Summary and evaluation of diabetes prevention knowledge lectures

It not only fills the common cognitive blind spots of ordinary residents on diabetes prevention, but also intuitively exposes the existing academic controversies and implementation difficulties in current diabetes prevention education. The overall practicality is strong, but there is still a lot of room for optimization.

Before the start of the lecture, I was still mumbling that this kind of health lecture would only be attended by a bunch of retired old people, but I was stunned when I signed in - several young people in office attire came with leave application slips in their hands, saying that their elders in the family had been diagnosed with diabetes and came here specifically to learn how to help their families adjust their diet. There was also a takeaway guy in a blue vest who stood in the back row while waiting for the order and took photos of PPTs with his mobile phone for 20 minutes before leaving. There were many more cognitive blind spots than I expected. The 62-year-old Aunt Zhang is a typical example. She usually doesn’t touch a lick of white sugar. She always thinks that “if you don’t touch sugar, you won’t get diabetes.” After hearing this, I realized that I eat two big bowls of refined white rice every night. Drinking a bowl of sticky millet porridge is a real high blood sugar problem. After the on-site meal test, the blood sugar has reached 7.9mmol/L. I stood there for a long time with the report sheet and did not recover. I said that I would immediately replace half a can of rice with oats and quinoa.

This time we deliberately invited not only Western medicine doctors to give lectures, but also invited Chinese medicine practitioners from the Association of Traditional Chinese Medicine to share, which just put the two mainstream ideas in the field of prevention on the table. Director Li of the Department of Endocrinology is a typical evidence-based person. He made it clear at the beginning that "there is no evidence that eating sugar directly causes diabetes." The core trigger is insulin resistance caused by excess total calories. The core indicators of prevention are very stuck: waist circumference should not exceed 90cm for men and 85cm for women. At least 150 minutes of moderate-intensity exercise per week. Fasting + 2-hour postprandial blood glucose must be checked every year. Anything less will not work. The doctor of traditional Chinese medicine was much more soft-spoken. She mentioned a point that people rarely pay attention to: some people with normal body weight and not eating much can still have high blood sugar. The essence is that their phlegm-dampness constitution has poor transport and transformation capabilities. There is no need for such people to force themselves to run five kilometers. They usually do more Baduanjin and occasionally moxibustion on the Zhongwan point. Adjusting their physical fitness is much more useful than rigidly checking their exercise indicators. There were people discussing the two opinions at the scene. Some people thought that the standards of Western medicine are easy to quantify and just follow them. ； Some people think that the traditional Chinese medicine method is pain-free and easier to adhere to. We have not deliberately unified the answers. We have printed both solutions in the manual, and everyone can choose according to their needs.

To be honest, there were many mistakes in this lecture. Director Li first came up and talked about the pathogenesis of insulin resistance for half an hour. Half of the elderly people in the audience were shaking their heads while listening. We quickly stopped temporarily and asked her to switch to a science popularization on "Which foods raise blood sugar quickly?" There was also a very controversial episode: an audience member asked if they could buy anti-hyperglycemic health products on the market. Director Li said directly at the time, "All health products cannot lower blood sugar, so don't waste your money." After the show, an audience member who works in public nutrition talked to me and said that in fact, for people with abnormal glucose tolerance, appropriate dietary supplements such as chromium picolinate and alpha-lipoic acid can indeed help regulate blood sugar and cannot be beaten to death with a stick. Later, I mentioned this matter to Director Li, and she laughed and said that she was afraid that the elderly would be deceived because she said it too absolutely. Next time, the boundary of "health products cannot replace medicines, but can only be used as an auxiliary to lifestyle adjustments" must be made clear.

An interesting thing happened during the intermission. Uncle Wang, who was in his 40s, pulled Director Li and asked, "I can't walk 10,000 steps a day. Why was my blood sugar still critical during the last physical examination?" Director Li asked him if he always liked to buy a bottle of iced Coke and a hand cake as a reward after walking. The uncle scratched his head and smiled, saying that’s right, it’s all exercise, it’s okay to eat something. Director Li gave him a clear calculation: a bottle of Coke plus hand cakes consumes almost 600 calories, and walking 10,000 steps consumes 300 calories. This means that the more you move, the more you eat, which leads to excess calories. After hearing this, the uncle patted his thigh and said, "My steps for the past six months have been in vain, so I will replace the ice Coke with mineral water when I get back."

I have been doing community public health education for almost three years. I used to think that the more professional and comprehensive the knowledge, the better. But this time I discovered that what people want is not "what is the pathogenesis of diabetes" at all, but "what should I change in my meal tomorrow morning?" Instead of talking about academic theory for half an hour, it is better to give a "daily blood sugar lightning protection table". For example, don't drink white porridge with pickles in the morning, eat less rice dumplings with rice at noon, don't eat kebabs and drink cold beer at night, take a photo and save it on your phone. It works better than anything else.

We collected a questionnaire after the lecture. 70% of the audience said they would immediately adjust their diet after returning home, and 30% said they would go to the hospital to check their post-meal blood sugar this week. Of course, about 10% said the content was too complicated to remember. Next time we hold the lecture, we plan to split the lecture into two parts. In the first half, we will only talk about practical methods that can be implemented directly. In the second half, we will leave an hour for Q&A. We also plan to add a small activity of on-site meal setting, so that everyone can choose their own ingredients for the day. If they make mistakes, they can be corrected on the spot, so that they will remember it better. As for which of the traditional Chinese and Western medicine prevention programs has been debated for a long time, we will not give a standard answer. After all, the most effective prevention method is the one that you can stick to and that suits you.