Su Yan, a 60-year-old diabetic, experienced five episodes of hypoglycemic shock this year. After the fifth shock, she went to the hospital for a follow-up visit and, under the guidance of her doctor, had her insulin dosage reduced from 14 units to 12 units after years of injection.

Diabetes is a chronic disease that requires long-term, sustained management. From regular blood sugar monitoring and taking medication on schedule to adjusting diet and sticking to exercise, every aspect tests the patient's self-discipline. However, in reality, many patients struggle to win this "war of attrition." Some feel that since they have no symptoms, they don't need to manage it and stop taking their medication. Others find managing their diet and exercise too troublesome. Still, others become anxious and resistant to long-term medication due to concerns about side effects, ultimately giving up on management altogether.

Behind the "uncontrollable," there lies the confusion and frustration of countless patients, as well as one of the key pain points that need to be addressed in diabetes management.

Diabetic patients need a detailed chronic disease management plan

In chronic disease management, attention to detail is essential. At the level of medical treatment, Dr. Zhao Linhua, a chief physician at the Metabolic Diseases Institute of Guang'anmen Hospital, Chinese Academy of Traditional Chinese Medicine, introduced an integrated modern TCM diagnostic and treatment system for diabetes that combines the strengths of TCM and Western medicine, namely the "Classification-Stage-Syndrome" system. This was based on the innovative paradigm of "State-Target-Differentiation Treatment" proposed by Professor Tong Xiaolin, an academician of the Chinese Academy of Sciences and a TCM internal medicine expert.

Zhao Linhua explains that, in terms of classification, colloquially speaking, traditional Chinese medicine divides diabetes into two types: the "fat type" and the "thin type." The "fat type" is mostly type 2 diabetes, caused by long-term unhealthy lifestyles, diet, and stress; the "thin type" is commonly seen in type 1, type 1.5 (late-onset autoimmune diabetes in adults), and some type 2 diabetes, often related to congenital deficiencies.

The staging follows the four stages of "depression, heat, deficiency, and damage," covering pre-diabetes, early, middle, and late stages, as well as the complication stage. Among them, the "damage" state occurs when the disease progresses for a long time, leading to the decline of zang-fu organ functions and disruption of qi and blood circulation, producing phlegm-dampness and blood stasis, ultimately resulting in damaged meridians. "Meridian damage" refers to large vessel diseases, such as cardiovascular and cerebrovascular diseases and diabetic foot, while "collateral damage" refers to microvascular diseases, such as retinopathy and kidney disease.

Based on the classification and staging, traditional herbal formulas can be used to treat diabetes for different syndrome types. Zhao Linhua introduced that, for example, in the heat state, the syndrome of liver and stomach depression-heat can be treated with modified Da Chaihu Tang, adjusting the dosage according to the patient's condition, symptoms, age, etc., to enhance the precision of treatment.

At the level of patient daily management, Yang Jin, deputy director of the Endocrinology Department at Peking University Third Hospital, stated that health education needs to be conducted more meticulously, especially in family and community health centers. He mentioned that some hospitals have already established specialized clinics or one-stop diabetes diagnosis and treatment centers, with dedicated nutritionists or health managers providing detailed consultations and services to patients.

For instance, simply telling patients to reduce carbohydrate intake may not be clear to them. "It's necessary to combine what patients usually like to eat, how they eat, and list their typical eating habits before making adjustments," Yang Jin illustrated. For example, if a patient does not consume much staple food regularly, controlling blood sugar does not require reducing staple food intake. If a patient enjoys fruits, they can eat more low-glycemic fruits and less high-glycemic fruits. In summary, plans should be formulated based on the patient's daily life to ensure effective implementation.

Yang Jin reminds that as age increases and treatment progresses, the condition of chronic diseases may change, and the dosage of insulin injections or other medications may need adjustment. Blood sugar management is a complex process that requires patients to closely monitor their blood sugar levels themselves and make medication adjustments under the guidance of a doctor.

The frequency of follow-up visits for type 2 diabetes patients is related to the degree of achievement of disease management goals. Yang Jin explains that when patients are newly diagnosed with diabetes, they usually need to be observed for one or two months, and the condition will gradually stabilize after two or three months. After the condition stabilizes, the frequency of follow-up visits is adjusted based on the patient's control situation: if the condition is stable and the patient is doing well, a follow-up visit every six months may be sufficient; if the condition changes, such as if blood sugar levels are not 达标, follow-up visits may be needed every 2-3 months.

Zhao Linhua states that an increasing number of diabetes patients are seeking help from both Western and traditional Chinese medicine. Currently, her team often collaborates with Western medicine teams to conduct clinical research on traditional Chinese medicine or integrated Chinese and Western medicine treatments for diabetes and its complications. "For example, the team once combined traditional Chinese medicine treatment for patients who did not respond to metformin to further adjust their blood sugar levels."

"Using bitterness to counteract sweetness" is an important treatment method in traditional Chinese medicine for diabetes. Zhao Linhua introduces that bitter-tasting Chinese medicines like Huanglian and Huangqin, which are bitter and cold in nature, can clear heat and regulate the function of the gastrointestinal tract, helping to suppress patients' excessive appetite. Bitter ingredients like bitter gourd and bitter lettuce also have a heat-clearing function and can be paired with ginger in clinical applications to protect the stomach. Sourness counteracts sweetness, and sour-sweetness transforms yin. For the common symptom of dry mouth and thirst in diabetes patients, sour foods like Wumei can be added to the diet. In the complication stage, patients should focus on promoting blood circulation and unblocking collaterals, and can appropriately consume foods like loofah, which have some effects in promoting blood circulation and unblocking collaterals.

Zhao Linhua emphasizes that whether it's using foods that have medicinal properties or taking traditional Chinese medicine (TCM) or patent medicines, patients need to combine their own condition and symptoms and follow medical advice.

Preventing and Being Vigilant of Diabetes Complications

Zhao Linhua introduces that Academician Tong Xiaolin refers to diabetes as the "sugar network disease," emphasizing that TCM prevention and treatment of diabetes must adhere to the concept of "treating both sugar and network," achieving early network treatment and whole-process network treatment. This means preventing and delaying complications while controlling blood sugar, which is consistent with modern medical treatment concepts.

Yang Jin states that in clinical practice, diabetic patients often overlook the prevention of complications. The macrovascular complications of diabetes include heart attacks, strokes, and other cardiovascular diseases, while the microvascular complications involve conditions in areas such as the eyes and kidneys.

Recently, the One-Stop Diabetes Diagnosis and Treatment Center at Peking University Third Hospital treated an elderly diabetic patient named Xu An. On the day of her follow-up visit, she experienced a two-hour pain in the precordial area. After taking medication, the pain significantly subsided, so she did not pay much attention. Upon inquiry, it was found that she had actually been experiencing discomfort in the precordial area for over 10 days.

Initially, neither the patient nor her family realized the urgency of the situation. Yang Jin explained the necessity of seeking immediate medical attention at the Cardiovascular Department by reviewing the electrocardiogram brought by the family. Poor diabetes management can lead to complications such as microvascular, macrovascular, and neuropathy. Xu An was ultimately diagnosed with acute myocardial infarction complicated by diabetes. After surgery and two months of rest, her condition improved significantly, and her blood sugar levels stabilized.

Yang Jin noted that studies show that about one-third of diabetic patients also have cardiovascular diseases, and their risk of developing cardiovascular diseases is 2-4 times higher than that of non-diabetic patients.

Pre-diabetes refers to a stage where blood sugar levels are mildly abnormal but have not yet reached the level of diabetes. Pre-diabetes requires regular monitoring and diagnosis to determine when it may progress to diabetes. Yang Jin stated that some people with good blood sugar control can maintain this condition for 3-10 years without further progression, and some may even return to a normal state from pre-diabetes. "Pre-diabetes is reversible," he said.

According to the general progression of the disease, diabetes requires attention to three levels of prevention—primary prevention targets high-risk populations, secondary prevention focuses on preventing complications in diabetic patients, and tertiary prevention aims to prevent fatal or disabling outcomes from complications. In the prediabetes stage, individuals can prevent the progression to diabetes through methods such as diet, exercise, and weight management. If diabetes has already developed, it is essential to focus on preventing complications in the eyes, kidneys, heart, and blood vessels. When complications arise, such as heart attacks or retinopathy, standard health management must be employed to prevent fatal or disabling risks.

However, Yang Jin said that in clinical practice, many patients only discover they have diabetes after developing complications. "Some go to an ophthalmologist for a retinal examination and are found to have diabetic retinopathy, yet the patients themselves claim they don't have diabetes. In reality, they have had diabetes for a long time. This is not uncommon in ophthalmology."

In July 2024, the "Healthy China Action—Implementation Plan for Diabetes Prevention and Control (2024-2030)" jointly formulated by 14 departments, including the National Health Commission, proposed that by 2030, the standardized management service rate for primary care of type 2 diabetes patients should reach 70% or higher, with continuous improvements in diabetes treatment rates, control rates, and complication screening rates. Yang Jin explained that this requires not only focusing on blood sugar but also managing other risk factors for complications, including blood pressure, blood lipids, and body weight. "Although China has made significant progress in screening and preventing diabetes complications, it is still not perfect."

Chronic disease management should focus on psychological and emotional regulation

"Diabetic patients have a long course of the disease and are prone to emotions such as anxiety and depression. During treatment, we consider these factors. Anxiety and depression can lead to difficult blood sugar control, and conversely, difficult blood sugar control can exacerbate anxiety." Zhao Linhua said. In this regard, during clinical treatment, in addition to considering blood sugar control, it is also necessary to comprehensively consider the emotional changes of diabetic patients.

In clinical practice, there are many methods in traditional Chinese medicine for addressing patients' emotional issues. Zhao Linhua explains that on one hand, applying Chinese patent medicines or herbal compound formulas with the effect of soothing the liver and resolving depression can effectively help improve patients' anxiety and sleep issues. Some non-pharmacological therapies, such as acupuncture, ear acupressure, five sound therapy, Baduanjin, and Tai Chi, are also very helpful in regulating patients' emotions and sleep and are often used as adjunctive treatments for chronic diseases.

Yang Jin told reporters that mental state greatly affects health. Some diabetic patients, especially students and young people who have just started working, worry about others finding out about their condition and easily feel confused and stigmatized.

In clinics, wards, or communities, Yang has encountered family members who over-intervene in diabetic patients' lives, sometimes causing arguments due to dietary restrictions; he has also met family members who pay no attention to the patients' condition management. "Neither over-intervention nor neglect is correct," he said. "Family members are the patients' closest social support system. They live in the same environment, share common living habits and dietary routines. This is also the most supportive environment for patients to develop self-management abilities."

Yang Jin suggests that both patients and family members should have a correct understanding of chronic diseases. Patients need to learn how to manage their diet and daily exercise, while family members should cooperate, help, and encourage patients. However, during family gatherings or if they accidentally overeat, the patient's blood sugar may rise slightly. As long as it doesn't persistently increase and they have a timely management awareness, an occasional occurrence is not a big problem.

Zhao Linhua pointed out, "Some family members of elderly patients are particularly filial, but they lack understanding of the disease, always worrying that the patient isn't eating enough or getting enough nutrition, hoping the patient eats more and gains weight." She believes that many elderly patients themselves are often more cautious and serious about dietary advice, but family members may think the elderly are "overly serious." In reality, the digestive function of the elderly is relatively weaker, and eating smaller, more frequent meals is better for blood sugar control. "At this point, it is necessary for patients and family members to have a common understanding of the disease and make reasonable plans."

In the long-term management of chronic diseases, some people believe that folk remedies, miracle drugs, or health supplements can replace medications. Faced with these patients, Yang Jin feels helpless while also thinking that there is still a long way to go in health education for patients and their families. First, patients need to improve their understanding of the disease and its management. "For example, patients who stop taking medication due to concerns about side effects actually have a misconception in their understanding. Rational selection and regular follow-ups can to the greatest extent avoid side effects. Additionally, currently marketed diabetes medications all require the ability to lower blood sugar while also protecting organs prone to complications, such as the heart and kidneys."

Secondly, chronic patients need to receive support from their families and society during long-term management. "Some patients lack sufficient support behind them, thinking that long-term management is very troublesome and causing psychological pressure, and they want to seek quick and easy methods," Yang Jin said.