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

Abstract

In 1995, the Hong Kong Diabetes Register (HKDR) was established by a doctor-nurse team at a university-affiliated, publicly funded, hospital-based diabetes center using a structured protocol for gathering data to stratify risk, triage care, empower patients, and individualize treatment. This research-driven quality improvement program has motivated the introduction of a territory-wide diabetes risk assessment and management program provided by 18 hospital-based diabetes centers since 2000. By linking the data-rich HKDR to the territory-wide electronic medical record, risk equations were developed and validated to predict clinical outcomes. In 2007, the HKDR protocol was digitalized to establish the web-based Joint Asia Diabetes Evaluation (JADE) Program complete with risk levels and algorithms for issuance of personalized reports to reduce clinical inertia and empower selfmanagement. Through this technologically assisted, integrated diabetes care program, we have generated big data to track secular trends, identify unmet needs, and verify interventions in a naturalistic environment. In 2009, the JADE Program was adapted to form the Risk Assessment and Management Program for Diabetes Mellitus (RAMP-DM) in the publicly funded primary care clinics, which reduced all major events by 30-60% in patients without complications. Meanwhile, a JADE-assisted assessment and empowerment program provided by a universityaffiliated, self-funded, nurse-coordinated diabetes center, aimed at complementing medical care in the community, also reduced all major events by 30-50% in patients with different risk levels. By combining universal health coverage, public-private partnerships, and data-driven integrated care, the Hong Kong experience provides a possible solution than can be adapted elsewhere to make quality diabetes care accessible, affordable, and sustainable. THE SOCIETAL BURDEN OF DIABETES In 2017, according to the Global Burden of Diseases, Injuries, and Risk Factors Study, noncommunicable diseasesdmainly cardiovascular diseases (CVD), cancer, chronic respiratory diseases, and diabetesdaccounted for three-quarters of global deaths, or 41 million (1). Because diabetes independently increases the risk of cardiovascular, renal, and cancer death by 1.3-to 3-fold, prevention and control of diabetes is a top priority in the prevention of noncommunicable diseases (2). Between 1990 and 2010, U.S. surveillance data reported that in people with diabetes, the incidence of acute myocardial infarction (MI) had decreased by 68% to 45 per 10,000 person-years, stroke by 53% to 53 per 10,000 person-years, and

Real‐world data reveal unmet clinical needs in insulin treatment in Asian people with type 2 diabetes: the Joint Asia Diabetes Evaluation (JADE) Register

“…The latter is a web-based structured diabetes care programme in Asia set up since 2007. 18 It consists of a portal with built-in protocols to guide data collection during structured comprehensive assessment (blood/urine tests and eye/foot examination), performed every 12 to 24 months as recommended by most guidelines. 19 Apart from enabling the physicians to establish a diabetes register for quality improvement, the data are used to estimate the 5-year probability of major clinical events using validated risk equations, followed by issue of personalized reports with decision support to empower shared decision-making between physicians and patients.…”

“…25 This real-world evidence points to the importance of patient education and engagement, calling for better psychosocial and behavioural support from the healthcare team (including clinicians and allied health personnel), families, and peers to optimize diabetes care. 18,26 In this real-world register, which involved mainly hospital-based clinics, premixed and basal-only regimens were most popular, receptor agonists (GLP-1RAs) are a possible option. 19 That said, because of the high cost of GLP-1RAs, initiation of basal insulin, followed by addition of prandial insulin before the largest meal or switching to twiceor thrice-daily premixed insulin, remains the mainstream therapy.…”

Circulating branched‐chain amino acids and incident heart failure in type 2 diabetes: The Hong Kong Diabetes Register

“…Upon entry into the HKDR, all patients provided written informed consent for banking of blood samples for future research purpose on an anonymous basis. Details of the HKDR have been published elsewhere . Figure shows the study flow.…”

“…Although mass spectrometry is the gold standard for measuring BCAAs, we have used a validated commercial assay with internal control and yielded results comparable to that reported in other Chinese cohorts (6.5%‐17.6% patients with T2D; median BCAAs 607 vs 413.4‐502.7 μmol/L, respectively) . Second, although 48.5% of eligible HKDR enrolees did not have complete clinical data and biosamples for analysis after excluding patients with prior HF, ASCVD, or CKD, 83% of them had biosample collection (compared to 26.6% of the present study cohort) prior to the introduction of territory‐wide diabetes risk assessment program in 2000 which has begun to improve the standards of care in Hong Kong . Although our results are more reflective of diabetes care in recent years, these may have limited generalizability to high‐risk patients, given the higher risk profile in our study cohort compared to those without BCAA measurements.…”

“…where. 18 Figure 2 shows the study flow. This study complied with the Declaration of Helsinki and was approved by the local institutional review board.…”