Diabetes Prevention Screening Program

Insulin release test and urine microalbumin/creatinine ratio are enough, there is no need to do a bunch of fancy self-paid items.

Aunt Zhang, whom I met at a community free clinic last week, is a typical example. She had just received a physical examination report from her work unit, and her fasting blood sugar was 5.8mmol/L, which was within the reference range. She thought she was fine at first, but after asking, she found out that she had been experiencing dry mouth recently and had to wake up two or three times at night. Her daughter is a diabetic and is in a high-risk group. She was advised to do an OGTT. The result was that her blood sugar two hours after taking sugar was 11.3mmol/L, which is the threshold for diagnosis of diabetes.

The one that everyone is most familiar with is definitely fasting blood glucose. The result can be obtained by drawing a tube of venous blood. It is cheap and convenient. Many physical examinations only check this one item. But is it enough to just check fasting blood sugar? This matter has actually been quarreling in clinical circles for many years. General practitioners at the grassroots level are more inclined to use it as a general screening project. After all, it is highly popular and low-cost, and is suitable for large-scale screening. ； However, endocrinologists generally feel that the missed diagnosis rate is too high, especially since the Chinese diet has a high proportion of carbohydrates. Many people's blood sugar rises after meals in the early stages, and their fasting blood sugar may stay within the normal range for most of half a year. By the time the fasting blood sugar exceeds the limit, pancreatic islet function has often been reduced by half. Here is a little practical reminder. When checking fasting blood sugar, don’t deliberately starve the day before, and don’t eat barbecue and drink milk tea until midnight. Fasting for 8-12 hours is the most appropriate. If you are hungry for too long after 14 hours, glycogen will decompose and increase the results, which is not accurate.

Let’s talk about glycated hemoglobin. This indicator reflects the average blood sugar level in the past 2-3 months. You don’t have to fast and you can pump it at any time, which is very convenient. Many European and American guidelines have now adopted glycation ≥6.5% as one of the diagnostic criteria for diabetes, but this has not yet been fully promoted in China. The core controversy is that the testing standardization level of hospitals at different levels is different. The results measured by instruments in some grassroots hospitals are too inaccurate, and it is easy to make a diagnosis based on this alone. I met a 26-year-old Internet employee before who drank two cups of milk tea with water every day. His fasting blood sugar was 5.7mmol/L when tested by the unit. He thought he was fine. However, he came to the hospital to find out that his glycation level was 6.4%, which is already an early warning sign of diabetes. He will most likely develop diabetes in a year and a half.

As for the oral glucose tolerance test, many people get confused when they hear that they have to draw blood four times (fasting, 1 hour, 2 hours, and 3 hours after taking sugar). Many people would rather believe that they are fine than do it. There are also different opinions on whether to use it as a routine screening project. Experts in the public health field think that the cost is too high and it takes up medical resources. There is no need for the general population to do it. ； However, the consensus of endocrinology departments is that as long as they are high-risk groups, even if their fasting blood sugar is normal, it is best to do it once every three years. It can detect more than 80% of early abnormalities in glucose metabolism. Aunt Zhang is the most typical example.

If you are a high-risk group, it is recommended to do two more advanced examinations. One is the insulin release test, which can be done at the same time as the OGTT. It mainly depends on whether your pancreatic islet function is good or not. Some people's blood sugar is completely normal, but the peak of insulin secretion has been delayed. For a normal person, the insulin reaches the peak 1 hour after taking sugar, but it may take 3 hours for him. Such people are always hungry and feel flustered before meals. In fact, it is an early warning sign of diabetes, and it can be discovered two or three years earlier than abnormal blood sugar. I once had a friend who weighed 180 pounds and was diagnosed with this problem. He controlled carbohydrates and exercised regularly for half a year, and his insulin secretion completely returned to normal. The other is the urinary microalbumin/creatinine ratio, which can be measured by taking a morning urine test. It mainly checks whether there is early diabetic kidney damage. Many people have high blood sugar for three to five years without knowing it. Wait until foamy urine occurs and then check again. The kidney damage is already irreversible. This test is cheap and convenient, and early detection can completely reverse it.

Don’t do a bunch of useless tests. Insulin antibodies and C-peptide stimulation tests are all used to classify diabetes after diagnosis. General screening is simply unnecessary and a waste of money. The blood glucose meter that you usually prick your finger on can be used for preliminary screening. If the finger blood exceeds 6mmol/L, you must go to the hospital to draw venous blood for confirmation. Don't scare yourself at home, and don't take it seriously.

In fact, when it comes to diabetes, if it is discovered half a year early and half a year later, the outcome is quite different. I have seen people diagnosed with diabetes in their thirties who need lifelong insulin injections, and I have also seen people whose diabetes was completely reversed after pre-adjustment in half a year. The only difference lies in whether they have regular check-ups. There is no need to pursue expensive ones. Doing the right projects is much more useful than doing too many projects.