMI ≥ 28 kg/m²) and/or central obesity (waist circumference ≥ 90 cm for men, waist circumference ≥ 85 cm for women);
④ Sedentary lifestyle;
⑤ Family history of type 2 diabetes in a first-degree relative;
⑥ History of macrosomia (birth weight ≥ 4 kg) or gestational diabetes in women;
⑦ Hypertension (systolic blood pressure ≥ 140 mmHg and/or diastolic blood pressure ≥ 90 mmHg), or currently receiving antihypertensive treatment;
⑧ Dyslipidemia (high-density lipoprotein cholesterol (HDL-C) ≤ 0.91 mmol/L (≤ 35 mg/dL), triglycerides ≥ 2.22 mmol/L (≥ 200 mg/dl), or currently undergoing lipid-lowering therapy;
9. Patients with atherosclerotic cardiovascular and cerebrovascular diseases;
10. Individuals with a history of transient steroid-induced diabetes; patients with polycystic ovary syndrome (PCOS); patients receiving long-term antipsychotic and/or antidepressant medications. Definition of high-risk groups for diabetes in children and adolescents: In children and adolescents (≤ 18 years old), those who are overweight (BMI > 85th percentile for age and sex) or obese (BMI > 95th percentile for age and sex) and have any of the following risk factors:
① Family history of type 2 diabetes in a first or second-degree relative;
② Presence of clinical conditions related to insulin resistance (e.g., acanthosis nigricans, hypertension, dyslipidemia, PCOS);
③ Maternal history of diabetes during pregnancy or diagnosis of gestational diabetes. 3.4. The Dangers of Diabetes Diabetes itself is not terrible; what is terrible are the complications of diabetes! A doctor offered a simple explanation: "If you compare blood vessels to dams, then fluctuations in blood sugar are like floods, destroying the dams everywhere. Capillaries are the first to break down, leading to peripheral neuropathy. Then, larger blood vessels, such as those in the eyes and kidneys, develop problems, resulting in eye disease, kidney disease, and foot problems. Finally, problems with the large blood vessels lead to cardiovascular disease." In recent decades, the prevalence of diabetes in China has quadrupled. It is estimated that approximately 110 million people in China currently have diabetes, more than any other country in the world. A study published in JAMA, a top medical journal, shows that compared to those without diabetes, Chinese adults with diabetes will have an average lifespan shortened by 9 years. The study estimates that compared to adults with similar conditions but without diabetes, those who develop diabetes at age 50 have a cumulative mortality rate increasing from 38% to 69% over the following 25 years (until age 75), equivalent to a reduction of approximately 9 years in lifespan. This is mainly due to inadequate diabetes treatment and control, especially in rural areas. In rural areas, the risk of death from acute diabetic complications (such as diabetic coma) due to inadequate diabetes treatment and control is four times higher than in urban areas. Even in urban areas, the risk is significantly higher than in Western countries.
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