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中国糖尿病诊断标准演变及特殊人群血糖管理

  • 邹慧敏 ,
  • 王遂军
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  • 上海市杨浦区市东医院(上海理工大学附属市东医院)内分泌科,上海 200438

收稿日期: 2024-11-15

  录用日期: 2025-02-09

  网络出版日期: 2025-02-25

Evolution of diagnosis standards for diabetes in China and blood glucose management for special populations

  • ZOU Huimin ,
  • WANG Suijun
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  • Department of Endocrinology, Shidong Hospital, Yangpu District, Shidong Hospital Affiliated to University of Shanghai for Science and Technology, Shanghai 200438, China

Received date: 2024-11-15

  Accepted date: 2025-02-09

  Online published: 2025-02-25

摘要

我国糖尿病患病率逐年攀升,2021年我国20~79岁人群中糖尿病患病率高达13.79%,未确诊率高达56.0%,显示我国的糖尿病防控工作正面临严峻挑战。糖尿病是一种慢性代谢性疾病,患者血糖控制不佳容易出现严重的并发症风险,如心血管疾病、肾脏疾病、视网膜病变、神经病变等,对个人健康和社会经济造成沉重负担。及早发现糖尿病并采取有效干预措施,对预防并发症至关重要。目前,我国糖尿病诊断主要参考国外标准,以75 g口服葡萄糖耐量试验(oral glucose tolerance test,OGTT)和糖化血红蛋白(glycated hemoglobin,HbA1c)作为诊断金标准。然而,由于检测技术的差异等问题,这些方法在临床实践中仍存在一定的局限性,尤其是在基层医疗机构中,糖尿病筛查能力及同质化水平有待进一步提高。此外,我国糖尿病的知晓率、治疗率和控制率均处于较低水平,2021年数据显示,我国糖尿病患者知晓率为36.5%,治疗率为33.2%,控制率为49.2%。尽管近年来我国在糖尿病防治方面取得了一定进展,但仍存在较大的提升空间。为应对糖尿病防控的挑战,国内专家发布了一系列糖尿病指南及专家共识,强调对糖尿病患者管理的个体化和分层管理,针对儿童青少年、妊娠期妇女和老年患者,制定了不同的血糖控制目标及治疗方案。同时,强化血糖监测技术的应用推广也被视为提升血糖控制达标率的重要手段。然而,目前临床对儿童青少年2型糖尿病、妊娠期糖尿病及老年糖尿病合并肌少症患者的关注度仍显不足,缺乏规范的治疗策略和高质量的循证医学证据。针对我国糖尿病诊疗现状,仍需进一步提升疾病的检验水平、检查覆盖率及不同人群分类管理能力。

本文引用格式

邹慧敏 , 王遂军 . 中国糖尿病诊断标准演变及特殊人群血糖管理[J]. 诊断学理论与实践, 2025 , 24(01) : 14 -20 . DOI: 10.16150/j.1671-2870.2025.01.003

Abstract

The prevalence of diabetes in China has been increasing annually. In 2021, the prevalence rate of diabetes reached 13.79% among individuals aged 20–79, with an undiagnosed rate as high as 56.0%. This indicates that China's diabetes prevention and control faces significant challenges. Diabetes is a chronic metabolic disease. Poor blood glucose control increases the risk of serious complications such as cardiovascular disease, kidney disease, retinopathy, and neuropathy, which impose a heavy burden on both individual health and socioeconomic development. Early detection of diabetes and the implementation of effective interventions are crucial for preventing complications. Currently, China's diabetes diagnosis primarily adopts international standards, using the 75g oral glucose tolerance test (OGTT) and glycated hemoglobin (HbA1c) as the gold standards for diagnosis. However, due to disparities in detection technologies and other factors, these methods still have certain limitations in clinical practice, especially in primary medical institutions where diabetes screening capacity and standardization level require further improvement. In addition, China demonstrates relatively low levels of awareness, treatment, and control rates of diabetes. According to 2021 data, the awareness rate of diabetes in China was 36.5%, the treatment rate was 33.2%, and the control rate was 49.2%. Although China has made some progress in diabetes prevention and treatment in recent years, there is still significant room for improvement. To address the challenges of diabetes prevention and treatment, a series of diabetes guidelines and consensus statements have been released by domestic experts, emphasizing the individualized and stratified management of diabetes patients. Different blood glucose control targets and treatment plans have been formulated for children and adolescents, pregnant women, and elderly patients. Meanwhile, the promotion of glucose monitoring technologies is considered an important approach to improve the rate of achieving blood glucose control targets. However, clinical attention remains inadequate for type 2 diabetes in children and adolescents, gestational diabetes, and elderly diabetes with sarcopenia, lacking standardized treatment strategies and high-quality medical evidence. For the current state of diabetes diagnosis and treatment in China, it remains imperative to further improve the diagnostic testing level, the coverage of examinations, and the ability of stratified management for different population groups.

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