Diabetes prevention and control activity content

The core of diabetes prevention and control activities currently implemented in China is to focus on the three goals of "reducing the risk of onset for the general population, delaying the onset of disease for high-risk groups, and reducing the probability of complications for confirmed patients." It is implemented through the three core links of early screening, intervention, and follow-up. There is no unified standardized template, and all content is flexibly adjusted based on the characteristics of the service population and the resources that can be mobilized.

To be honest, I used to think that this kind of activity was nothing more than putting up a banner to test blood sugar, handing out pamphlets and shouting "Shut up and move your legs." It wasn't until I ran offline activities with the community public health team for more than half a year last year that I realized that there are many more ways to go than I thought. Last month at the free clinic in Zhaohui District 2, Hangzhou, we measured the fasting blood sugar of 120 residents in one morning. 17 values ​​exceeded 7mmol/L, and 8 of them had no idea that their blood sugar was high before. Don’t think that you’re done after measuring your blood sugar. We also brought non-mydriatic ophthalmoscopes and specialist nurses that day to examine the fundus and touch the dorsalis pedis artery for free for patients diagnosed with diabetes for more than 5 years. Three patients who had developed fundus microaneurysms were given referral orders on the spot. There was also an Aunt Zhang who had been diabetic for 8 years. The pulsation of the dorsalis pedis artery was very weak. Later, a B-ultrasound of the lower limb blood vessels was found to be 30% blocked. Fortunately, it was discovered early and did not develop into foot rot. That day I also met Uncle Wang, who said that he had just passed the blood sugar test during the physical examination at work last month. After careful questioning, we found out that he had deliberately cut out fruits and braised pork three days before the physical examination, and the test results were not at all true. We made an appointment for him on the spot to have his glycosylated hemoglobin tested a week later, and the result came out to be 6.8%, which is already at the red line of pre-diabetes.

Most of the activities in the community are for the elderly. If you change the scene, such as the sugar prevention activities of Internet companies, the gameplay will be completely different. I used to do health consulting for a major Internet company. The average age of their employees was only 28, but nearly 20% of them were found to be insulin resistant. Fasting blood sugar appeared to be normal, and the insulin level was twice the normal value. They were a typical diabetes reserve. In this situation, if you tell them about diabetic foot and fundus hemorrhage, they will have no idea at all. So we played a small game called "Sugar Level Challenge" and asked everyone to choose their usual milk tea, fried chicken, light salad, and guess the blood sugar level one hour after eating. If you guess correctly, you will be given sugar-free yogurt and low-GI biscuits as prizes. You will also be taught fragmented resistance movements that you can do at the work station: stand up and do 15 squats every hour after sitting, and hold two 500ml bottles of mineral water in your hands and lift 20 times. Many studies in the field of sports medicine believe that this kind of fragmented resistance exercise is more effective in improving insulin sensitivity than taking the time to run 3 kilometers at a time. Of course, many public health experts do not agree with this view. They believe that long-term persistence of 150 minutes of moderate-intensity aerobics per week will have a more stable long-term control effect on blood sugar. There is currently no unified consensus in the academic community. Everyone can choose according to their own schedule. Moving is always better than not moving.

Speaking of dietary intervention, this is also the most controversial part in the field of diabetes prevention. When we did popular science in the past, traditional nutrition doctors would recommend that everyone eat a low-GI diet, eat more whole grains, and make carbohydrates account for about 50% of total calories every day. However, in recent years, many studies have pointed out that for high-risk groups who have developed obvious insulin resistance, short-term strict restriction of carbohydrate intake (no more than 100g per day or even lower) can improve blood sugar indicators faster and even reverse type 2 diabetes. In practice, we will not forcefully set standards for everyone. For example, for the elderly who like to drink porridge, we suggest them to put more mixed beans and less white rice, and eat two bites of vegetables and eggs before drinking, which is much more effective than directly saying "no porridge"; for young people who rely on milk tea every day, we suggest them to change all sugar to three-quarter sugar and drink one less cup per week, which is much more acceptable than directly asking them to quit milk tea.

Oh, by the way, if you move to remote counties or rural areas, the priority of activities will be different. Last year, we followed the mobile screening vehicle to several villages in Dingxi, Gansu Province. Many villagers did not even know what blood sugar was. Many people came to check because their eyes were unclear and their feet were rotten. When tested, their blood sugar exceeded 20mmol/L. At this time, it is useless to give a long popular science lecture. The first step is to test glycated hemoglobin for free - this indicator can reflect the average blood sugar level in the past three months, which is much more accurate than a single fasting blood sugar test. It is for patients who have already been diagnosed. Provide basic hypoglycemic drugs such as metformin and glimepiride free of charge. Once their symptoms are relieved, slowly teach them to replace pure white flour buns with multi-grain buns mixed with oatmeal. Don’t lie down and rest immediately after eating. Go for a walk on the ridge, which will have better effects.

In fact, my biggest feeling after doing so many activities is that diabetes prevention and control has never relied on any high-level theory, and there is no absolutely correct activity template. Whether it is free screening, popular science games, door-to-door follow-up visits, or free medicine distribution, as long as it can fit people's actual lives, really make people willing to change a little bit of their habits, and help those who are already sick avoid complications, it is a valuable activity.