World Hospitals and Health Services - International Hospital ...

diabetes_care 9/30/05 12:40 Page 30
CLINICAL CARE: DIABETES
care. In fact, the number of village health officials has been
reduced by up to a third; the number of healthcare centres
has decreased significantly in the townships and villages.
The status of care
Given the limited data available on diabetes epidemiology
(the last nationwide study was performed over a decade
ago), it is essential that a reliable overview be obtained of the
status of diabetes care in China. This will form the basis for
any initiatives to reduce the medical and socio-economic
burden of diabetes complications.
A contribution to this knowledge was made recently by
the Diabcare-China 2003 study. As part of the Diabcare-Asia
2003 study, this Chinese research collected data from a
cohort of around 2,700 people with diabetes at 30 specialist
centres across China.
Status of people with diabetes
Of the people who participated in the study, around 97%
had type 2 diabetes. More than half of the people with
diabetes had poor blood glucose control (glycaemic
control). Only half of the people had an HbAlc
measurement (an indicator of long-term blood glucose
levels) during the previous 12 months. Furthermore, about
three-in-five people with diabetes had poor metabolic
control, showing above-average levels of triglycerides and
LDL cholesterol (so-called “bad” cholesterol).
The American Association of Clinical Endocrinologists has
declared that, as well as intensive glycaemic control, optimal
diabetes care must also include proper nutrition, weight
control, physical activity programmes and smoking
cessation. 3 It was therefore encouraging to find that a good
proportion of the people with diabetes in this study were
following a controlled diet (77%) and exercising regularly
(62%). In this study, 65% of people with diabetes had had
an eye examination in the previous 12 months; 31%
underwent foot examinations.
Psycho-social well-being and quality of life
Interestingly, responses to questions on psycho-social wellbeing
indicated that many people with diabetes either all or
most of the time felt “cheerful and in good spirits” (67%),
“calm and relaxed” (66%) and “active and vigorous” (53%).
There was a statistically significant relationship between
glycaemic control and psycho-social well-being.
The study outcomes also revealed that more than half of the
people with diabetes rated their quality of life to be good or at
least acceptable, with 65% agreeing that they felt that their
diabetes is “well regulated”. Again, a statistically significant
correlation was seen between glycaemic control and quality of
life. These findings underline the importance of identifying and
developing models and systems of care that better support
people with diabetes to achieve a desirable quality of life.
Education and awareness in the community
There is a lack of diabetes awareness in countries around the
world; but this lack of education has a tremendous
significance in China, with its huge population. The low
diabetes awareness among the general public is
compounded by misunderstandings around various aspects
of diabetes care, such as the use of insulin. Indeed, only a
decade ago, it was unthinkable that people with diabetes
could inject themselves with insulin.
The lack of diabetes awareness in China results in
relatively low rates of diagnosis – about 10%-15% for people
with type 2 diabetes, compared with 50% in Europe. In
order to address this gap, many diabetes education
programmes have been initiated for healthcare professionals.
It is estimated that during the past five years, 3000-5000
doctors in 300 provinces in China have received diabetes
education. Nurse education programmes are increasing also.
Encouragingly, there is growing recognition in China of the
need for healthcare providers to work together in a teambased
approach to care.
Given the size of the population, the growing body of
evidence that the cost of diabetes to societies can be
reduced through the provision of diabetes education is
particularly relevant in China.
In an effort to resolve widely held misunderstandings,
between 1997 and 2004, 490 lectures were held at the
People’s Liberation Army (PLA) General Hospital in Beijing,
offering diabetes education to over 15,000 people with the
condition. The objective of these events is to encourage a
greater degree of self-care for people with diabetes and nthus
reduce disabling complications.
A person has impaired glucose tolerance (IGT) when their
Triglycerides in the blood come from fats eaten in
foods but are also made in the body from other
energy sources such as carbohydrates. Any
calories consumed in a meal which are excess to
requirements are converted into triglycerides and
transported to fat cells to be stored. Excess
triglycerides in the blood are linked to
cardiovascular disease and other diseases of the
arteries. Elevated triglycerides may be a
consequence of inadequately controlled diabetes.
blood glucose levels are higher than normal, but below the
level of a person with diabetes. Most people with IGT are at
increased risk for developing type 2 diabetes.
In addition, the Chinese Ministry of Health, in accordance
with the guidelines of the International Diabetes Federation-
Western Pacific Region and the American Diabetes
Association, launched in 2003 their Guidelines for
Diabetes Prevention and Treatment, which were designed to
reduce the rates of death and disability due to diabetes. In
the guidelines, emphasis has been placed on regular
screening, lifestyle modifications supported by dietary and
behavioural advice, and drug therapy options.
Country-wide interventions
The Chinese media has been used to enhance the public
awareness of diabetes. In 2002, television programmes
30 | World Hospitals and Health Services | Vol. 41 No. 3