Diabetes Prevention Screening Program

Fasting blood glucose combined with oral glucose tolerance test, glycated hemoglobin, insulin/C-peptide release test, islet autoantibody detection, and baseline screening for metabolism-related complications. There is no need to listen to the "diabetes special screening packages" on the market that cost thousands of dollars. Most people can clearly understand the risks by simply choosing a few of them as needed.

Last week, I met a 42-year-old private company owner at a community free clinic. Last year, his fasting blood sugar was 5.8mmol/L, which was within the reference range. He didn’t take it seriously. Over the past six months, he drank white wine and ate barbecue, and his weight increased by 8 pounds. Recently, he always felt tired. Two hours after he drank sugar water, his blood sugar reached 13.2mmol/L. He had already reached the diagnostic standard for diabetes. I regretted it so much.

Many people's understanding of diabetes screening is still "just check fasting blood sugar". In fact, the risk of missed diagnosis is really high due to this understanding. Now there are differences in the academic circles on this point: some scholars believe that routine screening of fasting blood glucose for the general population is enough, and it is low-cost and easy to popularize. ； But the clinical data of the other group is even more shocking - the proportion of carbohydrates in the diet of Chinese residents is generally high, and nearly 40% of pre-diabetic people have completely normal fasting blood sugar, only postprandial blood sugar rises. Only checking fasting is equivalent to letting these people go. When I prescribe examinations for patients myself, as long as they have a family history of diabetes, have a body mass index of over 24, and sit for long periods of time and like to drink milk tea, I will ask if they need a glucose tolerance test. They drink two cups of sugar water and have their blood drawn twice. It costs tens of dollars, so you can buy it with confidence.

Speaking of this, I have to mention glycated hemoglobin, which many people tend to ignore. This indicator reflects your average blood sugar level in the past 2-3 months, and is not affected by whether you have eaten or stayed up late that day. After 2020, our country has officially included it in the diagnostic criteria for diabetes. The normal value is 4%-6%. As long as it exceeds 6.5%, diabetes can be directly diagnosed. Oh, by the way, this test is not omnipotent. If you have blood diseases such as iron deficiency anemia or thalassemia, the results will be lower. You cannot completely believe it. You have to look at it in conjunction with blood sugar.

Many people will ask, my blood sugar is normal, do I still need to check my insulin? I just met a 30-year-old Internet programmer two months ago. His fasting blood sugar was 5.4mmol/L and glycation was 5.7%. He seemed to be fine. However, a C-peptide release test found that his peak C-peptide was 8 times that of fasting and was delayed until 2 hours. To put it bluntly, he had severe insulin resistance. ——For example, it’s like the door lock of your house is rusty. It used to turn once to open, but now it needs to be turned three or four times. Insulin is the key. Now in order to lower blood sugar, the body can only desperately secrete more insulin. At this stage, blood sugar can still remain normal, but after another two or three years, the pancreatic islets are exhausted and blood sugar will go up. Intervention is the best at this time. You don’t need to take medicine. You can run for half an hour every day and drink two cups of milk tea. It can be completely reversed. Intervention after blood sugar is high will be at least three times more difficult.

As for pancreatic islet autoantibody testing, it is mainly used to distinguish types of diabetes. There is also controversy in the academic circles over the scope of its screening: most primary hospitals do not think it is necessary to do it routinely. Only people with a family history of type 1 diabetes and those with first onset of hyperglycemia under the age of 30 need to be screened.； However, many endocrinology departments in tertiary hospitals now recommend that all patients with initial onset of hyperglycemia be checked because the incidence of latent autoimmune diabetes in adults (also known as LADA, commonly known as "type 1.5 diabetes") in adults is increasing. Diabetes may look exactly like type 2 diabetes. Taking oral medications can also lower blood sugar, but in fact, pancreatic islet function declines very quickly. If it is not detected and the wrong use of sulfonylurea drugs that stimulate pancreatic islet secretion will completely deplete the remaining pancreatic islet function, early detection of antibodies can avoid this pitfall.

Finally, when it comes to the baseline screening for metabolic-related complications, many people will wonder, I haven’t been diagnosed with diabetes yet, so why check for complications? In fact, in the early stage of diabetes, the damage to blood vessels and kidneys caused by high blood sugar has already begun. Routinely check your blood lipids, blood pressure, urine microalbumin, and fundus to know whether you have already suffered early damage. If you already have microalbumin in your urine, you must not only control sugar, but also salt and blood lipids. Otherwise, it will be irreversible when it progresses to diabetic nephropathy.

I usually don’t prescribe a full set of tests for everyone when I come up. After all, no one wants to draw multiple tubes of blood for no reason. If you are only slightly overweight, have no family history, and have a regular daily routine, it is enough to check your fasting blood sugar and glycation every year. ； If you have a family history, like to drink milk tea and stay up late, have a big belly and thin limbs, it is best to do a glucose tolerance and C-peptide release test. ； If you are under 30 years old and have not gained much weight but suddenly experience elevated blood sugar and weight loss, you must check for pancreatic islet autoantibodies and do not take medicine randomly.

Oh, by the way, fingertip blood sugar can only be used for daily monitoring. For screening or diagnosis, venous blood must be drawn, otherwise the results will be inaccurate and money will be wasted. If you have recently had a fever, had surgery, or taken hormonal drugs, do not test for glucose tolerance for the time being. The results may be biased. It is not too late to check again after your physical condition is stable.

In fact, diabetes is a disease that can be scary or scary. As long as it is detected early and intervened early, many people will not progress to the point of needing to take medicine in their lifetime. Spending hundreds of dollars for a screening is better than taking medicine and insulin every day, right?