Diabetes Prevention Program

As long as layered and individualized intervention is carried out, more than 80% of people at high risk of type 2 diabetes can completely postpone the onset of type 2 diabetes or even avoid the disease for life. There is no need to take the extreme path of "completely quitting sugar and starving to the point of fainting".

Don't believe it, I just encountered a typical example last week. The 52-year-old Aunt Zhang's physical examination revealed that her fasting blood sugar was 6.8mmol/L. The doctor said she had impaired glucose tolerance and was in the early stages of diabetes. She changed all her white rice to hard-to-swallow multigrain rice when she got home. She didn't even dare to touch apples and bananas. She was so hungry for half a month that her eyesight turned black when she squatted down to pick things up. When she checked again, her blood sugar increased by 0.2mmol/L. She sat in my clinic wiping her tears and said that she was suffering so much and it still didn't work.

In fact, this is also the biggest misunderstanding that many people have about diabetes prevention: they always think that it is effective only if they are strictly implemented according to a unified standard answer, but in practice this is not the case at all. There are two parallel ideas about diabetes prevention in the industry. There is no absolute right or wrong, but the applicable scenarios are different: in the public health field, universal basic recommendations are more respected, which is what everyone often sees: "150 minutes of moderate-intensity exercise per week, no more than 25g of added sugar per day, and whole grains accounting for 1/3 of the staple food." This is a safety baseline for the entire population, as long as it is done Reduce the risk of disease by about 30%; clinical endocrinology departments prefer individualized and precise intervention. For example, some high-risk groups already have severe insulin resistance, and lifestyle adjustments alone are too slow to achieve results. Short-term GLP-1 drugs can be used as auxiliary drugs. In some people, high blood sugar is caused by cortisol disorders caused by staying up late and being stressed for a long time. Adjusting work and rest is much more important than controlling sugar.

Don’t tell me, when we did the intervention project, we would not give everyone a uniform recipe. Brother Wang, who drives a day shift online car-hailing service, sits in the car for 12 hours a day. It is simply unrealistic for him to go to the gym three times a week. We set three small requirements for him: get out of the car and stretch his arms and legs for three minutes after every two orders, replace all bottled sweet drinks in the car with sugar-free sparkling water or light tea, and replace the bean paste bread that used to fill his stomach with original almonds. He does not deliberately diet or take extra time to exercise. After eight months of persistence, his sugar tolerance was checked, and the indicators have completely returned to the normal range. There is also a young Internet operator who was born in 1996. She works overtime every day and eats takeout. Her fasting blood sugar is 6.3mmol/L. We asked her to note "1/3 less rice" every time she orders takeout. She gets off the subway one stop before get off work and walks home. She didn't even give up milk tea completely. She just changed one cup of full sugar every day to two cups of three-point sugar every week, and the index dropped after 3 months of review.

Of course, it is not without controversy. For example, there has been debate on the Internet for several years about "Can the ketogenic diet prevent diabetes?" Three high-risk groups in our project tried it. The blood sugar did drop quickly in the first three months. The highest fasting blood sugar dropped from 7.1 to 5.6, but follow-up problems also followed: one of them had mild gallstones, which directly caused biliary colic, and another one persisted for half a year and couldn't help but burst the carbon. He drank milk tea 8 times and ate 5 hot pot meals in half a month, and his blood sugar rebounded to 7.3, which was higher than before. The current consensus in the academic community is that ketosis can only be used as a short-term intervention method. It takes up to 3 months to evaluate physical indicators. It is definitely not suitable as a long-term prevention plan. Especially people with hepatobiliary diseases and gout should not touch it.

There is another pitfall that many people step on. Don’t think that you can just eat food labeled “sugar-free”. There used to be an uncle who was afraid of high blood sugar, so he ate sugar-free biscuits as a snack every day. After half a year of eating, his blood sugar rose higher and higher. When he took a look at the ingredient list, although there was no sucrose added, 20% shortening and maltodextrin were added, which raised blood sugar faster than white rice.

To be honest, after doing intervention for so long, my biggest feeling is that diabetes prevention has never been an ascetic practice. You don’t have to force yourself to completely give up your favorite cream cakes, nor do you have to swallow multi-grain rice that you are not used to eating, nor do you have to copy the sugar-control recipes of Internet celebrities. Small changes that can be adhered to in the long term have a much greater effect than extreme self-discipline in the short term. If you are really not sure whether you are a high-risk group, go to a community health service center near your home to do an OGTT (oral glucose tolerance test). You can find out for a few dozen yuan, which is much more reliable than guessing about symptoms online.