Treatment Goals for Diabetes

Treatment Goals for Diabetes include the following eight aspects.

1. Eliminate diabetes symptoms, making patients feel more comfortable. Some patients may have their symptoms disappear after treatment, but their blood sugar control is not good, which should cause attention.
2. Correct glucose metabolism disorders, control hyperglycemia, and reduce blood sugar to normal or near-normal levels.
3. Correct lipid metabolism disorders and other metabolic abnormalities, prevent the occurrence of chronic complications such as vascular lesions.
4. Prevent and treat the development of various acute and chronic complications, treat accompanying diseases, and alleviate patient suffering.
5. Ensure the normal growth and development of children and adolescents.
6. Ensure normal pregnancy, delivery, and childbirth for women in their reproductive age.
7. Through diabetes education, enable patients to learn basic diabetes knowledge, master necessary self-monitoring skills, have self-care abilities, and consciously apply them in disease monitoring and self-prevention and treatment, such as self-testing for urine sugar, blood sugar, insulin injection techniques, and self-handling of hypoglycemia, etc., to reduce “health losses” and “economic burdens.”
8. Improve the quality of life for people with diabetes, such as participating in normal social labor and social activities, maintaining a normal psychological and physical state, and striving to become healthy and long-lived.

Second, Diabetes Control Indicators (Treatment Goals for Diabetes)

There is no unified diabetes control indicator at home and abroad. As high blood sugar is the basis of diabetes complications, whichever standard is used, it should follow the principle of achieving the above objectives. It is necessary to control high blood sugar, prevent hypoglycemia, and prevent the occurrence and development of complications. Control indicators must be individualized.

(1) Biochemical indicators of diabetes control.

When formulating a patient’s control indicators, it is necessary to consider factors such as the severity of the disease, age, presence or absence of chronic complications, education level, medical care conditions, and economic status, so as to be time-varying and person-specific. Of course, achieving the ideal control is the best, but it is unrealistic to require this standard without considering individual differences. Table 3-1 and 3-2 list the biochemical control indicators and diabetes control indicators recommended internationally in recent years, which can be used as a reference for doctors and patients in monitoring the condition.

Table 3-1,Biochemical indicators of metabolic control in diabetes

Compliance projects	Ideal indicators	Acceptable indicators	Adverse indicators
Blood glucose (mmol/L)
Fasting	＜6.4	＜7.8	＞7.8
2 hours after meals	＜7.8	＜11.2	＞11.2
Glycated blood red egg (%)
HbA1c	＜6	＜8	＞8
Blood lipids (mmol/T)*
Tch	<5.2	<6.2	＞6.2
TG	≤1.7	2.2~2.8	＞2.8
LDL-C	≤3.4	≤4.2	≥4.2
HDL-C	≥1.2
Body Mass Index (BM1)
male	<25	<27	＞27
female	<24	<26	＞26

Table 3-2,Diabetes control indicators
target	Good	average	poor
Blood glucose (mmol/L)
Fasting	4.4~6.1	≤7.8	＞7.8
2 hours after meals	4.4~8.0	≤10.0	＞10.0
Glycated white hemoglobin (%)
HbA1c	<6.5	≤7.5	＞7.5
HbA1	<8	≤9.5	＞9.5
Urine sugar (%)	0	≤0.5	＞0.5
Blood lipids (mmol/L)
Tch	<5.2	<6.5	＞6.5
TG	<1.65	<2.2	＞2.2
HDL-ch	＞1.04	≥0.91	<0.91
LDL-ch	<3.4	<4.1	＞4.1
Body mass index (kg/m*m)
male	20~25	≤27	＞27
female	19~24	≤26	＞26
Blood pressure (kPa)	≤18.7/12	≤21.3/12.7	＞21.3/12.7

(2) DCCT Intensive Treatment Control Indicators.

DCCT initially targeted type 1 diabetes in the United States and successfully demonstrated that intensive insulin treatment can achieve strict blood sugar control and effectively delay the onset of chronic complications. Now, DCCT is also used for the treatment of type 2 diabetes. Its control indicators are:

• Fasting blood sugar between 3.9-6.7mmol/L;
• fasting blood glucose of 1 hour, 2 hours and 3 hours after meal <8.3mmol/l, 7.22mmol/l, 6.7mmol/l respectively, or postprandial <10mmol/l;
• 24-hour urine sugar quantitative analysis below 5g (or less than 2.5% of daily carbohydrate intake);
• Measure blood sugar at 3 a.m. once a week, with a range of 3.6-5.6mmol/L;
• Measure hemoglobin A1c (HbAc) once a month, within the normal range (<6.05%).

Refer to the simplified table 3-3 for reference.Treatment Goals for Diabetes.

(3) The control indicators of senile diabetes,

as mentioned earlier, senile diabetes has its particularity. The renal glucose threshold of elderly patients increases, urine glucose cannot reflect the blood glucose level, and the renal function of the elderly is relatively reduced, which often leads to the accumulation of hypoglycemic drugs, and the occurrence of late-onset hypoglycemia, and most of them are asymptomatic hypoglycemia, which is easy to induce cardiovascular and cerebrovascular accidents. Therefore, the control indicators of metabolism in elderly patients should be appropriately relaxed, and the principle is “appropriately control hyperglycemia, but also strictly prevent hypoglycemia”. See table 3-4 for the control indicators.

(4) General Control Indicators for Clinical Treatment of Diabetes.

The above control indicators detailed the standards of good, moderate, and poor disease control. Generally, it is considered that the disease is under control when it reaches a level above moderate. However, the table is rather complex and requires a doctor’s evaluation of the disease control level. In order to more effectively assess the treatment efficacy, a simple, memorable, accessible, feasible, and achievable control indicator is needed that is easy for doctors and patients to apply, especially for elderly patients, outpatients, and those receiving treatment outside the hospital.

Therefore, domestic diabetes experts have proposed the following general control indicators for patients with diabetes (Table 3-4). Patients who generally meet the standards listed in the table are considered to have reached the treatment goals, and those who do not meet the indicators need to adjust their treatment plan to achieve the desired control. In addition, if you want to thoroughly understand the disease control situation, you should follow the standards listed in Tables 3-1 and 2.

Based on the understanding of the above diabetes control indicators, doctors should formulate and implement individualized comprehensive treatment plans for patients. Patients should actively cooperate, timely return to the clinic, self monitor the changes of blood and urine glucose levels, and timely detect the HbA1c level.

The three organically cooperate, and timely and appropriately adjust the treatment plan, so that patients can reach the treatment standard. This practical control standard, even if it cannot reach the ideal control level, is better than poor control and allowing the disease to develop naturally. Medical staff must warn patients that failure to meet the treatment standard is harmful, and make them believe that the control goal of treatment is achievable, reasonable and feasible.