糖尿病 中国就医指南

Diabetes mellitus is a chronic, progressive metabolic disorder characterized by persistent hyperglycemia resulting from defects in insulin secretion, insulin action, or both. It is broadly classified into type 1 diabetes (T1D), an autoimmune condition causing near-total beta-cell destruction and absolute insulin deficiency; type 2 diabetes (T2D), the most prevalent form, driven by insulin resistance and relative insulin deficiency; gestational diabetes mellitus (GDM), which develops during pregnancy; and other specific types including monogenic diabetes and secondary forms due to pancreatic disease, endocrinopathies, or medications. Pathogenesis involves complex interactions among genetic susceptibility, epigenetic modulation, environmental triggers (e.g., sedentary lifestyle, ultra-processed diets, chronic stress), and immune dysregulation—particularly in T1D where autoreactive T-cells destroy insulin-producing islet beta cells. In T2D, adipose tissue inflammation, mitochondrial dysfunction in skeletal muscle and liver, and impaired incretin signaling contribute to systemic insulin resistance and progressive beta-cell failure. Globally, diabetes affects over 537 million adults (2023 IDF Atlas), with prevalence projected to rise to 643 million by 2030. China bears the world’s largest diabetes burden—approximately 141 million adults live with the disease, and another 388 million have prediabetes. Key modifiable risk factors include obesity (especially central adiposity), physical inactivity, unhealthy diet high in refined carbohydrates and saturated fats, smoking, and sleep deprivation; non-modifiable risks include age >45 years, family history, history of GDM, polycystic ovary syndrome (PCOS), and certain ethnic backgrounds (e.g., Han Chinese exhibit heightened susceptibility to beta-cell dysfunction at lower BMI thresholds). Uncontrolled diabetes significantly impairs quality of life: patients report higher rates of fatigue, depression, anxiety, sexual dysfunction, and cognitive decline. Microvascular complications—including retinopathy (leading cause of adult-onset blindness), nephropathy (a major cause of end-stage renal disease), and neuropathy (causing pain, foot ulcers, and amputations)—and macrovascular complications such as coronary artery disease, stroke, and peripheral arterial disease substantially increase morbidity and mortality. Early diagnosis, individualized glycemic targets, comprehensive cardiovascular risk management (blood pressure, lipids, antithrombotic therapy), structured diabetes self-management education and support (DSMES), and psychosocial care are essential to preserve function, prevent complications, and sustain long-term well-being.

# 糖尿病治疗方案与详细费用明细（内分泌科）

一、非手术/保守治疗方案

• •适用人群：1型、2型初诊或血糖轻中度升高（HbA1c＜9.0%）、无严重并发症者
• •基础方案：生活方式干预（营养指导+运动处方）+ 二甲双胍单药

- 血糖谱（7点指尖血）：80–150元/次 - HbA1c检测：90–180元/次

• •升级药物方案（如SGLT2i/GLP-1RA）：

二、介入/强化管理方案

• •适用人群：血糖反复失控（HbA1c≥9.0%）、胰岛功能进行性下降、需胰岛素强化治疗者
• •动态血糖监测（CGM）系统植入（院内操作）：

• •胰岛素泵（院内初始化）：

三、并发症专项治疗（晚期/耐药/复杂型）

• •糖尿病肾病（eGFR＜60 mL/min）：

• •糖尿病足溃疡（Wagner 3级及以上）：

方案快速选择指南

• •预算≤5,000元/年：首选生活方式干预+国产二甲双胍+基础检验（推荐）
• •追求长期控糖达标（HbA1c＜7.0%）：GLP-1RA联合方案（年支出约1.5万元）
• •已出现中重度并发症：立即启动CGM+多学科管理，避免截肢/透析等终末花费