Diagnostic criteria for diabetes and the "five pillars" of comprehensive management

IV. Diagnostic Criteria for Diabetes

my country currently adopts the internationally accepted diagnostic criteria proposed by the WHO Expert Committee on Diabetes (1999).

1. Diagnostic criteria for diabetes

Diagnostic criteria for diabetes: Diabetic symptoms plus random blood glucose ≥11.1 mmol/L, or fasting blood glucose ≥7.0 mmol/L, or 2-hour postprandial glucose level ≥11.1 mmol/L after an oral glucose tolerance test (OGTT). Symptoms of diabetes include polyuria, polydipsia, and unexplained weight loss; random time refers to any time of day, regardless of the time and amount of food consumed at the last meal; fasting refers to the absence of any calorie intake within at least 8 hours.

2. Diagnostic criteria for gestational diabetes mellitus

The 2017 Chinese Guidelines for the Prevention and Treatment of Type 2 Diabetes Classify Pregnancy Complicated with Hyperglycemia into Three Categories.

(1) Gestational diabetes mellitus (GDM) is defined as an oral glucose tolerance test (OGTT) performed at any time during pregnancy, with a fasting blood glucose level of 5.1–6.9 mmol/L, an OGTT 1-hour blood glucose level ≥10.0 mmol/L, or an OGTT 2-hour blood glucose level of 8.5–10.9 mmol/L. A blood glucose level meeting any of the above indicators is sufficient for diagnosis.

(2) Gestational overt diabetes mellitus (ODM) mainly refers to diabetes mellitus that is discovered at any time during pregnancy and meets the diagnostic criteria for diabetes in non-pregnant individuals, namely fasting blood glucose ≥7.0 mmol/L or blood glucose ≥11.1 mmol/L 2 hours after glucose load, or random blood glucose ≥11.1 mmol/L.

(3) Pregnancy-pregnancy diabetes mellitus (PGDM) refers to type 1, type 2 or special type of diabetes diagnosed before pregnancy, which is the most severe type of diabetes during pregnancy.

3. How to correctly use blood glucose tests to diagnose diabetes

The recommended clinical diagnosis of diabetes is based on the glucose oxidase method for measuring venous plasma glucose. For individuals without diabetic symptoms but with only one blood glucose level meeting the diagnostic criteria for diabetes, a follow-up test on another day is necessary to confirm the diagnosis. The diagnostic criteria for diabetes in children are the same as for adults. The American Diabetes Association (ADA) has adopted a glycated hemoglobin level ≥6.5% as the diagnostic criterion for diabetes. However, due to insufficient relevant data and a lack of standardized testing methods in my country, and with several scholars raising questions about this diagnostic criterion, this method is not currently used in my country for diagnosing diabetes.

V. Treatment of Diabetes

In clinical practice, the International Diabetes Federation has proposed five key points for comprehensive diabetes management (commonly known as the "five pillars"), namely diabetes education, medical nutrition therapy, exercise therapy, blood glucose monitoring, and drug therapy.

(I) Diabetes Education

Currently, although the medical system for the diagnosis, treatment, and prevention of diabetes is quite comprehensive, some medical personnel still lack sufficient understanding of it, underestimate its importance, or fail to provide adequate guidance to patients. This results in a failure to effectively raise awareness among patients and their families within the chronic disease management system, and even instances of tacit approval or consent for patients to self-medicate with folk remedies. Furthermore, patients and high-risk groups, as the targets of diabetes prevention, are also central to chronic disease management. Their attitudes towards the disease, their treatment plans, and their adherence directly affect the success of diabetes treatment and the effective prevention and control of complications. Health education for high-risk groups is a crucial means of effectively curbing the incidence of diabetes. However, changing a person's lifestyle is a challenging task. Therefore, while intervention by medical personnel is important for the success of diabetes management, the key lies in correcting the lifestyles and attitudes towards the disease among patients and high-risk groups. To do this work well, patient education, one of the "five pillars" of healthcare, is indispensable.

(II) Medical Nutrition Therapy

1. Calculate the total heat.

Calculate the ideal weight based on the patient's age, gender, and height [ideal weight (kg) = height (cm) - 105], and calculate the total daily calorie requirement based on lifestyle habits.

At rest, the required energy intake is 25–30 kcal/(kg·d); for light physical labor, it is 30–35 kcal/(kg·d); for moderate physical labor, it is 35–40 kcal/(kg·d); and for heavy physical labor, it is ≥40 kcal/(kg·d). Children, pregnant women, malnourished individuals, and those with wasting diseases should increase their intake accordingly, while obese individuals should decrease their intake, gradually restoring their weight to ±5% of their ideal weight.

2. Nutritional distribution of total calories

Carbohydrates should provide 50%–60% of total calories in the diet; protein intake should be 10%–15% of total calories; fat should provide no more than 30% of total calories; and cholesterol intake should be <300 mg/day.

After determining the dietary composition, calculate the calories into food items based on the principle that each gram of carbohydrates and protein produces 4 kcal of energy, and each gram of fat produces 9 kcal of energy, and then create a meal plan, distributing the daily meals in 1/5, 2/5, and 2/5 portions.

Carbohydrates are mainly supplied by staple foods. For example, rice contains 77% carbohydrates, grains contain 60%–80%, tubers contain 15%–29%, and legumes contain 40%–60%. Generally, it is reasonable for grains to provide about 50% of the total energy from carbohydrates.

Alternatively, if calculations are difficult, daily staple food (rice and noodles) can be estimated using the following method:

Patients who are completely at rest should consume 200-250g of staple food per day; patients engaged in light physical labor should consume 250-300g of staple food per day; patients engaged in moderate physical labor should consume 300-400g of staple food per day; and patients engaged in heavy physical labor should consume 400-500g of staple food per day.

Protein is mainly obtained from meat, eggs, dairy products, and staple foods. For example, lean pork contains 18% protein, meaning that eating 50g of lean pork can provide about 9g of protein.

Because protein-rich foods often contain a lot of fat, and people with "five highs" (high blood pressure, high blood sugar, high cholesterol, and high blood sugar) should choose low-fat foods, it's crucial to pay close attention to the fat content when selecting these foods. Generally, the following methods can be used as a guide:

(1) Choose lean meats whenever possible, such as lean beef, lamb, lean pork, and fish.

(2) When choosing eggs, it is recommended to use chicken eggs.

(3) Selection of legumes, including soybeans and other legumes. Soybeans (such as yellow soybeans, green soybeans, black soybeans, etc.) have a protein content as high as 30% to 50%, and the quality is very good. They are rich in the eight essential amino acids needed by the human body and are the only plant-based foods that can rival animal-based foods in terms of high protein content, earning them the nickname "plant meat". In addition, other legumes (such as red beans, mung beans, white lentils, kidney beans, cowpeas, peas, broad beans, etc.) have very little fat, accounting for only 1%, and a protein content of 20% to 25%. They can supplement the lysine lacking in ordinary grains and also contain minerals and B vitamins.

(4) Choose nuts and seeds. These foods also contain high-quality protein, but they are high in fat. Patients should eat as little as possible or avoid them altogether.

(5) Selection of milk and dairy products: Most common milk and dairy products are rich in fat, but nowadays there are many low-fat dairy products available on the market that you can choose with confidence, such as skim/low-fat milk and skim yogurt.

(6) Fat can be obtained from cooking oil and meat, fish, milk, and soy products. Patients with "five highs" should mainly follow a low-fat diet and use vegetable oil for cooking. Among various foods, nuts have the highest fat content, various meats are in the middle, and rice, noodles, vegetables, and fruits have very little fat content.