Professor Liu Jing: The comprehensive management of diabetic patients, these points are easily overlooked!

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During the Twenty-third National Academic Conference of the Chinese Medical Association’s Diabetes Branch (CDS2019), Yimaitong was fortunate to have an exclusive interview with Professor Liu Jing, Director of the Endocrine and Metabolic Diseases Diagnosis and Treatment Center of Gansu Provincial People’s Hospital.The leader of the grass-roots diabetes prevention and treatment group of the Society of Diabetes, she has done a lot of work in the prevention and treatment of grass-roots diabetes, and she has quite a lot of achievements. In an interview, Professor Liu Jing shared the relevant experience of grass-roots diabetes prevention and treatment..Three issues that need to be addressed in the prevention and treatment of grass-roots diabetes. Grass-roots medical institutions are an important force for the prevention and treatment of diabetes. However, there are still many problems in the prevention and treatment of diabetes at the grass-roots level. Professor Liu Jing believes that the following three aspects need attention.The first aspect: the level of specialized medical care of primary doctors urgently needs to be improved.There are many general practitioners in primary medical institutions, and general practitioners lack knowledge about diabetes. For example, these doctors are too worried about hypoglycemia caused by hypoglycemic drugs, which limits clinical medication and treatment standards.Therefore, basic level doctors need to be trained in the diagnosis and treatment of diabetes and its related complications.In addition, grassroots doctors also have shortcomings in the concept of diabetes diagnosis and treatment.For example, what is the goal of diabetes control, how to improve the rate of control of diabetes patients, primary doctors lack the corresponding cognition and treatment methods, and need to strengthen learning in this area.Second aspect: Insufficient medical diagnosis and treatment equipment at the grassroots level.In basic medical institutions, there should be detection instruments and equipment related to diabetic microangiopathy, such as neuropathy detection equipment, fundus mirrors, non-mydriatic fundus cameras, and so on.In contrast, for the diagnosis of large vessel disease, the equipment is relatively sufficient, so primary medical institutions need to strengthen the equipment for microvascular disease detection, and make full use of these instruments and equipment to screen for complications of diabetic patients and strive to find them early.Deal early.Third aspect: The linkage between primary medical institutions and large hospitals needs to be strengthened.Doctors in tertiary or secondary hospitals work in county-level hospitals or more basic medical institutions. This requires policy support in order to achieve reasonable communication and distribution.In addition, in primary medical institutions, such as county hospitals, special diabetes departments should be established, and specialists should be sent to higher-level hospitals. Higher-level hospitals generally have diabetes specialties. On this platform, patients can be well managed and doctors canGet updated treatment ideas, such as comprehensive management of diabetic patients, rational use of oral hypoglycemic drugs and insulin, and standardized blood glucose monitoring for diabetic patients.Blood glucose management should pay attention to individualized management. When it comes to the management of patients with diabetes, the first thing that comes to mind is the patient’s blood glucose management.Different blood glucose standards need to be formulated according to the age of the patient and different physical conditions.We should guide grassroots doctors to set individual blood glucose control targets according to the specific conditions of patients.For patients with diabetes below 60 years of age, who have no complications need to strictly control blood glucose, and when they are older and have multiple complications, it is necessary to formulate relatively loose control standards for patients.Don’t miss the uric acid indicator in the comprehensive management of diabetes. Diabetic patients need comprehensive management. In addition to blood glucose, other indicators also need attention.In addition to blood glucose, primary doctors need to pay attention to the blood lipids and blood pressure of diabetic patients. These indicators are also closely related to the occurrence and development of complications.In addition, the weight of the patient also needs attention. During the treatment process, it is important that we make fat people lose weight and make thin people become fat.Finally, Professor Liu Jing mentioned that the uric acid level of diabetic patients should also be paid attention to, and uric acid also plays a certain role in the pathogenesis of diabetes.There are two cases of hyperuricemia. One is hyperuric acid accompanied by changes in the kidneys and joints. It is called gout and is treated according to the principles of gout treatment. The other is high uric acid, but there are no other symptoms. WeIt is called painless hyperuricemia.Professor Liu Jing believes that the pathogenesis of hyperuricemia is related to insulin resistance, cardiovascular damage, and an increase in cellular inflammatory factors. Therefore, uric acid also needs to be closely monitored in the comprehensive management of diabetes.To cope with hyperuricemia, lifestyle interventions should be taken first. Diets should be adjusted appropriately. Drink more water and alkalize urine. If lifestyle interventions cannot effectively reduce uric acid, drug intervention is needed.For patients with and without diabetes, hyperuricemia patients have different treatment and control goals. When combined with diabetes, patients’ uric acid levels should be controlled more strictly.The working model of the Diabetes Medical Association has achieved initial results On the prevention and treatment of grass-roots diabetes, Professor Liu Jing shared her relevant experience, which is worth learning from.At the initiative of the Gansu Provincial Health and Health Committee, the Gansu Provincial People’s Hospital established the Diabetes Medical Association. Professor Liu Jing is the chairman of the Gansu Diabetes Professional Committee. She has established secondary diabetes committees in 14 prefectures in Gansu Province.Subsequently, under the guidance of the local health committees, they were jointly awarded the “diabetes department” to the county-level hospitals that met the standards, and the hospitals with a higher level of diabetes diagnosis and treatment were awarded the “diabetes prevention and treatment center”, and then carried out on this basisLink up and down.On the one hand, primary doctors are invited to study and train in higher-level hospitals; on the other hand, doctors in higher-level hospitals give lectures and rounds in lower-level hospitals.This model also promotes effective two-way referrals for diabetic patients. Patients who cannot be treated in the primary hospital are transferred to the higher-level hospital for treatment in a timely manner. Doctors at the higher-level hospital develop a treatment plan for the patient, and then transfer the patient back to the primary-level hospital.Inform local doctors of follow-up management plans for referral patients to achieve long-term tracking and effective management of patients with diabetes.Through this model, a network for the prevention and control of diabetes chronic diseases has been established, which has played a certain role in the prevention and treatment of grass-roots diabetes in Gansu Province..
The role of the medical association of Professor Liu Jing’s team in the prevention and control of diabetes has been valued by the Gansu Provincial Health Committee. At present, the Gansu Provincial Health Committee has instructed the Gansu Provincial People’s Hospital Endocrine and Metabolic Diseases Diagnosis and Treatment Center to lead the provinceThe pilot construction of the compact medical consortium aims to explore an innovative model of endocrine diabetes medical consortium suitable for the actual situation of Gansu Province, and promote the hierarchical diagnosis and treatment of diabetes in Gansu Province.This compact medical consortium requires the formation of homogenization and standardized management of diabetes diagnosis and treatment, such as the homogenization of various tests such as glycated hemoglobin and endogenous creatinine clearance measurement.At the same time, through the remote consultation, remote academic lectures, remote case discussions, remote network continuing education, remote rounds, etc. of the Gansu Provincial Remote Network Consultation Center, the WeChat platform was jointly applied to build a channel for communication and exchanges with primary doctors, and a two-way transferClinic opened up green channels and so on.I hope that our grassroots diabetes prevention and control work can be done better and better, and contribute to the grand goal of “Healthy China 2030”!The above content is only authorized by for exclusive use, please do not reprint without authorization of the copyright party.


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