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Type 1 diabetes mellitus care and education in China: The 3C study of coverage, cost, and care in Beijing and Shantou

  • Helen C. McGuire
    Correspondence
    Corresponding authors at: PATH, 455 Massachusetts Avenue NW, Suite 1000, Washington, DC 20001, United States (H.C. McGuire); Department of Endocrinology and Metabolism, Peking University People’s Hospital, No. 11, Xizhimen Nan Da Jie, Xicheng District, Beijing 100044, P.R. China (Professor L. Ji).
    Affiliations
    International Diabetes Federation, Chausée de la Hulpe 166, Watermael Boitsfort, 1170 Brussels, Belgium

    PATH, 455 Massachusetts Ave NW, Washington DC, 20001, USA
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  • Linong Ji
    Correspondence
    Corresponding authors at: PATH, 455 Massachusetts Avenue NW, Suite 1000, Washington, DC 20001, United States (H.C. McGuire); Department of Endocrinology and Metabolism, Peking University People’s Hospital, No. 11, Xizhimen Nan Da Jie, Xicheng District, Beijing 100044, P.R. China (Professor L. Ji).
    Affiliations
    Department of Endocrinology and Metabolism, Peking University People’s Hospital, No. 11, Xizhimen Nan Da Jie, Xicheng District, Beijing 100044, PR China
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  • Katarzyna Kissimova-Skarbek
    Affiliations
    International Diabetes Federation, Chausée de la Hulpe 166, Watermael Boitsfort, 1170 Brussels, Belgium

    Jagiellonian University Medical College, Faculty of Health Sciences, Department of Health Economics and Social Security, Poland
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  • David Whiting
    Affiliations
    International Diabetes Federation, Chausée de la Hulpe 166, Watermael Boitsfort, 1170 Brussels, Belgium
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  • Florencia Aguirre
    Affiliations
    International Diabetes Federation, Chausée de la Hulpe 166, Watermael Boitsfort, 1170 Brussels, Belgium
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  • Puhong Zhang
    Affiliations
    The George Institute for Global Health at Peking University Health Science Center, Level 18, Tower B, Horizon Tower, 6, Zhichun Road, Haidian District, Beijing 100088, China
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  • Shaoda Lin
    Affiliations
    Department of Endocrinology and Metabolism, The First Affiliated Hospital of Shantou University Medical College, No. 57, Changping Road, Shantou 515041, Guangdong Province, China
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  • Chunxiu Gong
    Affiliations
    Department of Endocrinology, Genetics and Metabolism, Beijing Children’s Hospital, Capital Medical University, No. 56 South Lishi Road, Xicheng District, Beijing, 100045, China.
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  • Weigang Zhao
    Affiliations
    Department of Endocrinology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No.1 Shuaifuyuan Wangfujing Dongcheng District, 100730, Beijing, China
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  • Juming Lu
    Affiliations
    Department of Endocrinology, PLA General Hospital, 28 Fuxing Road, Haidian District, Beijing 100853, China
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  • Xiaohui Guo
    Affiliations
    Department of Endocrinology, Peking University First Hospital, 7 Xishiku St, Xicheng District, Beijing 100034, China
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  • Ying Ji
    Affiliations
    Department of Social Medicine and Health Education, School of Public Health, Peking University, No. 38 Xueyuan Road, Haidian District, Beijing 100191, China
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  • Till Seuring
    Affiliations
    International Diabetes Federation, Chausée de la Hulpe 166, Watermael Boitsfort, 1170 Brussels, Belgium
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  • Tianpei Hong
    Affiliations
    Department of Endocrinology and Metabolism​, Peking University Third Hospital, No.49, Huayuan North Road, Haidian District, Beijing 100191, China
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  • Lishu Chen
    Affiliations
    Department of Endocrinology, The Second Affiliated Hospital of Shantou University Medical College, No. 69, Dongxia North Road, Shantou 515000, Guangdong Province, China
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  • Jianping Weng
    Affiliations
    Department of Endocrinology and Metabolism, The Third Affiliated Hospital of Sun Yat-sen University, No. 600, Tianhe Road, Tianhe District, Guangzhou 510630, Guangdong Province, China
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  • Zhiguang Zhou
    Affiliations
    Institute of Metabolism and Endocrinology, The Second Xiangya Hospital, Key Laboratory of Diabetes Immunology, Ministry of Education, Central South University, National Clinical Research Center for Metabolic Diseases, No. 139, Renmin Middle Road, Furong District, Changsha 410011, Hunan Province, China
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Published:February 28, 2017DOI:https://doi.org/10.1016/j.diabres.2017.02.027

      Highlights

      • System barriers hamper application of guidelines to practice internationally.
      • Deficits are evident in care and education for type 1 diabetes in China.
      • Regional differences between Beijing and Shantou are evident.
      • Diabetes-related complications are associated with absenteeism from work and school.

      Abstract

      Aims

      The paucity of data on Type 1 diabetes in China hinders progress in care and policy-making. This study compares Type 1 diabetes care and clinical outcomes in Beijing and Shantou with current clinical guidelines.

      Methods

      The 3C Study was a cross-sectional study of the clinical practices and outcomes of people with Type 1 diabetes. The study sequentially enrolled 849 participants from hospital records, inpatient wards, and outpatient clinics. Data were collected via face-to-face interviews with patients and health professionals, the Summary of Diabetes Self-Care Activities, medical records, and venous blood samples. Care was audited using ISPAD/IDF indicators. Data underwent descriptive analysis and tests for association.

      Results

      The median age was 22 years (IQR = 13–34 years), and 48.4% of the sample had diabetes less than six years. The median HbA1c was 8.5% (69 mmol/mol) (IQR 7.2–10.5%), with significant regional variance (p = 0.002). Insulin treatment was predominantly two injections/day (45% of patients). The highest incidence of diabetic ketoacidosis was 14.4 events/100 patient years among adolescents. Of the 57.3% of patients with LDL-C > 2.6 mmol/L, only 11.2% received treatment. Of the 10.6% considered hypertensive, 47.1% received treatment. Rates of documented screening for retinopathy, nephropathy, and peripheral neuropathy were 35.2%, 42.3%, and 25.0%, respectively. The median number of days of self-monitoring/week was 3.0 (IQR = 1.0–7.0). There were significant differences in care practices across regions.

      Conclusions

      The study documented an overall deficit in care with significant regional differences noted compared to practice guidelines. Modifications to treatment modalities and the structure of care may improve outcomes.

      Keywords

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      References

      1. World Health Organization. Changing mindsets: strategy for health policy and systems research. World Health Organization; 2012. p. 2,6. Accessed via http://www.who.int/alliance-hpsr/alliancehpsr_changingmindsets_strategyhpsr.pdf [May 2011].

        • Cheung B.M.
        • Ong K.L.
        • Cherny S.S.
        • Sham P.C.
        • Tso A.W.
        • Lam K.S.
        Diabetes prevalence and therapeutic target achievement in the United States, 1999 to 2006.
        Am J Med. 2009; 122: 443-453
      2. Scottish Diabetes Survey Monitoring Group. Scottish Diabetes Survey 2010. NHS Scotland 2011: 4. Accessed via http://www.diabetesinscotland.org.uk/Publications/SDS%202010.pdf, May 2011.

      3. Webster G, Sullivan-Taylor P, Walker V, Palmer B. Diabetes Care Gaps and Disparities in Canada. Canadian Institute for Health Information, 2009. Accessed via http://www.cihi.ca/CIHI-ext-portal/pdf/internet/PHC_DIABETES_CANADA10_EN, June 2011.

        • Braga M.
        • Casanova A.
        • Teoh H.
        • et al.
        • Diabetes Registry to Improve Vascular Events (DRIVE) Investigators
        Treatment gaps in the management of cardiovascular risk factors in patients with type 2 diabetes in Canada.
        Can J Cardiol. 2010; 26: 297-302
        • Saaddine J.B.
        • Engelgau M.M.
        • Beckles G.I.
        • Gregg E.W.
        • Thompson T.J.
        • Narayan K.M.
        A diabetes report card for the United States: quality of care in the 1990s.
        Ann Intern Med. 2002; 136: 565-574
        • McFarlane S.I.
        • Jacober S.J.
        • Winer N.
        • et al.
        Control of cardiovascular risk factors in patients with diabetes and hypertension at urban academic medical centres.
        Diabetes Care. 2002; 25: 718-723
        • Narayan K.M.
        • Benjamin E.
        • Gregg E.W.
        • Norris S.I.
        • Engelgau M.M.
        Diabetes translation research: where are we and where do we want to be?.
        Ann Intern Med. 2004; 140: 958-963
        • Edge J.A.
        • Swift P.G.
        • Anderson W.
        • Turner B.
        Diabetes services in the UK: fourth national survey; are we meeting NSF standards and NICE guidelines?.
        Arch Dis Child. 2005; 90: 1005-1009
      4. Non Communicable Diseases and Health, World Health Organization. Innovative care for chronic conditions: building blocks for action. World Health Organization; 2002. Accessed via http://www.who.int/chp/knowledge/publications/icccglobalreport.pdf [May 2011].

        • Epping-Jordan J.
        • Pruitt S.D.
        • Bengoa R.
        • Wagner E.H.
        Improving the quality of health care for chronic conditions.
        Qual Saf Health Care. 2004; 13: 299-305
        • McGuire H.
        • Kissimova-Skarbek K.
        • Whiting D.
        • Ji L.
        The 3C study: coverage cost and care of Type 1 diabetes in China – study design and implementation.
        Diabetes Res Clin Pract. 2011; 94: 307-310
        • Xin Y.
        • Yang M.
        • Chen X.J.
        • Tong Y.J.
        • Zhang L.H.
        Clinical features at the onset of childhood Type 1 diabetes mellitus in Shenyang, China.
        J Paediatr Child Health. 2010; 46: 171-175
        • Usher-Smith J.A.
        • Thompson M.J.
        • Sharp S.J.
        • Walter F.M.
        Factors associated with the presence of diabetic ketoacidosis at diagnosis of diabetes in children and young adults: a systematic review.
        BMJ. 2011; 343https://doi.org/10.1136/bmj.d409
      5. International Diabetes Federation. Global IDF/ISPAD guideline for diabetes in childhood and adolescence. International Diabetes Federation; 2011. Accessed via http://www.idf.org/sites/default/files/Diabetes-in-Childhood-and-Adolescence-Guidelines.pdf [June 2011].

        • American Diabetes Association
        ADA standards of medical care in diabetes.
        Diabetes Care. 2012; 35: S11-S63
      6. International Diabetes Federation. International standards of diabetes education, 3rd ed. International Diabetes Federation; 2009. Accessed via http://www.idf.org/files/docs/INTNL-STANDARDS-EN.pdf [May 2011].

        • Yang D.
        • Deng H.
        • Luo G.
        • Wu G.
        • Lin S.
        • Yuan L.
        • et al.
        Demographic and clinical characteristics of patients with type 1 diabetes mellitus: a multicentre registry study in Guangdong, China.
        J Diabetes. 2016; 8: 847-853
        • Improving Chronic Illness Care
        Assessment of chronic illness care version 3.5.
        MacColl Institute for Healthcare Innovation, Group Health Cooperative, 2000
        • Toobert D.J.
        • Hampson S.E.
        • Glasgow R.E.
        Summary of diabetes self-care activities measure.
        Diabetes Care. 2000; 23: 943-950
        • Silverstein J.
        • Klingensmith G.
        • Copeland K.
        • et al.
        Care of children and adolescents with type 1 diabetes.
        Diabetes Care. 2005; 28: 186-212
        • Dabelea D.
        • Rewers A.
        • Stafford J.M.
        • Standiford D.A.
        • Lawrence J.M.
        • Saydah S.
        • et al.
        Trends in the prevalence of ketoacidosis at diabetes diagnosis. The SEARCH for diabetes in youth study.
        Pediatrics. 2014; 133: e938-e945
        • Usher-Smith J.A.
        • Thompson M.J.
        • Sharp S.J.
        • Walter F.M.
        Factors associated with the presence of diabetic ketoacidosis at diagnosis of diabetes in children and young adults: a systematic review.
        BMJ. 2011; 343: d4092
        • Gunn E.R.
        • Albert B.B.
        • Hofman P.L.
        • Cutfield W.S.
        • Gunn A.J.
        • Jefferies C.A.
        Pathways to reduce diabetic ketoacidosis with new onset type 1 diabetes: evidence from a regional pediatric diabetes center: Auckland, New Zealand, 2010 to 2014.
        Pediatr Diabetes. 2016; 11https://doi.org/10.1111/pedi.12456
        • Xin Y.
        • Yang M.
        • Chen X.J.
        • Tong Y.J.
        • Zhang L.H.
        Clinical features at the onset of childhood type 1 diabetes mellitus in Shenyang, China.
        J Paediatr Child Health. 2010; 46: 171-175https://doi.org/10.1111/j.1440-1754.2009.01657.x
        • Vanelli M.
        Effectiveness of a prevention program for diabetic ketoacidosis in children. An 8-year study in schools and private practices.
        Diabetes Care. 1999; 22: 7-9
        • Yang Z.
        • Wang K.
        • Li T.
        • et al.
        Childhood diabetes in China. Enormous variation by place and ethnic group.
        Diabetes Care. 1998; 21: 525-529
        • Rewers A.
        • Chase H.P.
        • Mackenzie T.
        • et al.
        Predictors of acute complications in children with type 1 diabetes.
        JAMA. 2002; 287: 2511-2518
        • The D.C.C.T.
        Research group adverse events and their association with treatment regimens in the diabetes control and complications trial.
        Diabetes Care. 1995; 18: 1415-1427
      7. Epidemiology of Diabetes Interventions and Complications (EDIC) design, implementation, and preliminary results of a long- term follow-up of the diabetes control and complications trial cohort.
        Diabetes Care. 1999; 22: 99-111
        • Craig M.E.
        • Jones T.W.
        • Silink M.
        • Ping Y.J.
        Diabetes care, glycemic control, and complications in children with Type 1 diabetes from Asia and the Western Pacific Region.
        J Diabetes Complications. 2007; 21: 280-287
        • Gong C.X.
        • Wei L.Y.
        • Wu D.
        • Cao B.Y.
        • Meng X.
        • Wang L.L.
        Effectiveness of multiple daily injections or continuous subcutaneous insulin infusion for children with type 1 diabetes mellitus in clinical practice.
        Int J Endocrinol. 2014; (Epub 2014 Aug 14): 526591https://doi.org/10.1155/2014/526591
        • Reh C.
        • Mittelman S.D.
        • Wee C.P.
        • Shah A.C.
        • Kaufman F.R.
        • Wood J.R.
        A longitudinal assessment of lipids in youth with Type 1 diabetes.
        Pediatr Diabetes. 2011; 12: 365-371
        • Guy J.
        • Ogden L.
        • Wadwa R.P.
        • et al.
        Lipid and lipoprotein profiles in youth with and without Type 1 diabetes: the SEARCH for diabetes in youth case-control study.
        Diabetes Care. 2009; 32: 416-420
        • Qin Z.Y.
        • Yan J.H.
        • Yang D.Z.
        • Deng H.R.
        • Yao B.
        • Weng J.P.
        Behavioural analysis of Chinese adult patients with type 1 diabetes on self-monitoring of blood glucose.
        Chin Med J. 2017; 130: 39-44https://doi.org/10.4103/0366-6999.196574
        • Fisher W.A.
        • Kohut T.
        • Schachner H.
        • Stenger P.
        Understanding self-monitoring of blood glucose among individuals with type 1 and type 2 diabetes: an information-motivation-behavioural skills analysis.
        Diabetes Educ. 2011; 37: 85-94https://doi.org/10.1177/0145721710391479
        • Guo J.
        • Whittemore R.
        • Jeon S.
        • Grey M.
        • Zhou Z.G.
        • He G.P.
        • et al.
        Diabetes self-management, depressive symptoms, metabolic control and satisfaction with quality of life over time in Chinese youth with type 1 diabetes.
        J Clin Nurs. 2015; 24: 1258-1268
        • Cooke D.
        • Bond R.
        • Lawton J.
        • et al.
        • UK NIHR DAFNE Study Group
        Structured Type 1 diabetes education delivered within routine care: impact on glycaemic control and diabetes-specific quality of life.
        Diabetes Care. 2013; 36: 270-272
        • Owen C.
        • Woodward S.
        Effectiveness of dose adjustment for normal eating (DAFNE).
        Br J Nurs. 2012; 21 (p. 224, 226–228, 230–232)
        • Lin K.
        • Yang X.
        • Wu Y.
        • Chen S.
        • Yin G.
        • Zhan J.
        • et al.
        Impact of disease management programs on metabolic control in patients with type 1 diabetes mellitus: a cohort study in Shantou, China.
        Medicine. 2016; 95 (e5681): 52