Relevant data show that the proportion of patients with type 2 diabetes in youth is as high as 16%. Studies have shown that patients diagnosed with diabetes before the age of 30 have more severe neurological damage and impaired kidney function, resulting in higher mortality. As a result, young diabetics face greater health, psychological, and social challenges. What should I do if a young person has diabetes? Recently, experts from diabetes associations and other institutions in Australia jointly released the first management consensus for people aged 18 to 30, providing exclusive advice for young patients. Let's explain the main points for you now.
Young people with diabetes face many special pathological challenges. For example, studies have shown that young diabetics have a higher risk of developing diabetic nephropathy, retinopathy, and peripheral neuropathy, and are also prone to hypertension and arteriosclerosis. In addition, young patients with type 2 diabetes have more severe proteinuria, and the risk of death increases by 3 times with a higher proportion of abdominal obesity and high blood lipids. Therefore, it is crucial to control metabolic levels and cardiovascular disease risk factors and reduce the harm of complications.
The first expert consensus put forward 12 core recommendations. #1: Screening for diabetes in people who are overweight or obese, as well as those with other risk factors. Second, screening results, glycosylated hemoglobin levels reach 5.7% to 6.4%, or fasting blood glucose is impaired, should be done glucose tolerance test. Third, in order to reduce the risk of complications, the control goal of glycosylated hemoglobin should be set below 6.5%. Fourth, if the β cells decline rapidly, frequent re-examination is required and early treatment is intensified.
The fifth core recommendation of the first expert consensus is to focus on the increased incidence of MODY in young adult-onset diabetes. Sixth, fully consider the psychological burden faced by young people with type 2 diabetes. Seventh, avoid the risk of increased weight or hypoglycemia due to medical factors. 8th, control blood pressure, systolic blood pressure is less than 130mmHg, diastolic blood pressure is less than 80mmHg. 9. Early use of lipid-lowering statins. 10th, if the LDL level exceeds 3.4 mmol/L, lipid-lowering therapy should be performed to control this indicator below 2.6 mmol/L. 11. It is recommended to do at least 300 minutes of moderate-intensity exercise per week. 12. If possible, the treatment and care team should include specialists in endocrinology, nutrition, psychology, exercise physiologists, etc.
Young people who are overweight or obese and have one or more of the following risk factors may need to be screened for type 2 diabetes. 1. Have been diagnosed with type 2 diabetes during pregnancy or have a history of gestational diabetes. Second, immediate family members are diabetics. Third, high-risk groups. Fourth, clinical examination has evidence of insulin resistance, impaired fasting blood glucose, impaired glucose tolerance, and large-vessel disease. Fifth, antipsychotic drugs have been used. Experts also recommend that care be taken to distinguish between types of diabetes and to identify single-gene diabetes. Therefore, insulin autoantibodies, as well as the associated enzyme or antigen levels, are measured.
The first expert consensus proposes specific dietary and physical activity interventions for young patients with type 2 diabetes. First, if overweight people continue to lose weight, losing 7% to 10% of their weight can help control blood sugar and cardiovascular disease risk. Patients are advised to adopt a healthy diet and increase physical activity. However, current research evidence suggests that dietary and physical activity interventions have a weaker impact on weight loss and glycemic control, so pharmacological interventions should be strengthened. In a word, when it is time to take medicine, you must take medicine. Expert consensus specifically recommends that patients need to reduce their total energy intake, quit sugary drinks, ensure adequate intake of vegetables and fruits, reduce the intake of saturated fats, and increase the intake of high-fiber foods. In addition, it is necessary to reduce sedentary time, ensure adequate sleep, and limit the time spent using electronic products to less than 2 hours per day.
The first expert consensus, with particular emphasis, should be paid attention to the psychological condition of young diabetics, because problems such as disease distress, depression, eating disorders, mood swings are more common in young patients with type 2 diabetes, and patients may face stigma, appropriate psychological intervention should be carried out, and alcohol and drug abuse need to be vigilant. For glycemic management and drug therapy strategies, it should be noted that metformin therapy may fail, additional treatment needs to be added earlier, and when blood glucose is difficult to control, insulin is required, and glycosylated hemoglobin testing is performed every 3 months. Finally, the prevention and management of complications should be strengthened, hypertension, nephropathy, retinopathy, peripheral neuropathy, dyslipidemia, cardiovascular disease, ovarian cyst syndrome, non-alcoholic fatty liver disease, obstructive sleep apnea should be strengthened, and pregnancy and prenatal care of female patients need to be strengthened.
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