Reaching far in China

Times are changing in China. The spill over effect of the economic development is a rise in the diabetes prevalence.

But action has been taken; a National Diabetes Programme supported by The World Diabetes Foundation is aiming at bringing diabetes awareness and prevention to half of the republic’s population and to bend the curve. But it takes time to turn a coaster.

Since the 1990’s the growing economy has helped raise the living standards of the Chinese population, offering more opportunities but also making the people world famous for riding bikes eat more and exercise less.

Ministry of Health recognising the problem

A few decades ago, diabetes was relatively rare in China. But in 2003, 23.8 million Chinese suffered from diabetes. In 2007, the number was 39.8 million and is expected to rise to 59.2 million within the next 18 years.

 Almost 97% of all diabetes cases are related to type 2 and therefore preventable - and so are the complications if diagnosed in due time. But only 10-15% of all type 2 diabetes cases are in fact diagnosed, compared with 50% in Europe.

The Ministry of Health has realised the growing problem and also acknowledges the potential of preventing, detecting and treating diabetes in the population. Since 2004, the Ministry has been responsible for a project designed to address the problem. One of the project’s two main components is the development and dissemination of diabetes prevention and treatment guidelines to train doctors and nurses.

This guideline component is run effectively by the Chinese Diabetes Society, a network of diabetes doctors. So far 6,800 health professionals from more than 50 cities all over China have been trained.

Diabetes care made accessible

Programme Coordinator Mr. Ulrik Uldall Nielsen has followed the project development: “The guideline component is truly the way forward in making diabetes care accessible to people by ensuring that care is available in the localities. Secondarily, the prevention interventions made by the trained health care providers will have much greater impact on people when done at this level of care“, he says.

The second component, an integrated Diabetes Management Model, has been designed to improve the sharing of patient information between hospitals and health clinics, which will benefit the patients. Sharing patient information will help the health professionals in each facility target the services offered and will ensure that the patients are referred to the right facility.

This part of the project is run by National Centre for Chronic and Non Communicable Disease Control (NCNCD) and Prevention at the Chinese Centre for Disease Control and Prevention (CDC) under the Chinese Ministry of Health. The model is tested in six pilot sites and the experience so far is that this part of the project is more complex than anticipated.

Linking hospitals and community centres

The programme is none the less moving forward, although at a slower pace than originally hoped. During a field visit in September 2007, Dr Kong Lingzhi, Deputy Director General, Ministry of Health, Bureau of Disease Prevention and Control, confirmed this by showing great enthusiasm during her speech, where she emphasised the importance of the model to succeed: “The integral model for seamless care for diabetes between community centres and hospitals is very crucial. Integration of services in itself is not the objective, the objective is to improve outcomes in a cost effective way.”

During the same field visit Dr. Anil Kapur, Managing Director of the World Diabetes Foundation, visited Caoyang Community Health Centre and subsequently the larger 6th People’s Hospital. The health centre staff has been trained and provided with protocols of care, and two medical doctors and a nurse educator provide outpatient diabetes services.

Patients who are difficult to monitor are referred to the teaching hospital on specific days, where the nurse and the doctor accompany the patients and take part in assessment, which actually increases their skills. Patients not requiring admission or special care are referred back to the community centre.

Dr. Anil Kapur summed up the positive experience by saying that; “if a seamless model for care between hospital and community centre has to be set up in large urban Chinese metropolises, it would have to be similar to the one being practiced in Shanghai.”

Project hopes to reach half a billion people

To date approx. 6,800 doctors and nurses from more than 50 cities all over China have been trained, using the 'National Diabetes Prevention and Treatment Guideline' developed by the project. A total of 8,000 doctors and nurses will be trained within the project framework.

The project is expected to impact 500 million people by providing access to effective and affordable diabetes care through the establishment of a network of diabetes centres at existing hospitals and community health centres. A long term reduction in diabetes prevalence and diabetes related complications is expected and due to training and awareness raising alone, diagnosis is expected to increase by 2.5 million new cases per year.

Read more about the programme

This page was last updated 5-6-2011 by bisl.wdf