Principles of modern comprehensive treatment of diabetes

Modern comprehensive treatment of diabetes

In 1995, the International Diabetes Federation (LDF) proposed five principles for modern comprehensive treatment of diabetes:

1. Diet control. This is the foundation of diabetes treatment. The purpose of diet control is to reduce the intake of carbohydrates, alleviate the burden on islet β cells, and lose weight while achieving a reasonable diet to ensure the needs of life activities.
2. Exercise therapy. This is the main basic treatment for obese type 2 diabetes (insulin resistance accompanied by insulin secretion deficiency), which can improve insulin sensitivity and reduce insulin resistance.
3. Blood glucose monitoring. Blood glucose monitoring is one of the central links of treatment, and only by timely monitoring the changes in the condition of diabetes can we adjust the treatment measures early and achieve good control.
4. Drug therapy. This is the key to diabetes treatment and the main means to control the disease, including oral hypoglycemic drugs and insulin. The rational selection of hypoglycemic drugs (oral hypoglycemic drugs and insulin) is the focus of treatment, and achieving treatment targets is its goal.
5. Diabetes education. Diabetes is a lifelong disease, and diabetes education can enable patients to become the most accurate “doctors” in understanding their own conditions, which is beneficial for coordinating with doctors’ treatment.

There are differences in the treatment principles between type 1 diabetes and type 2 diabetes.

The treatment principles of type 1 diabetes are as follows:

1. Insulin treatment should be initiated immediately. Once diagnosed with type 1 diabetes, insulin must be used promptly to achieve good control of the disease.
2. Correctly handle slowly progressive diabetes. The clinical course of this type is similar to type 2 diabetes, but sulfonylurea drugs may accelerate the damage to beta cells, leading to a rapid development into complete type 1 diabetes. Therefore, if suspected of this type, insulin treatment should be started early, which has a certain protective effect on the remaining insulin-producing beta cells, slowing down the disease progression and reducing the risk of ketosis.
3. Timely adopt the treatment measures of the Diabetes Control and Complications Trial (DCCT). The experiment proves that insulin intensive treatment and strict control of blood glucose levels close to normal can effectively delay the incidence of retinopathy, nephropathy, and neuropathy in patients with type 1 diabetes, and slow down the course of the disease. If good control cannot be achieved with conventional insulin treatment, intensive treatment should be started early. Insulin intensive treatment involves using exogenous insulin to maintain blood plasma insulin levels close to normal physiological states and maintain blood glucose levels close to normal.
4. Self-monitor blood glucose. During insulin treatment, the blood glucose levels of patients with type 1 diabetes fluctuate rapidly, and self-monitoring should be relied on to adjust and maintain treatment goals.
5. Diet control, exercise therapy, and diabetes education. These aspects should highlight the characteristics of type 1 diabetes, while also focusing on the social and psychological factors affecting disease control in patients with type 1 diabetes, and conduct diabetes education more meticulously.

In addition to the general principles of diabetes treatment, such as education, diet control, exercise therapy, and self-monitoring, type 2 diabetes should also focus on the following aspects:

1. Implement staged treatment, develop different plans for obese and non-obese individuals, and refer to the diabetes staged treatment section for specific methods.
2. Adopt insulin therapy when necessary: applicable to non-obese individuals, long-term disease course, unable to achieve treatment goals after staged treatment, dietary therapy, and reasonable adjustment of oral hypoglycemic drugs; confirmed poor efficacy of sulfonylurea drugs; and special situations such as acute metabolic disorders, stress states, pregnancy, etc.
3. Combine sulfonylurea drugs (SU) with low-dose insulin therapy: SU can promote insulin release and improve peripheral insulin sensitivity, while low-dose exogenous insulin can correct hypoinsulinemia, thereby inhibiting hepatic glucose production and promoting glucose utilization. The ultimate goal is to break the vicious cycle caused by chronic hyperglycemia through a smaller physiological dose of insulin.
4. Insulin intensification therapy: After undergoing the above combined treatment for 2-3 months, if blood glucose control is still unsatisfactory, meaning unable to achieve treatment goals, short-term insulin intensification therapy should be adopted, especially suitable for type 2 diabetic patients with insufficient insulin secretion and a certain degree of insulin resistance.

A study aimed to evaluate the impact of intensive insulin therapy on glycemic control and the risk of hypoglycemia in patients with type 2 diabetes. The researchers conducted a randomized controlled trial at the University of Copenhagen, involving patients who were previously treated with oral antidiabetic drugs and were candidates for insulin therapy. The study compared the effects of standard insulin therapy with those of an intensified insulin regimen, which included more frequent adjustments based on continuous glucose monitoring (CGM) and self-monitoring of blood glucose (SMBG) results.

The study enrolled 200 patients, with 100 patients in each treatment group. After one year of follow-up, the intensified insulin therapy group showed significantly better glycemic control, as evidenced by a lower HbA1c level (mean reduction of 1.5% compared to 0.8% in the standard therapy group). However, the intensified therapy group also experienced a higher frequency of hypoglycemic events, with 30% of patients reporting at least one episode of symptomatic hypoglycemia, compared to 10% in the standard therapy group. The study concluded that while intensive insulin therapy effectively improved glycemic control in type 2 diabetes patients, it also increased the risk of hypoglycemia, emphasizing the need for careful monitoring and patient education to mitigate this risk.

This research highlights the balance between the benefits of improved glycemic control and the increased risk of hypoglycemia associated with insulin intensification therapy in the management of type 2 diabetes, providing valuable insights for clinical practice in Europe and beyond.