How should diabetes prevention?

How should diabetes prevention?
1. A means for the prevention of diabetes susceptible individuals or entire populations of non-selective prevention, mainly refers to environmental factors and lifestyle changes to prevent or reduce diabetes in all activities. If appropriate restrictions on energy intake, avoiding obesity, and promote normal weight and to encourage more physical activities. The general needs of the implementation of preventive measures, national, government and health authorities have attached great importance to it as a national policy, mobilize large numbers of medical health personnel and use of mass media widely Che Didi for social marketing and education to raise awareness 有关 the basics of diabetes to understand the dangers of diabetes and its complications and seriousness to achieve the desired results.

In addition, type 2 diabetes is a genetic tendency of many diseases has been found that more than 20 candidate genes, such as insulin gene, insulin receptor, insulin receptor substrate -1 gene, glucose transporter gene, glucokinase gene, glycogen synthase gene, β3 receptor gene and mitochondrial genes associated with type 2 diabetes, these candidate genes associated with type 2 diabetes, the study carried out at risk of population projections provide molecular basis, many of the world countries are committed to this research, I believe the near future for our type 2 diabetes prevention or delay the occurrence and development to create better conditions.

The primary prevention of type 1 diabetes have on proposals with positive islet cell antibodies and (or) glutamic acid decarboxylase antibody-positive first-degree relatives of type 1 diabetes to take immune (such as cyclosporine and 6 - mercaptopurine, etc. ) and free radical scavengers (such as tobacco amide) intervention to avoid or delay the purpose of type 1 diabetes, now in its early stages of exploration and research, but this marks the prevention of type 1 diabetes in the coming new era.

2. Secondary prevention with high risk of type 2 diabetes (mainly family history of diabetes, hypertension, hyperlipidemia, obesity or overweight over 40 years of age, and gestational diabetes, etc.) for the survey objects, hidden on the early detection of 2 diabetes and glucose metabolism [impaired glucose tolerance (IGT) or impaired fasting glucose (IFG) or (IGT IFG)] population in time for early intervention and management to prevent or reduce the incidence of complications of diabetes, especially focusing on early stage to prevent or delay diabetes populations (including IGT or IFG or IGT IFG) progress to type 2 diabetes. IGT is now widely considered the development of type 2 diabetes in a transition stage, sometimes referred to as "pre-diabetes" (prediabetic phase). International Diabetes Federation report that almost all patients with type 2 diabetes, the disease to go through the IGT stage before. From a global perspective, IGT prevalence rates vary considerably among different ethnic groups, ranging from 3% to 20%. Like type 2 diabetes, IGT increased incidence increases with age, and weight gain or obesity and lack of physical activity, positive family history of type 2 diabetes is a strong risk factor for IGT addition, fetal malnutrition, low birth weight children and low birth weight after 1 year Zheyi indicate its future place in the 40 to 60 years of age increased the possibility of IGT, in addition, there is that the blood triglyceride levels and IGT, but the causal relationship between the two has not been determined. IGT prevalence was 2.5% China 4.2%, and national IGT patients, each of the 2% to 14% may change to type 2 diabetes. Literature generally 5 to 10 years, IGT 19% ~ 60% of patients will be transformed into type 2 diabetes. Data reported IGT to type 2 diabetes in China's annual change was 7.7% 8.95%. On the other hand, the study found, IGT than in patients with abnormal glucose metabolism, is also often accompanied by hyperinsulinemia, lipid metabolism disorders (high triglycerides, HDL-cholesterol lowering, LDL-cholesterol), hyperuricemia, hyperfibrinogenemia and fibrinolytic system dysfunction (such as plasminogen activator inhibitor -1 activity increased, decreased activity of tissue-type plasminogen), etc., which cause high blood pressure, cardiovascular and cerebrovascular atherosclerosis disease risk was significantly increased. Accordingly, the present treatment of the IGT intervention group was referred to an important position, the main purpose is to reduce type 2 diabetes and cardiovascular disease risk. Diabetes Research Center, now has many domestic and foreign populations on the IGT intervention as the main subject of a multi-center study. Intervention includes behavior intervention and drug intervention in two ways.

(1) behavioral intervention: including the restriction of total calorie intake, lower fat diet (<30%), especially saturated fatty acids in (<10% ? Smoking, drinking or reducing drinking; increased physical activity, strengthening aerobic exercise; lower body weight (> 5%) or maintain normal weight. The more successful interventions to lower the conversion rate of diabetes. to increase physical activity in patients on the IGT significantly beneficial, such as the promotion of cycling to work or advance one-stop increase in walking distance and little by elevators. Eriksson and other forward-looking men, had 181 cases of IGT were observed for 6 years, results showed that: to encourage regular exercise group, the incidence of diabetes was 10.6%, rather than the intervention group was 28.6%, relative risk 0.37. In general, diet and exercise interventions often at the same time. Finland Tuomilehto, etc. on the 522 cases of IGT were randomly assigned to diet and exercise intervention group (individual guidance, reduce the total fat and saturated fat intake, increasing intake of cellulose income and amount of exercise, the aim of reducing body weight) and the control group, mean follow-up was 3.2 years, four years after the cumulative incidence of diabetes in the intervention group was 11%, 23% of the control group, experimental group during the intervention in patients with IGT decreased risk of diabetes 58 %. Daqing China from the survey data show that diet and exercise can IGT to type 2 diabetes to reduce the conversion rate of 50%.

Behavioral intervention is the basis for safe and effective, but there are some defects in its long-term implementation, thus affecting its long-term intervention effects. May have the following performance:

Said, but not heard.

Heard, but not understanding.

Understanding, not receiving.

Accepted, but not action.

Action, but not long-term adherence.

(2) Drug Therapy: As a result of diet and exercise intervention, patients often difficult to persevere in practice, poor compliance, long-term effect of intervention is limited, in recent years, increasing attention IGT drug intervention, including biguanide drug (metformin) , α-glucosidase inhibitors and thiazolidinedione derivatives - insulin sensitizing agents. Drug intervention on the premise that the drug itself non-toxic, can improve insulin resistance and protection of B cell function, could reduce cardiovascular disease risk factors, do not gain weight, does not cause hypoglycemia, long-term use safe. Metformin can improve insulin resistance, reduce the intestinal absorption of glucose, inhibition of glycogen gluconeogenesis, improve glucose tolerance, reducing body weight and blood pressure, improve lipid metabolism to some extent, adverse reactions. U.S. "Diabetes Prevention Program (DPP)" collected 3234 cases of IGT patients (with fasting blood glucose ≥ 5.6mmoL / L), were randomly divided into placebo control group (n = 1082), strengthening the diet and exercise intervention group (n = 1079 to reduce the fat and calorie intake, to ensure every exercise 150min) and metformin group (n = 1082, metformin 1700mg / d), research began in 1996, showed that compared with the placebo control group, strengthening food and exercise intervention group and the metformin group were significantly decreased body weight, cumulative incidence of diabetes decreased by 58% and 31%. α-glucosidase inhibitors (acarbose peace Basen) delay the intestinal absorption of glucose, reduce postprandial blood glucose range, and improve insulin resistance, reduce blood insulin levels and blood pressure, improve lipid metabolism. Application of α-glucosidase inhibitors (acarbose) as IGT intervention clinical trials in large international multi-center, "Prevention of NIDDM (STOP-NIDDM)", the study collected 1429 cases of IGT were randomly divided into placebo and acarbose groups (acarbose, 100mg, 3 times / d), an average of 3.3 years follow-up showed that acarbose group the cumulative incidence of diabetes, 32.7%, 41.9% placebo group, acarbose level so that the absolute risk of diabetes reduced by 9%, study suggests that acarbose on IGT to diabetes, delaying the effective conversion. Acarbose to prevent other applications of IGT still Britain's "Early Diabetes Intervention Study (EDIT: acarbose, metformin, acarbose metformin)" and the Netherlands, "IGT Acarbose Intervention Study (DAISI)" and so on. This series of important IGT intervention trials to be completed and published, the largest sample to be applied Nagelienai and valsartan in type 2 diabetes prevention study being conducted (to be collected 7500 cases of patients with cases of collection has been completed, the proposed the 2008 publication of the results). Thiazolidinedione derivatives (troglitazone, rosiglitazone and pioglitazone) can directly enhance the role of insulin, reduce blood insulin levels, improve the IGT. And glucose and lipid metabolism in patients with diabetes and mild lower blood pressure. Troglitazone in the DPP in 1996 was U.S. intervention in drugs as one of IGT, but the application took place during the lethal drug-related liver injury caused by the termination of the use in 1999. Fewer adverse reactions, the role of more similar products, such as rosiglitazone (DREAM, to be collected 4000 cases of IGT, the forward-looking group observed for 3 years, is expected to be completed in 2006, to observe the intervention therapy for prevention of diabetes and its macrovascular disease affecting ) or pioglitazone and other ongoing clinical trials, using the process of liver function should be closely monitored. However, current value of IGT drug intervention - effective relationship is not yet clear, pending the results of the study to be clarified. Generally believed that, IGT and associated with the risk factors and the development of diabetes can be prevented or stayed. There are other weight loss drugs trial of sibutramine and drugs such as Xenical (selective inhibition of gastrointestinal lipase), can prevent or delay the obese IGT or type 2 diabetes. Recently, Tenenbaum and other reports, 303 cases of their fasting blood glucose in 6.1 ~ 7.0mmol / L forward-looking group of coronary heart disease patients (bezafibrate group, 156 cases, Bezafibrate 400mg / d; placebo control group, 147 cases) observation of 6.2 years, the result bezafibrate group the incidence of diabetes was significantly lower than the placebo group (42.3%: 54.4%), suggesting improved lipid metabolism can be reduced to some extent, impaired fasting glucose in patients with coronary heart disease 2 type the risk of diabetes, the result is worthy of more research.

The secondary prevention of type 1 diabetes is mainly present as early as possible from non-insulin-dependent diabetic patients identify exactly like the early onset of clinical type 2 diabetes [but islet cell antibodies (ICA), glutamic acid decarboxylase antibody (GAAs) and tyrosine acid phosphatase-like protein autoantibody] the slow progress of type 1 diabetes (also known as adult onset latent autoimmune diabetes, LADA). Treatment of their attempts are: ① early use of insulin, insulin injections and oral diazoxide (diazoxide: open potassium channels, inhibition of insulin secretion), avoid the use of sulfonylurea drugs, these measures will reduce the islet B cells load, reducing islet cell immune molecules [self antigen and major histocompatibility complex (MHC)] expression and immune injury; ② immunosuppression: small doses of cyclosporin A, azathioprine, or traditional Chinese medicine Tripterygium glycosides, etc. to interfere with T lymphocyte proliferation and on the islet B cell injury; ③ promote repair: a clinical study on long-term oral nicotinamide can prevent or slow the progression of islet cell antibody positive patients developed overt type 1 diabetes, a new hair extension 1 Diabetes clinical remission; ④ immune: subcutaneous fat, BCG can improve the new type 1 diabetes in clinical remission rate. The main purpose of several treatments is to reduce further damage to the remnants of their own immune B cells to avoid or delay the move to full progress of type 1 diabetes, which is the blood glucose control and prevention of complications is useful, but the method The clinical data LADA is not yet over, some of which result is not certain, there is some toxicity, expensive and difficult to be accepted Deng Jun, Jinzaoqixiao Jiliangzhushe more positive effects of insulin, and more practical, but still need further Jilei clinical experience .

3. Tertiary prevention which have diagnosed diabetes, by all means comprehensive treatment to prevent or delay the complications, mainly targeted at the development of chronic complications.

(1) the dangers of chronic complications of diabetes: diabetes chronic complications involving all body tissues and organs, including blood vessels (including the large blood vessel) disease, and neuropathy most obvious and prominent. Epidemiological and clinical study: the incidence of diabetes, cardiovascular disease is the general population of 2 to 4 times, and the early onset and poor prognosis in patients with type 2 diabetes is a major cause of death. Reported in the literature in developed countries, 50% of patients with type 2 diabetes due to ischemic heart disease death; diabetic patients with cerebrovascular disease, especially ischemic cerebrovascular disease, risk of non-diabetic population of 2 to 3 times, about the cause of death in patients 15%; limbs large arteries, particularly arteriosclerosis, or occlusive disease, is an important factor leading to adult amputees (about 50%); diabetic nephropathy (DN) is an important chronic diabetic microvascular complications in type 1 diabetes eventually 30% to 40% of renal insufficiency, clinical proteinuria in patients with type 2 diabetes prevalence is as high as 10% to 25%, duration 20 years, the cumulative incidence of clinical proteinuria is 25% ~ 31%, clinical the 5% to 10% of type 2 diabetes died of kidney failure. DN in Europe and the United States and other countries has become a stage renal failure requiring dialysis or kidney transplantation in a single most important reason, the number of diabetic patients with a significant increase in DN in our country has become an important cause of renal dysfunction one of the reasons. Diabetic retinopathy is another important diabetic microvascular complications, is the cause of adult vision loss or blindness in one eye in the United States each year for diabetes diagnosis and treatment of the direct costs of up to 60 billion. Diabetic neuropathy (including peripheral nerves and autonomic nervous system) is the most common chronic complications of diabetes, often cause great suffering to patients and serious injury. In addition, diabetes often leads to cataracts, skin and bone and joint diseases and a significant increase chances of infection and other various complications.

(2) chronic complications of diabetes, the integrated control measures: the incidence of chronic complications of diabetes is affected by many factors, in order to minimize or delay the occurrence of chronic complications of diabetes and development of a comprehensive and reasonable to be taken comprehensive measures.

① positive control or eliminate risk factors associated with complications:

A. Ideally control high blood sugar, eliminate or reduce the toxic effects of chronic high blood sugar: available diabetes education, diet therapy, exercise therapy, medication and blood glucose monitoring and other means to make blood sugar as close to normal (fasting glucose <6.0mmoL / L , 2h postprandial blood glucose <8.0mmol / L, HbA1c <6.5%), which is the basis for prevention and treatment of diabetic chronic complications. From North America's Diabetes Control and Complications Trial (DCCT) and UK (United Kingdom) Prospective Diabetes Study (UKPDS) study has unequivocally established that good glycemic control can significantly reduce type 1 diabetes and type 2 diabetes chronic complications and development. Recently many scholars concerned about long-term treatment of diabetes, not only to good control of blood glucose, blood glucose should also try to avoid the obvious fluctuations, due to significant fluctuations in blood sugar low blood sugar is not only the harm, and on atherosclerosis in formation also has significant adverse effects.

B. the rational use of antihypertensive drugs, the ideal control of blood pressure: Hypertension and diabetes often exists, and to accelerate a variety of chronic complications of diabetes and development of an ideal blood pressure can significantly reduce or delay diabetes, macrovascular and microvascular complications and development. Currently there are six categories of clinical common first-line antihypertensive drugs such as diuretics, β blockers, α blockers, calcium antagonists and angiotensin converting enzyme inhibitors and angiotensin Ⅱ receptor antagonists. The latter two no adverse effects on glucose and lipid metabolism can be used as drug of first choice. In particular, angiotensin-converting enzyme inhibitors are widely recognized, their blood pressure effectively, while a number of chronic complications of diabetes can provide relatively more effective in rats. On diabetic patients with hypertension should seek to control the blood pressure 130/80mmHg, or lower, with proteinuria 125/75mmHg blood pressure should be controlled in the following.

C. correct lipid metabolism: Diabetes is often associated with abnormal lipid metabolism (such as hypertriglyceridemia, high LDL-cholesterol levels and lower HDL-cholesterol and oxidized-LDL and glycated LDL levels increase, etc.), will promote the size of the vessel complications. Clinical hyperlipidemia should be based on different types of drugs taken by different [at home and abroad of the lipid-lowering drugs commonly used clinically, 5 major categories: bile acid release agent, acid type, fiber acid derivatives and HMG-acid malonyl coenzyme A (HMG-CoA) reductase inhibitors], and diet therapy, promotion of normal blood lipid control. From multi-center study abroad report: HMG-CoA reductase inhibitors can significantly reduce blood cholesterol and triglycerides in patients with diabetes, increased HDL, significantly reduced coronary heart disease (including myocardial infarction) and death rate, while significantly patients with diabetic nephropathy reduces urinary protein excretion and renal function decline more exudative diabetic retinopathy, delayed its progress, its vision of reducing and reducing the risk of loss.

D. improve insulin resistance and reduce hyperinsulinemia: blood sugar due to insulin resistance and inappropriate treatment Erzhi hyperinsulinemia, lasting hyperinsulinemia may stimulate arterial smooth muscle and endothelial cell proliferation, increased hepatic VLDL produce, promote arterial wall lipid calm, damage endogenous fibrinolytic system, such as stimulating endothelial cells to produce plasminogen activator inhibitor -1 (PAI-1), the promotion of thrombosis; long-term hyperinsulinemia through more kind of mechanism to increase blood pressure and lead to weight gain, etc., the role of diabetes may accelerate the occurrence and size of the process of hardening of the arteries. Thus, while in the treatment of diabetes, to take appropriate measures to improve insulin sensitivity, reduce or prevent hyperinsulinemia contribute to diabetic vascular complications. The most commonly used are clinically proven to improve insulin resistance in different levels of the drugs: metformin drug thiazolidinedione derivatives and α-glucosidase inhibitors, other angiotensin-converting enzyme inhibitor there (ACEI), trace elements such as chromium and vanadium, a number of lipid-lowering drugs such as fiber acid derivatives and 3 - hydroxy -3 - methyl coenzyme A (HMG-CoA) reductase inhibitors and other β3 agonists. Reasonable diet and appropriate exercise of the increased insulin sensitivity is also useful.

E. improve hemorheology: Diabetic patients often suffer as endothelial cells, platelet hyperactivity, increased red blood cell adhesion and deformation decreased, blood coagulation and fibrinolysis system enhanced the drop of blood showed high viscosity, high-poly and high condensate state, the size of diabetic vascular complications, it can be properly applied cilostazol (Peida), pancreatic kallikrein (Yi open), ticlopidine, 2,5 - dihydroxybenzoic acid (I. Sheng-ming), low-dose aspirin, dipyridamole and traditional Chinese medicine such as Salvia and Chuanxiong.

F. Antioxidant Supplement: diabetes on one hand the body of free radicals increases, the other hand, free radical scavenging system function, and induced accumulation of free radicals in the body, but also to some extent in chronic diabetic complications, it may be appropriate to add antioxidants such as vitamin C, vitamin E, β carotene and superoxide dismutase enzymes, to reduce the increase in free radicals in vivo tissue damage.

G. Other: diabetes, reduction of intracellular inositol levels, especially in nerve cells more obvious reduction of inositol content, which participated in the occurrence of chronic complications of diabetes, according to inositol depletion theory, appropriate supplementary inositol in diabetic patients on prevention of chronic complications, especially neuropathy may be useful; aldose reductase inhibitors (inhibiting diabetes when high blood sugar alcohol pathway activated three pears) and aminoguanidine compounds (inhibition of protein non-enzymatic formation of advanced glycation end products), small-scale animal experiments and clinical studies have confirmed that a number of chronic complications of diabetes have better control effect, pending further large-scale clinical research to be evaluated; animal experiments showed that specific protein kinase C-β inhibitor (LY333531) reduce the incidence of diabetic nephropathy and retinopathy and development of inhibition of intimal hyperplasia hypertrophy, preliminary clinical studies on diabetic vascular and nerve lesions have some preventive effect.

② early diagnosis and treatment of: chronic complications of diabetes onset hidden, slow progress, the lack of significant early clinical manifestations often do not attach importance to patients, but when the progress to chronic complications, once the clinical stage, clinical manifestations appear, the disease is often difficult to reversed, thus strengthening the monitoring of chronic complications of diabetes, early diagnosis is important.

A. microvascular complications: including diabetic nephropathy and diabetic retinopathy. Determination of urinary protein through regular eye examinations and to early diagnosis.

a. Determination of urinary albumin: recommended for all type 2 diabetes and duration> 3 years with type 1 diabetes should be an annual urinary albumin excretion rate (UAER) screening assays, was elevated (UAER ≥ 20μg/min or 30mg/24h urine) should be 3 to 6 months of review, such as UAER2 determinations were 20 ~ 200μg/min the tips of early diabetic nephropathy, this time to strengthen intervention to help prevent disease progression or reversal. The sacrificing of urine specimens, there is no ideal method is widely recognized, including the 24h urine, overnight urinary 12h, 2h or 1h time of urine, etc.. Unconditional measure urinary albumin, total protein in urine regularly.

b. eye examination: visual acuity in patients with decreased or lost before the early to take laser treatment can prevent or delay the disease progress, protection of eyesight, it is suggested that all diabetic patients should be carried out once a year to fully dilate after ophthalmoscopy, fundus simple microscopy can find satisfaction in early diabetic retinopathy by fundus fluorescein angiography when necessary, of great value in guiding treatment. Eye examination can also help early detection of cataract, glaucoma and other eye diseases.

B. macrovascular complications: There is no pre-clinical macrovascular disease detection easy way, a lot of evidence that proteinuria or microalbuminuria in patients with cardiovascular disease occurrence and risk of death increased significantly, should consider all Diabetic patients are faced with a major increased risk of vascular disease. Strengthening of macro vascular disease risk factors such as glucose (fasting glucose, postprandial blood glucose and glycosylated hemoglobin), lipids (cholesterol, triglycerides, HDL and LDL), blood pressure, blood rheology, smoking, obesity and other monitoring and is necessary to treat and correct. ECG can be found regularly, some patients with painless myocardial ischemia, or silent myocardial infarction.

C. Neuropathy: Peripheral neuropathy with sensory impairment and limb symmetry, often show a variety of feelings subsided and the knee reflex or sensory abnormalities reduced or lost, application tuning fork vibration sense is the surveillance of diabetes and determination of diminished sense of a simple way. Autonomic neuropathy cardiac autonomic function tests such as measurement and determination of gastrointestinal dynamics often more complex, but the B-Determination of residual urine than simple bladder autonomic neuropathy on the tips of some value.

D. Diabetic Foot: Vascular (major blood vessel) and the incidence of neuropathy is its basis in external incentives such as infection and trauma occur under such circumstances. With lower limb nerve and vascular disorders is the occurrence of high-risk patients of diabetic foot. Palpation of foot pulse and temperature will help determine changes in blood vessels, such as hard hit arterial pulse, Doppler ultrasound examination can be further. Each diabetic patients should be regular foot examination, examination should include pain, temperature sensation, touch, vibration sense and feelings of stress level, observed the shape of a toe valgus foot, eagle, etc., and whether enough force points changes. 80% of the diabetic foot ulcer can identify high-risk patients and provide appropriate preventive care and education.

③ attention to chronic complications of diabetes susceptibility in the population: recent basic and clinical research found that many chronic complications of diabetes, often there is genetic susceptibility and development, clinical observation of diabetes and development of chronic complications of diabetic disease and the lack of complete control consistency, clinical 20% to 30% of diabetes patients regardless of blood glucose control results, never a serious chronic disease complications for many years, while about 5% of diabetes patients in the short term, even if good glycemic control, but occurred serious chronic complications, especially in diabetic nephropathy phenomenon was more obvious in performance, such as the clinical findings of type 1 diabetes eventually only 30% to 40% end-stage renal failure occurred, and its incidence peaks in the course of diabetes in 15 to 20 period after the occurrence of diabetic nephropathy were significantly lower risk of type 2 diabetes is also only 5% to 10% of patients died of kidney failure, diabetic nephropathy and clinical observation of patients with familial aggregation. The exact mechanism is unclear, some studies suggest genetic predisposition may be essential hypertension, heparin sulfate proteoglycan related enzymes (such as N-deacetylase) genetic polymorphism, angiotensin I converting enzyme gene polymorphism, insulin receptor gene mutation and aldose reductase activity in individual differences and so on. Genetic susceptibility factors in the role of chronic diabetic complications might be completely set up, but the exact molecular mechanisms still need further clarification in order to predict the clinical occurrence of chronic complications of diabetes, the risk of providing a powerful tool for helping these susceptible intensive treatment populations.

④ The epidemiological survey and census of high-risk groups: diabetes, especially type 2 diabetes, often due to lack of significant early clinical manifestations of diabetes-related knowledge and awareness of the lack, so most of the (1 / 3 to 2 / 3) Patients with a long period of high glucose and not timely diagnosis, in part to serious complications and even patient visits. There are reports of type 2 diabetes diagnosis, the average has been 3 to 7 years of course, so active in diabetes epidemiology and population at high risk of diabetes screening, early detection of high glucose in diabetes and impaired glucose tolerance by the recessive loss of patients, timely intervention is crucial.

⑤ diabetic patients and their families to enhance knowledge about diabetes education: diabetic patients and their families the basics of diabetes and its complications related to education, to understand the importance of diabetes control and complications of harm, to actively cooperate with the treatment and follow-up, on condition of diabetes control is also important.

4. Diabetes community control model to establish According to the survey, China's existing 30 million ~ 40 million diabetics, and the incidence rate is still rising, which our existing medical staff and the diabetes prevention system is a challenge . In contrast, the existing doctors, nurses, nutrition and health care workforce can not satisfy a comprehensive diabetes prevention and treatment needs. Only attention to the whole society, government action involved, the way to community control, with extensive media publicity and the right guidance, and relevant business participation and support in order to carry out these extensive integrated control measures for diabetes, take up the challenge .

Diabetes community control model includes three parts: the Diabetes Health Network, diabetes and diabetes prevention and treatment center family. Government and the Health Authority in the areas of concern and leadership, the establishment of the Office of diabetes prevention, diabetes prevention and control office under the guidance of the district, site of primary medical care the hospital staff and from diabetes, diabetes center or tertiary hospital diabetes prevention group composed of experts , to work together. Diabetes, diabetes center or tertiary hospitals for primary, secondary and tertiary prevention of academic guidance and technical advice. Whether in primary, secondary or tertiary prevention, we must emphasize training to community-based doctors, nurses and dietitians at the core of the diabetes team of professionals to effectively guide a comprehensive diabetes prevention and control system; regularly about diabetes and their families diabetes knowledge, education, disease prevention and to mobilize their enthusiasm and increase self-care ability, and initiative in close coordination with the medical staff in order to obtain the expected results.