Endocrinol Metab.  2018 Mar;33(1):17-32. 10.3803/EnM.2018.33.1.17.

Evolution of Diabetes Care in Hong Kong: From the Hong Kong Diabetes Register to JADE-PEARL Program to RAMP and PEP Program

Affiliations
  • 1Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Sha Tin, Hong Kong. jchan@cuhk.edu.hk
  • 2Department of Medicine and Geriatrics, United Christian Hospital, Kwun Tong, Hong Kong.
  • 3Hong Kong Institute of Diabetes and Obesity, Prince of Wales Hospital, The Chinese University of Hong Kong, Sha Tin, Hong Kong.

Abstract

The rapid increase in diabetes prevalence globally has contributed to large increases in health care expenditure on diabetic complications, posing a major health burden to countries worldwide. Asians are commonly observed to have poorer β-cell function and greater insulin resistance compared to the Caucasian population, which is attributed by their lower lean body mass and central obesity. This "double phenotype" as well as the rising prevalence of young onset diabetes in Asia has placed Asians with diabetes at high risk of cardiovascular and renal complications, with cancer emerging as an important cause of morbidity and mortality. The experience from Hong Kong had demonstrated that a multifaceted approach, involving team-based integrated care, information technological advances, and patient empowerment programs were able to reduce the incidence of diabetic complications, hospitalizations, and mortality. System change and public policies to enhance implementation of such programs may provide solutions to combat the burgeoning health problem of diabetes at a societal level.

Keyword

Diabetes mellitus, type 2; Diabetes complications; Integrated care

MeSH Terms

Architectural Accessibility*
Asia
Asian Continental Ancestry Group
Delivery of Health Care
Diabetes Complications
Diabetes Mellitus, Type 2
Health Expenditures
Hong Kong*
Hospitalization
Humans
Incidence
Insulin Resistance
Mortality
Obesity, Abdominal
Patient Participation
Prevalence
Public Policy

Figure

  • Fig. 1 Evolution and Implementation of Territory-wide Diabetes Quality Care Programs in Hong Kong. CUHK-PWH, Chinese University of Hong Kong-Prince of Wales Hospital; BP, blood pressure; BMI, body mass index; WC, waist circumference; HbA1c, glycated hemoglobin; JADE, Joint Asia Diabetes Evaluation; ABC, HbA1c, BP, low density lipoprotein cholesterol (LDL-C); PPP, Public Private Partnership; RAMP-DM, Risk Assessment and Management Program-Diabetes Mellitus; PEARL, Peer Support, Empowerment and Remote Communication Linked by Information Technology; T2DM, type 2 diabetes mellitus; PEP, Patient Empowerment Program.

  • Fig. 2 Hypothetical consequences of insulin deficiency and activation of the renin-angiotensin system (RAS) and insulin-like growth factor 1 (IGF-1) cholesterol pathways. Figure illustrates how insulin deficiency and activation of the RAS and IGF-1-cholesterol pathways might explain the link between type 2 diabetes mellitus and an increased risk of cancer. The possible benefits of insulin, statins and RAS inhibitors in reducing the risk of cancer in individuals with different subphenotypes: low density lipoprotein cholesterol (LDL-C) levels <2.8 mmol/L+triglyceride levels <1.7 mmol/L for those with upregulated IGF-1-cholesterol pathway; and LDL-C levels <2.8 mmol/L+albuminuria for those with hyperglycaemia-activated RAS pathway are shown. Double-headed arrow indicates crosstalk between pathways. Dashed arrow indicates pathway without supporting mechanistic evidence. Reprinted from Yang et al., with permission from Springer Nature [16]. SREBP, sterol regulatory element-binding protein.


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Predicting the Development of Myocardial Infarction in Middle-Aged Adults with Type 2 Diabetes: A Risk Model Generated from a Nationwide Population-Based Cohort Study in Korea
Seung-Hwan Lee, Kyungdo Han, Hun-Sung Kim, Jae-Hyoung Cho, Kun-Ho Yoon, Mee Kyoung Kim
Endocrinol Metab. 2020;35(3):636-646.    doi: 10.3803/EnM.2020.704.


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