What should be measured in diabetes prevention testing?

Fasting blood glucose and glycated hemoglobin must be checked as the core of diabetes prevention testing. High-risk groups should also undergo an oral glucose tolerance test. It is also recommended to simultaneously evaluate metabolism-related indicators and pancreatic islet function to try to identify risks in the early stages of no symptoms.

I met Xiao Zhou, a 32-year-old programmer at a community free clinic before. The annual physical examination at work only checked fasting blood sugar, and the values were around 5.3mmol/L. He never took it seriously. During that time, he always felt tired. He relied on energy drinks to cheer him up, but the more he drank, the more thirsty he became. When he came to check, the sugar level was high. The level of glycation has reached 6.6%, and it has soared to 12mmol/L two hours after supplementing the glucose tolerance meal. Diabetes has been diagnosed. If the glycation and glucose tolerance had been added a year or two earlier, it might still be in the early stages, and it could be brought back by adjusting the daily routine and diet, without taking medicine at all.

In fact, the logic of these tests is easy to understand. Fasting blood sugar is equivalent to an "instant snapshot" of your blood sugar when you get up in the morning without eating. If you deliberately ate less the day before, the value may pretend to be normal and "muddle through."”； Glycated hemoglobin is your "average running account" of blood sugar in the past three months. It will not be affected by a single meal and can truly reflect the overall blood sugar level during this period. ； The oral glucose tolerance test is equivalent to a "stress test" for your blood sugar metabolism system. Drink a standard amount of glucose water to see if your body can quickly adjust blood sugar to the normal range. Many people with normal fasting blood sugar cannot pass this test, which means they have metabolic defects.

There are currently two related minor controversies in the industry. One is whether glycated hemoglobin should be included in routine screening at the grassroots level. Some grassroots institution equipment is not regularly calibrated, and the measured value error can be as low as 1%. In this case, it is indeed not as reliable as measuring fasting blood glucose alone. However, as long as the equipment is calibrated by a regular medical institution, glycation is already recognized as a must-check item.； The other is whether the screening age should be lowered. Previous guidelines recommended annual screening for those over 40 years old. Nowadays, a large number of people in their twenties are suffering from type 2 diabetes in clinical practice. Many front-line doctors recommend that as long as the waist circumference is excessive, sedentary, like to eat high-sugar and high-fat foods, and have a family history of diabetes, it is best to have a check-up every year, regardless of whether you are 40 years old or not.

In addition to the items directly related to blood sugar, blood lipids, blood uric acid, blood pressure, liver and kidney function are usually measured. After all, diabetes is a metabolic disease, which often occurs together with high blood pressure, hyperlipidemia, and high uric acid. Only by looking at these indicators together can you more accurately judge your overall metabolic status, and give more practical adjustment suggestions. For example, if you also have high uric acid, you must also pay attention to eating less high-purine foods when controlling your sugar, and you cannot just focus on sugar.

Don’t bother with these checks. There are basically no symptoms in prediabetes. By the time you have the typical symptoms of eating more, drinking more, urinating more, and losing weight, the pancreatic islet function has often been damaged by more than 30%. Early detection and early intervention are better than anything else.