Diabetes Care Frontier 2024 Latest Articles

The core progress in the global diabetes care field in 2024 has completely broken out of the old framework of "blood sugar indicator theory only". The three most practical directions are the error control of civilian-grade non-invasive continuous glucose monitoring (CGM) and the standardization of weight-loss anti-diabetic drugs. With the introduction of nursing pathways and the updated consensus on prediabetes reversal intervention, the academic community has made it clear that people of different ages and underlying diseases should adopt differentiated sugar control goals, and there is no longer a universal standard of fasting blood glucose levels of 4.4-6.1mmol/L for everyone.

Last month, I went to attend a nursing branch meeting of the Chinese Diabetes Society (CDS). As soon as I sat down, I was teased by head nurse Li from the endocrinology department, whom I knew well, saying that half of the patients in the clinic recently came to ask about the dynamic blood glucose meter attached to the arm. Some said it was very easy to use, while others said that they were so anxious that they couldn't sleep after using it. To be honest, I used to think that civilian CGM was an IQ tax. It wasn’t until I met a type 1 diabetic patient last year who was sent to him twice because of asymptomatic hypoglycemia and coma. After using the new CGM, he received a half-hour warning of low blood levels in advance. I haven’t been to the emergency room for more than half a year, and I really felt the value of this thing. The civilian model CGM approved in 2024 has controlled the detection error to ±3.5%, fully meeting medical grade standards. The price of the 14-day model has dropped to about 120 yuan, and many regions have also included outpatient chronic disease reimbursement. Of course, controversy has always existed, and many geriatric experts clearly do not recommend it for patients with anxious constitutions: "Originally, it was fine to prick your finger twice a week, but now it jumps every 5 minutes, and you can watch your blood sugar jump when you eat an apple. Even if you are not sick, you will get sick." This is really not an alarmist statement. Not long ago, our department received a 28-year-old Internet practitioner. After he was diagnosed with abnormal glucose tolerance, he bought a CGM and watched it every day. As long as his blood sugar exceeded 7, he became restless. In the end, even the psychology department intervened and stopped the device for him and changed his fingertip blood test to three times a week. The indicators gradually stabilized.

Speaking of indicators, the most exciting update at this annual meeting is actually the adjustment of sugar control goals. Previously, we used to educate patients that fasting was less than 6.1 and glycosylated hemoglobin was less than 7%. Now this standard has become a "basic reference line" and is not a hard requirement. For example, for elderly people over 80 years old with high blood pressure and coronary heart disease, the glycation limit can be relaxed to 8.5 to qualify. For elderly people with cognitive impairment and unable to accurately express their physical feelings, it can even be relaxed to 9% - after all, a severe hypoglycemia brain injury is much more harmful than high blood sugar lasting for two or three months. A while ago, a family member of our department made trouble, saying that his 82-year-old man's fasting blood sugar was 7.8, and why the nurse didn't add medicine. It wasn't until we called up the monitoring system to show him the scene of the old man having hypoglycemia in the middle of the night last week that he fell over looking for candy in the dark, that the family member blushed and apologized.

The popularity of GLP-1 drugs spread from the weight loss circle to endocrinology departments last year. Before, when we encountered patients with nausea, vomiting, and constipation after taking the medicine, we could only dryly say, "Be patient, and you'll get used to it in two weeks." But this year is different. Nursing experts across the country have come up with a unified adaptation plan: First Taking 10mg of vitamin B6 with a small dose of injection can relieve 80% of the nausea. If the reaction is really severe, adjust the injection time to before going to bed. You will hardly feel it when you fall asleep. For the problem of constipation, the nutrition department has also prepared a special dietary fiber package without added sugar, which will not raise blood sugar and can promote intestinal peristalsis. Of course, many clinicians feel that this plan is too "pampering" for patients: the original purpose of nausea is to help patients keep their mouths shut, but if you eliminate all the adverse reactions, the patient will eat hot pot every day, and the effect of the medicine will be reduced by half, but the money will be wasted. Our department met a young man like this a while ago. He took semaglutide and had no adverse reactions after using the anti-nausea regimen. He drank milk tea every now and then. After a month, he did not lose weight and his blood sugar was 0.2mmol/L higher. Later, he was scolded by the bedside doctor before he honestly adjusted his diet.

Compared with patients who have been diagnosed, the people with the most nursing care this year are actually people with prediabetes. Previously, we told patients, "You are in the early stages of diabetes, just eat less and move more." In fact, it was the same as not saying that, because the patients didn't know how to move or eat at all. The "Consensus on Intervention and Nursing for Adults with Prediabetes in China" published at the beginning of this year clearly outlines the plan: 150 minutes of moderate-intensity exercise per week, which must include 40 minutes of resistance training (lifting dumbbells and squatting against the wall), and a diet of "one punch of staple food, two punches of green vegetables, and one punch of high-quality protein", and a dedicated nutritionist to follow up and adjust the plan every week. Last month, our department counted 22 early-stage patients who had just completed three months of intervention, and 17 had their glucose tolerance completely restored to normal levels. However, it should be mentioned here that it is now forbidden in the industry to say that "diabetes can be cured." Even if it is reversed in the early stage, it is also called "clinical remission." If you continue to stay up late and drink milk tea, it will 100% rebound. There is a patient in our department who had the disease reversed in 2019. Last year, he drank beer every day, and he has returned to the early stage this year. He can only come back and do intervention again.

I have been doing diabetes care for almost 10 years, and my biggest feeling is that there has never been a standard answer to the care of this disease. All new developments in 2024, to put it bluntly, are putting the position of "people" first, rather than focusing on cold indicators. After all, we are caring for people who are sick, not the disease, right?