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*Only for medical professionals to read and refer to the 2020 Chinese Type 2 Diabetes Prevention and Control Guidelines.
What changes have been made to the management of diabetes complications? Let's take a look at the editor~ As the research on type 2 diabetes at home and abroad has made significant progress, we have obtained more evidence-based medicine for the prevention, diagnosis, monitoring and treatment of diabetes and its chronic complications.
The Diabetes Branch of the Chinese Medical Association specially organized experts to revise the original guidelines and formed the "Guidelines for the Prevention and Treatment of Type 2 Diabetes in China (2020 Edition)"[1] (hereinafter referred to as the 2020 Edition Guidelines), which aims to deliver important progress and guidance in a timely manner clinical.
The 2020 version of the guide has 19 chapters, covering the epidemiology of diabetes in China, the diagnosis and classification of diabetes, the tertiary prevention of type 2 diabetes, the screening and evaluation of diabetes, the education and management of diabetes, the goals of comprehensive control of type 2 diabetes, and Treatment pathways for hyperglycemia, medical nutrition, exercise therapy and weight management, medical treatment of hyperglycemia, diabetes-related technologies, acute and chronic complications of diabetes, hypoglycemia, special conditions of diabetes, metabolic syndrome and traditional Chinese medicine treatment of diabetes, etc.
.
This article provides an in-depth interpretation of the most distressing complications for diabetic patients.
Diabetes complications include acute complications and chronic complications.
Figure 1: Not much to say about the classification of diabetic complications, dry goods! 01 Left square bracket diabetic ketoacidosis.
Left square bracket diabetic ketoacidosis is a syndrome of severe disorders of sugar, fat and protein metabolism caused by insufficient insulin and improper rise of glucocorticoids.
It is clinically characterized by high blood sugar and high blood ketones.
And metabolic acidosis is the main feature.
The 2020 version of the guidelines is compared with the "Chinese Type 2 Diabetes Prevention and Control Guidelines (2017 Edition)" [2] (hereinafter referred to as the 2017 version of the guidelines) as follows.
Figure 2: The difference between the 2020 guidelines and the 2017 guidelines for diabetic ketoacidosis.
It should be emphasized that compared with the 2017 guidelines, the 2020 guidelines have stricter pH indications for supplementing sodium bicarbonate solution-in When pH≤6.
9, it is recommended to supplement sodium bicarbonate solution (B) appropriately.
02 Hyperglycemia and hyperosmolarity in the left bracket.
Hyperosmolarity and hyperglycemia in the left bracket is one of the severe acute complications of diabetes.
It is clinically characterized by severe hyperglycemia without obvious diabetic ketoacidosis, significant increase in plasma osmotic pressure, and dehydration It is characterized by disturbance of consciousness.
The 2020 version of the guide compared to the 2017 version of the guide changes as follows.
Figure 3: The difference between the 2020 guidelines and the 2017 guidelines for hyperosmolar hyperglycemia states.
In the 2020 guidelines, the recommendation of “starting insulin therapy (A) when the blood glucose is still greater than 16.
7 mmol/L after simple fluid rehydration” is removed.
However, this does not mean that the role of insulin in the treatment of hypertonic hyperglycemia has shifted.
The 2020 version of the guidelines pointed out that the principle of insulin use for hyperosmolar hyperglycemia is roughly the same as that for the treatment of diabetic ketoacidosis.
Generally speaking, patients with hyperosmolar hyperglycemia are more sensitive to insulin and the amount of insulin is relatively small.
A continuous intravenous infusion of 0.
1U·kg-1·h-1 is recommended.
When the blood sugar drops to 16.
7mmol/L, the insulin infusion rate should be slowed down to 0.
02~0.
05U·kg-1·h-1, and the glucose solution should be continued intravenously, and the insulin dosage and glucose concentration should be continuously adjusted to make The blood glucose was maintained at 13.
9~16.
7mmoL/L until the hypertonic hyperglycemia state and the hyperglycemia crisis were relieved.
The remission of hypertonic hyperglycemia state is mainly manifested as the blood osmotic pressure level drops to normal and the patient's state of consciousness returns to normal.
03 Left square bracket diabetic nephropathy Left square bracket chronic kidney disease (CKD) includes chronic kidney structure and dysfunction caused by various reasons.
About 20%-40% of diabetic patients in my country have diabetic nephropathy, which has now become the main cause of CKD and end-stage renal disease.
The 2020 version of the guide compared to the 2017 version of the guide changes as follows.
Figure 4: The difference between the 2020 guidelines and the 2017 guidelines for diabetic nephropathy.
In the 2020 guidelines, recommendations for two new drugs have been added.
It is recommended to choose GLP-1RA or SGLT-2i for renal benefit based on renal function.
Among them, the use of SGLT-2i in patients with eGFR≥45 ml·min-1·(1.
73m2)-1 to reduce the progression of diabetic nephropathy and/or the risk of cardiovascular events is a level A recommendation.
In addition, the 2020 version of the guidelines has also added recommendations for individualized follow-up time for patients with diabetic nephropathy to ensure timely monitoring of the patient’s progress and adjustment of management plans.
Table 1 Recommendations for the risk of diabetic nephropathy progression and frequency of visits Note: The numbers in the table refer to the recommended number of annual follow-ups.
The background color represents the risk of chronic kidney disease progression: green is low risk, yellow is medium risk, orange is high risk, and red is very high risk.
04Left bracket diabetic retinopathy Left bracket diabetic retinopathy is a common chronic complication of diabetes and the main cause of blindness in adults.
The 2020 version of the guide has no obvious changes compared to the 2017 version of the guide.
Figure 5: The difference between the 2020 and 2017 guidelines for diabetic retinopathy.
05 Left bracket diabetic neuropathy.
Left bracket diabetic neuropathy is the most common chronic complication of diabetes.
Diabetic neuropathy is most representative of distal symmetrical polyneuropathy.
The 2020 version of the guide has changed as follows from the 2017 version of the guide.
Figure 6: The difference between the 2020 guidelines and the 2017 guidelines for diabetic neuropathy.
It should be emphasized that in the 2020 guidelines, A-level recommends pregabalin, gabapentin or duloxetine as the initial treatment for diabetic painful neuropathy .
06 Left bracket diabetic lower extremity arterial disease.
Left bracket lower extremity arterial disease is a component of peripheral arterial disease, which is manifested as stenosis or occlusion of lower extremity arteries. The main cause is atherosclerosis, but arteritis and embolism can also lead to lower extremity arterial disease.
Therefore, lower extremity arterial disease in diabetic patients usually refers to lower extremity atherosclerotic disease (LEAD).
The 2020 version of the guide compared to the 2017 version of the guide changes as follows.
Figure 7: The difference between the 2020 guidelines and the 2017 guidelines on diabetic lower extremity arterial disease.
The 2020 version of the guidelines has major changes in the management of diabetic lower extremity arterial disease.
Among them, Level A recommends that all patients with confirmed LEAD receive antiplatelet therapy.
The recommendation of vasodilator therapy for LEAD has also been upgraded from grade B to grade A.
In addition, three new A or B recommendations have been added.
07 Left square bracket diabetic foot disease Left square bracket diabetic foot disease is one of the chronic complications of severe diabetes and high treatment costs.
The severe cases can lead to amputation and death.
The 2020 version of the guide has no obvious changes compared to the 2017 version of the guide.
Figure 8: The difference between the 2020 guidelines and the 2017 guidelines for diabetic foot disease.
The above is the revision of the 2020 guidelines for the management of diabetic complications.
References: [1].
Diabetes Branch of Chinese Medical Association, Chinese Journal of Diabetes, 2021;13(4):317-411.
[2].
Guidelines for Prevention and Treatment of Type 2 Diabetes in China (2017 Edition)[J].
China Practical Internal Medicine Magazine, 2018, 38(04):292-344.
What changes have been made to the management of diabetes complications? Let's take a look at the editor~ As the research on type 2 diabetes at home and abroad has made significant progress, we have obtained more evidence-based medicine for the prevention, diagnosis, monitoring and treatment of diabetes and its chronic complications.
The Diabetes Branch of the Chinese Medical Association specially organized experts to revise the original guidelines and formed the "Guidelines for the Prevention and Treatment of Type 2 Diabetes in China (2020 Edition)"[1] (hereinafter referred to as the 2020 Edition Guidelines), which aims to deliver important progress and guidance in a timely manner clinical.
The 2020 version of the guide has 19 chapters, covering the epidemiology of diabetes in China, the diagnosis and classification of diabetes, the tertiary prevention of type 2 diabetes, the screening and evaluation of diabetes, the education and management of diabetes, the goals of comprehensive control of type 2 diabetes, and Treatment pathways for hyperglycemia, medical nutrition, exercise therapy and weight management, medical treatment of hyperglycemia, diabetes-related technologies, acute and chronic complications of diabetes, hypoglycemia, special conditions of diabetes, metabolic syndrome and traditional Chinese medicine treatment of diabetes, etc.
.
This article provides an in-depth interpretation of the most distressing complications for diabetic patients.
Diabetes complications include acute complications and chronic complications.
Figure 1: Not much to say about the classification of diabetic complications, dry goods! 01 Left square bracket diabetic ketoacidosis.
Left square bracket diabetic ketoacidosis is a syndrome of severe disorders of sugar, fat and protein metabolism caused by insufficient insulin and improper rise of glucocorticoids.
It is clinically characterized by high blood sugar and high blood ketones.
And metabolic acidosis is the main feature.
The 2020 version of the guidelines is compared with the "Chinese Type 2 Diabetes Prevention and Control Guidelines (2017 Edition)" [2] (hereinafter referred to as the 2017 version of the guidelines) as follows.
Figure 2: The difference between the 2020 guidelines and the 2017 guidelines for diabetic ketoacidosis.
It should be emphasized that compared with the 2017 guidelines, the 2020 guidelines have stricter pH indications for supplementing sodium bicarbonate solution-in When pH≤6.
9, it is recommended to supplement sodium bicarbonate solution (B) appropriately.
02 Hyperglycemia and hyperosmolarity in the left bracket.
Hyperosmolarity and hyperglycemia in the left bracket is one of the severe acute complications of diabetes.
It is clinically characterized by severe hyperglycemia without obvious diabetic ketoacidosis, significant increase in plasma osmotic pressure, and dehydration It is characterized by disturbance of consciousness.
The 2020 version of the guide compared to the 2017 version of the guide changes as follows.
Figure 3: The difference between the 2020 guidelines and the 2017 guidelines for hyperosmolar hyperglycemia states.
In the 2020 guidelines, the recommendation of “starting insulin therapy (A) when the blood glucose is still greater than 16.
7 mmol/L after simple fluid rehydration” is removed.
However, this does not mean that the role of insulin in the treatment of hypertonic hyperglycemia has shifted.
The 2020 version of the guidelines pointed out that the principle of insulin use for hyperosmolar hyperglycemia is roughly the same as that for the treatment of diabetic ketoacidosis.
Generally speaking, patients with hyperosmolar hyperglycemia are more sensitive to insulin and the amount of insulin is relatively small.
A continuous intravenous infusion of 0.
1U·kg-1·h-1 is recommended.
When the blood sugar drops to 16.
7mmol/L, the insulin infusion rate should be slowed down to 0.
02~0.
05U·kg-1·h-1, and the glucose solution should be continued intravenously, and the insulin dosage and glucose concentration should be continuously adjusted to make The blood glucose was maintained at 13.
9~16.
7mmoL/L until the hypertonic hyperglycemia state and the hyperglycemia crisis were relieved.
The remission of hypertonic hyperglycemia state is mainly manifested as the blood osmotic pressure level drops to normal and the patient's state of consciousness returns to normal.
03 Left square bracket diabetic nephropathy Left square bracket chronic kidney disease (CKD) includes chronic kidney structure and dysfunction caused by various reasons.
About 20%-40% of diabetic patients in my country have diabetic nephropathy, which has now become the main cause of CKD and end-stage renal disease.
The 2020 version of the guide compared to the 2017 version of the guide changes as follows.
Figure 4: The difference between the 2020 guidelines and the 2017 guidelines for diabetic nephropathy.
In the 2020 guidelines, recommendations for two new drugs have been added.
It is recommended to choose GLP-1RA or SGLT-2i for renal benefit based on renal function.
Among them, the use of SGLT-2i in patients with eGFR≥45 ml·min-1·(1.
73m2)-1 to reduce the progression of diabetic nephropathy and/or the risk of cardiovascular events is a level A recommendation.
In addition, the 2020 version of the guidelines has also added recommendations for individualized follow-up time for patients with diabetic nephropathy to ensure timely monitoring of the patient’s progress and adjustment of management plans.
Table 1 Recommendations for the risk of diabetic nephropathy progression and frequency of visits Note: The numbers in the table refer to the recommended number of annual follow-ups.
The background color represents the risk of chronic kidney disease progression: green is low risk, yellow is medium risk, orange is high risk, and red is very high risk.
04Left bracket diabetic retinopathy Left bracket diabetic retinopathy is a common chronic complication of diabetes and the main cause of blindness in adults.
The 2020 version of the guide has no obvious changes compared to the 2017 version of the guide.
Figure 5: The difference between the 2020 and 2017 guidelines for diabetic retinopathy.
05 Left bracket diabetic neuropathy.
Left bracket diabetic neuropathy is the most common chronic complication of diabetes.
Diabetic neuropathy is most representative of distal symmetrical polyneuropathy.
The 2020 version of the guide has changed as follows from the 2017 version of the guide.
Figure 6: The difference between the 2020 guidelines and the 2017 guidelines for diabetic neuropathy.
It should be emphasized that in the 2020 guidelines, A-level recommends pregabalin, gabapentin or duloxetine as the initial treatment for diabetic painful neuropathy .
06 Left bracket diabetic lower extremity arterial disease.
Left bracket lower extremity arterial disease is a component of peripheral arterial disease, which is manifested as stenosis or occlusion of lower extremity arteries. The main cause is atherosclerosis, but arteritis and embolism can also lead to lower extremity arterial disease.
Therefore, lower extremity arterial disease in diabetic patients usually refers to lower extremity atherosclerotic disease (LEAD).
The 2020 version of the guide compared to the 2017 version of the guide changes as follows.
Figure 7: The difference between the 2020 guidelines and the 2017 guidelines on diabetic lower extremity arterial disease.
The 2020 version of the guidelines has major changes in the management of diabetic lower extremity arterial disease.
Among them, Level A recommends that all patients with confirmed LEAD receive antiplatelet therapy.
The recommendation of vasodilator therapy for LEAD has also been upgraded from grade B to grade A.
In addition, three new A or B recommendations have been added.
07 Left square bracket diabetic foot disease Left square bracket diabetic foot disease is one of the chronic complications of severe diabetes and high treatment costs.
The severe cases can lead to amputation and death.
The 2020 version of the guide has no obvious changes compared to the 2017 version of the guide.
Figure 8: The difference between the 2020 guidelines and the 2017 guidelines for diabetic foot disease.
The above is the revision of the 2020 guidelines for the management of diabetic complications.
References: [1].
Diabetes Branch of Chinese Medical Association, Chinese Journal of Diabetes, 2021;13(4):317-411.
[2].
Guidelines for Prevention and Treatment of Type 2 Diabetes in China (2017 Edition)[J].
China Practical Internal Medicine Magazine, 2018, 38(04):292-344.
