Diabetes, as an increasingly serious health problem around the world, has been receiving a lot of attention in its prevention and treatment. Now, exciting news has come to us that the China Diabetes Prevention and Control Guidelines (2024 Edition) has been officially updated and released, injecting new vigour and direction into the clinical treatment and management of diabetes!

This update has expanded and upgraded the original Chinese Guidelines for the Prevention and Control of Type 2 Diabetes and changed its name to Chinese Guidelines for the Prevention and Control of Diabetes. This important change is of great significance, meaning that the scope of management has achieved a major breakthrough, and children and adolescents with diabetes, special types of diabetes, and type 1 diabetes mellitus (T1DM) have been included, thus realising comprehensive coverage of the entire population for the management of diabetes. The management of diabetes for the whole population has been fully covered.

1. Basic knowledge of diabetes

(I) Definition and pathogenesis of diabetes mellitus

Diabetes mellitus is a metabolic disease characterised by hyperglycaemia, which arises from defective insulin secretion or impaired biological action, or both.

(ii) Characteristics of Different Types of Diabetes Mellitus

1.1 Type 1 diabetes mellitus (insulin-dependent or childhood-onset diabetes mellitus): the onset of the disease is usually at a young age, mostly in adolescents, and the onset of the disease is relatively sudden, with symptoms such as polydipsia, polyuria, polyphagia, and emaciation. Patients often have high blood glucose levels, and many even present with ketoacidosis as the first symptom, and this type of diabetes is ineffective when treated with oral medication alone, and must rely on insulin for treatment.

2.2 Type 2 diabetes mellitus (non-insulin-dependent or adult-onset diabetes mellitus): It is common in middle-aged and elderly people, with a relatively high incidence in obese people, and is often accompanied by hypertension, dyslipidaemia, atherosclerosis and other diseases. The onset of the disease is insidious, and there may be no symptoms in the early stages, or only mild weakness, thirst and other manifestations, and for patients who do not have a significant increase in blood glucose, they need to be diagnosed through glucose tolerance tests. It is worth noting that both type 1 and type 2 diabetes have obvious genetic heterogeneity, and for type 2 diabetes, obesity caused by overeating and reduced physical activity is the most important environmental causative factor.

3. Gestational diabetes mellitus: refers to the development or diagnosis of diabetes mellitus during pregnancy in women with normal glucose metabolism or potentially impaired glucose tolerance prior to pregnancy.

New points for diabetes management in children and adolescents

(i) Type 2 diabetes in children and adolescents

When diagnosing type 2 diabetes mellitus in children and adolescents, special attention needs to be paid to the presence of concomitant diseases or complications, such as hypertension, microalbuminuria, fundus lesions, sleep apnoea, dyslipidaemia, hepatic steatosis, and so on. After puberty, attention also needs to be paid to the presence of comorbid polycystic ovary syndrome (PCOS). The starting pharmacological regimen is more flexible, with metformin or insulin alone or a combination of both. In the presence of diabetic symptoms, severe hyperglycaemia, ketosis or diabetic ketoacidosis (DKA), insulin therapy is required, and can be continued in combination with metformin when the acidosis is corrected.

(ii) Special types of diabetes mellitus

Genetic testing for monogenic diabetes mellitus is recommended for all patients with diabetes mellitus starting within 6 months of birth. About 90% of patients with monogenic diabetes caused by mutations in the potassium channel genes (ABCC8 and KCNJ11) respond well to high-dose oral sulphonylureas, which not only contribute to long-term stable glycaemic control, but also may have additional benefits for the development and function of the neuromotor system. Mitochondrial genetic testing is recommended for patients with maternal genetic characteristics, early onset diabetes with deafness, progressive decline in islet β-cell function, and abnormally high basal and post-load lactate. The typical GCK – MODY patient, on the other hand, presents mainly with non-progressive, mild fasting hyperglycaemia and is not at increased risk of diabetes-related complications.

(iii) Type 1 diabetes mellitus

Type 1 diabetes mellitus can be divided into 3 stages: stage 1 is an immune disorder, stage 2 is an abnormality of blood glucose, and stage 3 is a clinical symptom. In screening, for high-risk groups (e.g., first-degree relatives, etc.), islet autoantibody testing is used to screen for subclinical T1DM, which is important for early diagnosis and prevention of the risk of ketoacidosis. In the monitoring segment, continuous glucose monitoring should be used as early as possible to assist diabetes management in patients with T1DM after diagnosis. In terms of treatment, multiple daily insulin injections or continuous subcutaneous insulin infusion regimen should be the core of the treatment, while strengthening the comprehensive management. Happily, Professor Deng Hongkui’s pioneering research on reprogramming somatic cells into pluripotent stem cells using chemical methods has brought new light and hope for the cure of T1DM.

Tips for daily management of diabetic patients

(I) Principles of Glucose Control

When diabetic patients control their blood glucose through diet, exercise or medication, it is important that no hypoglycemia occurs as the first prerequisite to ensure that the blood glucose reaches the standard smoothly.

(ii) Monitoring requirements

Patients are required to monitor their blood glucose (the frequency of monitoring depends on the condition of the patient) and glycated haemoglobin (once every 3-6 months), covering fasting and 2-hour postprandial blood glucose, and under special circumstances, pre-bedtime and night-time blood glucose, in order to have a comprehensive understanding of the fluctuation of blood glucose and make timely adjustments to the treatment plan.

(iii) Complication prevention

To prevent complications of diabetes mellitus, it is not enough to simply control blood glucose, but also to manage health in all aspects. Strict control of blood pressure and blood lipid levels, active improvement of microcirculation disorders, efforts to improve immunity, and maintenance of normal functioning of internal organs, thereby reducing the risk of complications and improving the quality of life.

The update of China Diabetes Prevention and Control Guidelines (2024 Edition) provides more comprehensive, scientific and detailed guidance for diabetes patients, their families and healthcare workers. Let’s join hands to pay attention to the prevention and treatment of diabetes, actively practice a healthy lifestyle, manage diabetes scientifically, and work hard to create a healthier and better future!