Treatment plan for diabetes

Treatment Goals

Treatment goals for diabetes: Control symptoms of diabetes, prevent acute metabolic complications, prevent chronic complications, improve the quality of life of diabetic patients, establish a more complete diabetes education management system, and provide patients with individualized guidance on lifestyle intervention and medication.

Treatment Measures

What are the common treatment measures for diabetes?

What are the general treatment measures for diabetes? The treatment of diabetes requires comprehensive treatment. Given that the condition and age of each diabetic patient are different, the treatment plan is also different. However, no matter what type of diabetes, no matter how serious the condition is, dietary treatment should be carried out. As well as receiving as much diabetes knowledge as possible, self-management ability should be improved. At the same time, the enthusiasm of the patient and his/her family must be mobilized to achieve a better control result.

The five key points of comprehensive diabetes management include diabetes education, medical nutrition treatment, exercise treatment, drug treatment, and blood sugar monitoring.

1. Diabetes Education

Patients and their families should learn and understand as much as possible about diabetes and its complications. They should actively seek help from professionals, follow the doctor's advice for treatment, and improve their awareness and ability of self-management.

2. Medical Nutrition Treatment

Medical nutrition treatment is the basic management measure for diabetes, which aims to help patients develop nutrition plans, form good eating habits, determine a reasonable total energy intake, reasonably and evenly distribute various nutrients, and restore and maintain ideal weight.

Generally, ideal weight can be estimated based on height (cm) -105. Adults with normal weight need 15-20 kcal of energy per kilogram of ideal body weight per day when completely bedridden, 25-30 kcal in resting state, and energy intake can be increased as appropriate according to physical labor. Dietary nutrition distribution should be balanced: Carbohydrate supply accounts for 50-60% of total calories: Adult patients' daily staple food intake is 250-400 g, and monosaccharide and disaccharide intake should be limited. Protein intake accounts for 15-20% of total calories, and adult patients are given 0.8-1.2 g per kilogram of ideal body weight per day. At least half of the protein should come from animal protein.

Daily fat intake accounts for 25-30% of total calories, of which saturated fatty acid intake is less than 10% of total energy, and cholesterol intake is less than 300 mg/d. Foods rich in dietary fiber are recommended. Daily energy intake should be reasonably distributed to each meal, which can be distributed according to 1/5, 2/5, 2/5, or 1/3, 1/3, 1/3 for three meals a day.

3. Exercise Treatment

Exercise treatment is particularly important for patients with type 2 diabetes who are obese and should be performed under the guidance of a physician: 150 minutes of moderate-intensity exercise per week is recommended.

4.Blood Glucose Monitoring

Disease monitoring based on blood glucose monitoring is also very important. Blood glucose monitoring indicators are mainly fasting and postprandial blood glucose and HbA1c. GA can be used to evaluate the short-term efficacy of blood glucose control after adjustment. Patients can use a portable blood glucose meter to monitor their blood glucose at home.

In addition: Disease monitoring should also include monitoring of cardiovascular risk factors and complications: patients should undergo blood lipid tests and comprehensive heart, kidney, nerve, fundus, and other related examinations at least once a year.

Drug therapy

Due to the large individual differences, there is no absolute best, fastest, and most effective medication: except for commonly used OTC drugs: the most appropriate drug should be selected under the guidance of a doctor in combination with personal conditions.

Currently, diabetes treatment drugs include two categories: oral drugs and injectable preparations. Oral hypoglycemic drugs mainly include insulin secretagogues, non-insulin secretagogues, DPP-4 inhibitors, and SGLT-2 inhibitors. Injectable preparations include insulin, insulin analogs, and GLP-1 receptor agonists.

I. Oral Drugs

Insulin Secretagogues Promoting insulin secretion: mainly including sulfonates and glinides.

-Carbohydrate Drugs

Including glibenclamide, gliclazide, glipizide, gliclazide, etc. This type of drug controls blood sugar by promoting insulin secretion from pancreatic β cells. Improper use can lead to hypoglycemia, especially in elderly patients and those with liver and kidney dysfunction, it can also cause weight gain. This type of drug is suitable for use with metformin or other hypoglycemic drugs to control blood sugar.

Precautions for use include the use of gliquidone for patients with mild renal insufficiency; patients with poor compliance are advised to choose drugs that are taken once a day.

- Meglitinide Drugs

Including repaglinide and nateglinide. This type of drug exerts a hypoglycemic effect by increasing insulin secretion: the use is the same as sulfonated drugs. This type of drug takes effect quickly after absorption and has a short duration of action. Improper use may lead to hypoglycemia, but the incidence and degree of hypoglycemia are milder than sulfonated drugs. Non-insulin Secretagogues Including metformin, thiazolidinediones, and a-glucosidase inhibitors.

- Metformin

Metformin has almost no effect on normal people: but it has a significant hypoglycemic effect on diabetic patients and does not affect insulin secretion: it reduces the output of glucose in the liver: it has a mild weight loss effect: it can reduce the risk of cardiovascular disease and death and prevent the development of prediabetes into diabetes. Metformin alone does not cause hypoglycemia.

Metformin is the first-line drug recommended by the current diabetes guidelines for the treatment of type 2 diabetes: it can be used alone or in combination with other hypoglycemic drugs.

Thiazolidinedione Drugs

Common drugs include rosiglitazone and pioglitazone. This type of drug can improve blood sugar by increasing insulin sensitivity. Side effects include weight gain, edema, and increased risk of heart failure. It does not cause hypoglycemia when used alone, but it can increase the risk of hypoglycemia when used in combination with insulin or secretagogues. Thiazolidinedione drugs can be used with metformin or in combination with other hypoglycemic drugs to treat hyperglycemia in type 2 diabetes, especially in obese patients with significant insulin resistance.

α-Glucosidase Inhibitor Drugs

Including acarbose and voglibose. It is suitable for patients whose main food component is carbohydrates and whose postprandial blood sugar is significantly increased. Its mechanism of action is to inhibit the absorption of carbohydrates in the upper small intestine, which can reduce postprandial blood sugar and improve fasting blood sugar. There are usually gastrointestinal reactions when used.

DPP-4 Inhibitors

Mainly improving blood sugar by increasing insulin secretion. At present, there are 5 types of drugs on the market in China, namely saxagliptin, sitagliptin, vildagliptin, linagliptin, and alogliptin. They can be used alone or in combination to treat type 2 diabetes. Using alone does not increase the risk of hypoglycemia or weight gain.

SGLT-2 Inhibitors

Achieving the purpose of lowering blood sugar by inhibiting the renal reabsorption of glucose and promoting the excretion of glucose from the urine: they have the effects of reducing weight and lowering blood pressure, and can also reduce uric acid levels, reduce urinary protein excretion, and reduce triglycerides. They can be used alone or in combination to treat type 2 diabetes. Using alone does not increase the risk of hypoglycemia.

The main ones are dapagliflozin, canagliflozin and empagliflozin. Dapagliflozin and empagliflozin can be taken before or after meals, and canagliflozin needs to be taken orally before the first meal.

In addition to having a strong hypoglycemic effect, this type of drug also has a strong effect of reducing the risk of cardiovascular disease, heart failure, and renal failure in patients with type 2 diabetes, independent of the hypoglycemic effect.

|Injectable Drugs Insulin

It can be divided into regular insulin, rapid-acting insulin, intermediate-acting insulin, long-acting insulin, and premixed insulin. Different insulins are selected according to the patient's specific glucose-lowering needs. Common side effects of insulin are hypoglycemia and weight gain. Patients who receive long-term insulin injections may also experience subcutaneous fat hyperplasia and atrophy. Allergy to insulin is rare.

GLP-1 Receptor Agonists

Have a hypoglycemic effect by stimulating GLP-1 receptors. By enhancing insulin secretion, inhibiting glucagon secretion, delaying gastric emptying, and reducing food intake through central appetite suppression.

Currently, the GLP-1 receptor agonists on the market in China include exenatide, benaglutide, liraglutide, and dulaglutide, all of which need to be injected subcutaneously. Clinical trial results show that liraglutide and dulaglutide have the effect of reducing the risk of cardiovascular disease in patients with type 2 diabetes independent of their glucose-lowering effects. Common side effects of GLP-1 receptor agonists are nausea and loss of appetite.

Surgical treatment

The main surgical method is metabolic surgery.

| Indications

patients aged 18-60, in good general condition, obese type 2 diabetes patients, or obese type 2 diabetes patients with other cardiovascular risk factors whose blood sugar is difficult to control after lifestyle intervention and various drug treatments. Contraindications

- Patients with drug abuse, alcohol addiction, and uncontrollable mental illness;

- Patients who can't understand the risks and expected consequences of metabolic surgery;

- Patients with type 1 diabetes;

- Patients with type 2 diabetes whose pancreatic β-cell function has been significantly impaired;

- Patients with contraindications to surgery; BMl<25kg/m^2;

- Gestational diabetes and other special types of diabetes. Common Surgical Methods

Sleeve Gastrectomy

The operation is relatively simple, and the postoperative complications and reoperation rate are the lowest among all metabolic surgeries. It is currently considered to be the preferred one for type 2 diabetes accompanied by moderate to severe obesity.

Gastric Bypass

The operation is relatively complex, with great trauma and a high incidence of complications. After surgery, more attention should be paid to the monitoring and supplementation of nutrients: it is used for patients with a relatively long course of type 2 diabetes who need to lose more weight.

| Surgical Management

Preoperative evaluation of patients with type 2 diabetes who have indications for metabolic surgery.

Total calories should be restricted after surgery. Patients should adopt a gradually phased diet, avoid concentrated sweets, ensure protein intake, replenish water, and supplement vitamins and micronutrients. In addition, patients need to persist in exercise, improve health-related quality of life, and follow up throughout their lives.