Some time ago, the “Chinese Expert Consensus on Mitigating Type 2 Diabetes” (hereinafter referred to as the “Consensus”) was released, which systematically introduced the definition of the alleviation of type 2 diabetes in China and proposed 16 ways to alleviate type 2 diabetes. Today, I take this opportunity to take you to interpret the core content of this consensus.
Type 2 diabetes in China
Definition of mitigation
Let’s start with a clear definition: type 2 diabetes remission.
The consensus recommends the 2021 American Diabetes Association (ADA) release of the type 2 diabetes remission criteria, that is, glycated hemoglobin (HbA1c) < 6.5% after patients stop glucose-lowering drugs for at least 3 months. Type 2 diabetes remission criteria mean that blood glucose can remain in a standard or normal state without hypoglycemic drug therapy. It is important to note that remission is not a cure, and there are currently no drugs or methods that have been proven to cure type 2 diabetes. The Consensus recommends enhanced lifestyle intervention as the basic plan for all T2DM remission, and recommends some relatively specific operation methods, the core idea is “control the mouth, take a step forward”.
How to mitigate it?
1. Appetite management:
(1) Slow down the speed of meals: increase the number of chewings, chew 20~40 times per bite of food; Pause between meals, reduce the volume of each bite, and use non-dominant chopsticks or forks.
(2) Drink water before meals and eat a small number of nuts before meals, such as 10 almonds and 20 peanuts: nuts contain unsaturated fatty acids, which can stimulate the secretion of cholecystokinin after eating, and reduce appetite through vagus and non-vagus nerve pathways.
(3) Arrange the order of meals reasonably: (1) Drinking soup before meals is easy to produce satiety. (2) Vegetables, low-sugar fruits, large volume, low energy, slow down the absorption rate, induce satiety. (3) Meat dishes and meat are high in energy, and they are eaten in the third place to further increase satiety. (4) Eat a small amount of staple foods and carbohydrates at the end of the meal, and slowly absorb them to reduce postprandial blood sugar fluctuations.
(4) Increase foods rich in dietary fiber: Dietary fiber is slowly emptied in the stomach, which is easy to produce satiety. It can increase the intake of oats, whole wheat bread made from meal replacement powder that removes 80% starch, green leafy vegetables, low-sugar fruits and other foods.
Second, exercise intervention
(1) Evaluate health:
(1) Understand the medical history: high blood sugar, high blood pressure, high blood lipids, obesity and cardiovascular disease and other diseases that affect exercise.
(2) Methods for assessing athletic ability: A Endurance: Choose a fixed route and record how long it takes to complete each walk? bUpper limb strength: How many pushes can be done in 2 minutes? c Lower limb strength: sit on a chair and stand up and sit down, how many times can it be completed in 2 minutes? d Balance: Stand on one foot (it is recommended to practice with armrests) for a few minutes? e Flexibility: Sit on a stable chair, stretch out one leg on the opposite chair, heels facing the ground, use your hand to stretch your legs, see how far you can stretch?
(3) Evaluation of exercise safety and cardiorespiratory endurance: exercise stress test is usually used to evaluate the most serious cardiovascular ischemic hazards in exercise and avoid sudden death. While performing the load exercise test, the appropriate heart rate range corresponding to the intensity of aerobic exercise can be calculated to guide the formulation of exercise prescription.
(2) Set goals: Monday to Friday and weekend exercise schedule, how long to exercise? What kind of sport do you want to do?
(3) Choose sports: it is best to choose favorite and suitable projects, you can consider walking, jogging, swimming, gardening, ball games, dancing, fitness, dumbbells, etc.
(4) Set intensity: try to adhere to at least 30 min of moderate-intensity aerobic exercise every day, if you can’t pump the whole 30 minutes a day, you can do 10 minutes each time, exercise 3 times a day. Do strength training more than 2 times a week for 30 minutes. During the exercise process, it is necessary to avoid injury, adjust in time, choose the appropriate exercise mode, the appropriate intensity, the appropriate sports environment and equipment, and monitor the effect in time, which can avoid sports injuries. When the body mass declines too rapidly, the body fatigue and function decline, the exercise load should be appropriately reduced, and when the body mass change is not obvious, the exercise load should be increased to accelerate fat loss.
The following is the recommended clinical treatment method in the “Consensus”, and we recommend that all surgical and drug treatment options must be diagnosed in a regular hospital and judged by the attending doctor.
3. Weight loss drugs
Orlistat was briefly used (12~24 weeks) as an adjunct to BMI ≥ 27 kg/m2 combined with T2DM remission. Orlistat is a lipase inhibitor that prevents the hydrolysis of triacylglycerol to free fatty acids and monoacylglycerides by inhibiting lipase in the gastrointestinal tract, reduces the absorption of dietary fat (triacylglycerol) by the intestinal lumen mucosa, and promotes the elimination of fat. Orlistat is the only weight loss drug approved for body mass management in China.
The adverse reactions of orlistat are mainly steatorrhea, increased frequency of stools, and it is easy to become a “jet warrior” if used improperly. In addition, long-term use for more than 1 year will reduce the absorption of fat-soluble vitamins and β carotene, and liver function impairment has rarely been reported. Orlistat is recommended for short-term (half a year) in obese patients with T2DM whose body weight is not improved optimally after intensive lifestyle interventions.
4. Metabolic surgery
In patients with T2DM with a BMI ≥ 32.5 kg/m2, metabolic surgery may be considered for T2DM relief if nonsurgical measures do not significantly improve body mass and metabolic disorders. Surgery includes laparoscopic Rouxen-Y gastric bypass (LRYGB), laparoscopic sleeve gastrectomy, biliopancreatic diversion (BPD), and other medications. Metabolic surgery is relatively extreme and is not recommended for patients with serious underlying medical conditions or other medical conditions that are not suitable for surgery.
The “Consensus” concludes that diabetes is a complex disease, and the mitigation plan recommended by this consensus cannot stop the drug treatment of every early T2DM patient, but the implementation of the mitigation plan can enable more T2DM patients to regain a healthy life and improve their quality of life. Helping patients relieve T2DM is not only to reduce drugs, stop drugs, and control blood sugar steadily, but also to teach patients a scientific lifestyle of healthy and long life, and benefit life, as well as benefit the patient’s family and the country.
Source: Yangtze Famous Medical Group