Diabetes control duration

There is no unified standard answer to the duration of diabetes management. Type 1 diabetes patients, type 2 diabetes patients with a disease duration of more than 10 years and obvious decline in pancreatic islet function, and diabetes patients who have developed severe cardiorenal complications need lifelong regular management.； Overweight/obese patients with type 2 diabetes who have a disease duration of less than 2 years, retain more than 70% of islet function, and have no complications have a high probability of achieving clinical remission through intensive intervention for 3-12 months. Subsequently, they only need to monitor metabolic indicators every 3-6 months, and do not need long-term strict taboos or medication.

Last month, I went to the outpatient clinic with the director and met a 32-year-old Internet programmer who had just been diagnosed with type 2 diabetes. His fasting blood sugar was 8.3, glycation 7.0, and BMI 28.7. The insulin release test showed that the peak was only delayed, and there was no obvious decline of the pancreatic islets. The director did not prescribe medication for him, but only set a three-month intervention goal: control carbohydrates within 200g per day, and get 150 minutes of moderate-intensity exercise per week. The young man has a strong execution ability. He eats brown rice and lean meat salad for lunch, and follows the live broadcast of aerobics after get off work. He has lost 22 pounds in 3 months. His glycation level is 5.8 and his fasting blood sugar is stable at around 5.4. The director "relaxed" him on the spot: He didn't need to count calories every day to eat. As long as he didn't eat high-sugar and high-fat foods, he could test his fasting blood sugar 2-3 times a week and check his glycation every six months. It has been almost two years now, and his indicators have been very stable. Occasionally having a hot pot dinner with friends and drinking half a cup of milk tea does not fluctuate much.

Aunt Zhang, who also came for follow-up consultation that day, was different. She was 62 years old and had been diagnosed with diabetes for 14 years. Before, she always felt that "if you don't feel uncomfortable, you don't need to take medicine." Now she takes two anti-diabetic drugs and one anti-hypertensive drug every day. She must test her blood sugar before meals. She cannot touch porridge or pickled products. Even when she eats an orange, she has to calculate the portion and only dares to eat half. The director put it very bluntly: Her condition must be strictly controlled from now on, and if she continues to be left unchecked, she may need dialysis in three to five years.

Regarding the length of control, there have always been two views in the industry that are not contradictory but have completely different opinions.

Most endocrinologists of the old school will repeatedly emphasize to their patients that "diabetes is a lifelong disease and needs to be managed for a lifetime." There is actually nothing wrong with this. Even for people with diabetes who have entered clinical remission, it is not a "radical cure" in essence. It just gives the damaged pancreatic islets a long vacation. If they stop drinking milk tea and eating late-night snacks every day and gain back ten pounds in weight, their blood sugar will most likely rebound, and all previous efforts will be in vain. I met a young man two years ago. He achieved remission within half a year of intervention. He was so restless that he drank ice cola every now and then. Within half a year, his blood sugar spiked back to over 8 points, so he had to start taking medicine again to control his blood sugar.

But now more and more young doctors are more inclined to "relax" patients. At an industry academic meeting a while ago, a deputy chief physician in his thirties said it quite honestly: Many young people with diabetes who have just been diagnosed are already anxious. If you tell them to take care of themselves for the rest of their lives, they will easily break the pot. Instead, it is better to set a small goal for him for three months and tell him that if he achieves it, he will have the opportunity to not need to take medicine, and his execution will be much stronger. After all, the ultimate goal of sugar control is to improve the quality of life, not to tie people to blood glucose meters and boiled vegetables.

To put it bluntly, this is similar to maintaining a car. If you just bought a new car and just applied a little paint, you should pay attention to maintenance after the touch up. You don't have to go to the repair shop every day.； If you have run hundreds of thousands of kilometers and the engine and gearbox are old and damaged, then you need to perform regular maintenance and pay attention to the condition of the vehicle every day, and you must not be careless in the slightest.

Many people have a deep misunderstanding of "control". They think that control is equivalent to eating chaffy vegetables every day and not being able to touch anything delicious. In fact, not at all. Even for people with diabetes who need lifelong control, as long as their blood sugar is stable, eating a piece of cake and drinking half a cup of fruit tea occasionally is not a scourge at all, as long as they don't eat it every day. The core of control is "stability", not harshness.

I have met too many newly diagnosed patients asking, "How long do I have to control it before I get better?" There is really no need to dwell on this fixed duration. Check your pancreatic islet function and glycosylated hemoglobin every six months, and your body will give you the most accurate answer. After all, the reason why we put so much effort into controlling sugar is never to be completely liberated at a certain point in time, but to live a lifetime comfortably and without complications.