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

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.

From Hong Kong Diabetes Register to JADE Program to RAMP-DM for Data-Driven Actions

“…The evolution of diabetes care in Hong Kong, modified from Ng et al(61). ABC goals refer to HbA 1c ,7% (53 mmol/mol), BP ,130/80 mmHg, and LDL-C ,2.6 mmol/L (100 mg/dL).…”

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

“…At least three mechanisms may account for the association between AF and MI: (1) atherosclerosis and its associated inflammatory process, yielding a pro-thrombotic state; (2) direct coronary thromboembolism from the left atrial appendage; and (3) tachyarrhythmia episodes resulting in supply-demand mismatch [37]. Asians have a higher prevalence of diabetic kidney disease than Caucasians, accounting for 40% to 55% of those on dialysis, compared with less than 30% of those in Western countries [38]. Asian people with a low baseline eGFR have a higher risk of future stroke [39].…”

“…Asian people with a low baseline eGFR have a higher risk of future stroke [ 39 ]. Both the MI and stroke risk equations, which included eGFR as a predictor, derived from the Hong Kong Diabetes Registry performed better among Chinese patients with type 2 DM than the respective UKPDS risk engines, which did not include eGFR as a predictor; this difference suggests that renal dysfunction is an important risk factor for CVD, especially in Asian populations [ 26 , 38 , 39 ].…”

Efficacy and safety of fixed‐dose combination therapy with gemigliptin (50 mg) and rosuvastatin compared with monotherapy in patients with type 2 diabetes and dyslipidaemia (BALANCE): A multicentre, randomized, double‐blind, controlled, phase 3 trial

“…In particular, more intensive glucose control in newly diagnosed patients is associated with a significant decrease in the long‐term risk of cardiovascular disease (CVD) . Based on extensive trial evidence, lipid‐lowering therapy with statins and targeted antihypertensive treatment have also been shown to reduce the risk of CVD in patients with type 2 diabetes . Current guidelines for management of type 2 diabetes emphasize that patients require continuous medical care, with multifactorial risk reduction strategies beyond glycaemic control…”

“…5 Based on extensive trial evidence, lipid-lowering therapy with statins and targeted antihypertensive treatment have also been shown to reduce the risk of CVD in patients with type 2 diabetes. [6][7][8][9][10][11] Current guidelines for management of type 2 diabetes emphasize that patients require continuous medical care, with multifactorial risk reduction strategies beyond glycaemic control. 2,10 The DPP IV inhibitor gemigliptin is an anti-hyperglycaemic agent with well-recognized clinical efficacy in the treatment of diabetes.…”