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Walking with Diabetic Patients for a Decade—Hong Kong Institute of Diabetes and Obesity

CUHK diabetes research team
Front row: Prof. Juliana Chan (centre), Prof. Ronald Ma (left)
Early team members
From left: Prof. Clive Cockram, Prof. Juliana Chan and Prof. Kenneth Young
Prof. Juliana Chan and Prof. Ronald Ma

The term diabetes is the shortened version of diabetes mellitus. It is derived from the Greek word diabetes meaning siphon──to pass through, and the Latin word mellitus meaning honeyed──the excess sugar found in urine. It is often thought of as a condition in which the body has taken in too much sugar. People with diabetes may display no acute symptoms. It causes no pain unlike a heart attack. Neither does it spread with the ferocity of cancer. It can be easy to ignore, but the chronic illness can damage health severely and even lead to fatal complications. Diabetes is a major health problem worldwide.

From Unit to Institute

The research of diabetes in CUHK dates back to 1985 when Prof. Clive Cockram joined the Faculty of Medicine and founded the Metabolic Investigation Unit. At first it consisted of three, four physicians and nurses. Prof. Juliana Chan became one of them in 1989. 'We discovered that people in Hong Kong have diabetes, albuminuria, and kidney disease even at a younger age and with a relatively normal body weight compared to patients of European descent. Back then, research in diabetes was extremely rare in Asia, except that we had been conducting large-scale clinical trial on new drugs, and collaborating with universities in the UK, the US, Japan, and the National Institutes of Health.'

It was a time when diabetic research and care in China had just taken its baby steps. Sometimes doctors from the mainland came to the Prince of Wales Hospital to study its therapeutic model. The unit began to run short courses, and its scope of work expanded to education, research, and nursing care. To further facilitate collaboration across faculties and universities, the Hong Kong Institute of Diabetes and Obesity (HKIDO) was established in 2005 under the suggestion of Prof. Kenneth Young, then Pro-Vice-Chancellor, with Professor Chan as its founding director.

Quotable Qualifications

The HKIDO is a major education centre in Hong Kong that offers academic programmes in diabetes. 'Like the Master of Science Programme in Endocrinology, Diabetes and Metabolism, the Professional Diploma Programme in Diabetes Management and Education that is well-received by family doctors, and the Certificate Course in Obesity and Weight Management, they are quotable qualifications of the Medical Council of Hong Kong. Together with the Professional Diploma Programme in General Endocrinology and Metabolism, these courses have benefitted more than 600 health care professionals over the years,' said Prof. Ronald Ma.

The institute is dedicated to building up its worldwide network. Every year, the Diabetes and Cardiovascular Risk Factors──East Meets West Symposium is held with an attendance of over 700 local and international experts. The 17th edition of the event is coming this October.

Undesirable 'Growth'

Globally, Asia has witnessed the fastest growth in the number of diabetic patients in the past few decades. For example, in the 1980s, under 1% of Chinese adults had diabetes, but it increased to over 10% (circa 110 million adults) in 2012. A research jointly conducted by the HKIDO, Shanghai Jiao Tong University and Sun Yat-sen University, predicted that by 2030, the annual projected cost of diabetes care in China will amount to 360 billion RMB. In Hong Kong, the landscape is no less worrying. According to data from the International Diabetes Federation in 2014, there were about 570,000 cases of diabetes in Hong Kong with a prevalence rate of 9.9%, higher than the world average. Undiagnosed cases are estimated to be over 300,000.

Debunking Myths

Diabetes is usually associated with senility, obesity, and having a sweet tooth, but that is not exactly true. Between 1995 and 2009, the HKIDO analysed cases of 10,000 diabetes patients. Results show that 20% of diabetes cases are young-onset at an average age of 30. Among them, 30% have normal body weight, indicating that young individuals with normal body weight are also at risk of suffering from diabetes. Another online survey conducted by Professor Chan in over 10 Asian countries found that of the 30,000 respondents, over 1/5 have young-onset diabetes at 40, which means many women of child-bearing age and people in the prime of their lives still fall prey to the disease.

Professor Ma said, 'Except for eating sweet food, weight gain caused by high calorie intake also poses risk of developing diabetes. Other risk factors include smoking, high blood pressure, and high cholesterol. Genes play a pivotal role, too. If a close relative, especially on the maternal side, has a history of diabetes or gestational diabetes, the risk increases four- to five-fold.'

'A hundred people with diabetes may be a hundred different cases. DNA, genetic predisposition, and many other factors are all parts of the onset equation. It is very complicated,' said Professor Chan. It is essential to raise public awareness of the disease. The HKIDO's mission──prevent, control, and cure──means actively identifying high-risk subjects for preventive treatment, building and maintaining a registry of diabetic cases in the community, and empowering and supporting patients.

Community Engagement

In 2007, the HKIDO established the Yao Chung Kit Diabetes Assessment Centre. Thanks to a generous donation from the Yao Yiu Sai Education and Charitable Memorial Fund, the centre provides a comprehensive assessment programme at an affordable price to identify subjects with diabetic complications and those at risk. Comments by an endocrinologist and explanation by a nurse specialized in diabetes are given to the patients to help them make informed choices about their health. The assessment services are in high demand. The centre serves as an important back-up to the mainstream medical system and the community physicians.

In 2011, the centre worked with organizations like the Lions Clubs and other organizations to launch the Outreach Programme to Raise Diabetes Awareness and Healthy Lifestyle, in which they hosted public health talks across districts, offered basic diagnostic services and risk assessments for free, and conducted surveys to identify high-risk groups for preventive care and follow-up.

Dancing with Diabetes

Professor Chan reiterated that many people with diabetes are able to prevent the onset of complications. As long as they face up to the disease, exercise self-discipline, take their medicine, follow up with their doctors, and manage their blood sugar, cholesterol and blood pressure, the tortures of dialysis and amputation are totally avoidable. As Professor Ma said, 'It is extremely difficult to change lifestyles. When patients are asked to exercise more and watch their diet, they simply say they have been working multiple jobs and that they eat irregular meals and have no time for rest at all.'

People with chronic illness are prone to loneliness and depression. It is important to feel support from peers and a professional team. The centre develops a membership scheme to send patients information about diabetes on a regular basis. It also organizes activities for members to establish bonds with their peers. Nurses and volunteers of the centre line up patients to form peer groups. 'The therapy process helps many to change for the better. They become willing to share their thoughts. Sociologist, psychologists, behaviourists, and doctors are invited to host workshops for three to four hours to teach patients how to listen to and motivate others. They make up for what doctors have no time to do. This improves the quality of holistic health care,' said Professor Chan.

From Patients, For Patients

It is a core mission of the HKIDO to translate basic sciences and clinical research into the enhancement of human health and holistic capacity. Professor Ma has recently been funded with HK$60 million by the University Grant Council’s's third round of Theme-based Research Scheme to pursue an integrated trans-omics approach to diabetic cardio-renal complications.

'In the past dozens of years, more than 10,000 patients with type 2 diabetes have been followed up for a mean duration of eight years, from onset to the progression of complications to the patients' death. Thanks to the DNA they donated, we have collected a huge amount of data in the Hong Kong Diabetes Registry. By analysing the data, we hope to discover the genetic and other biomarkers for diabetic complications for Chinese people. It can help identify at-risk subjects.' It also lays a foundation for developing novel drugs. In the long term, the centre aims to provide genetic testing that exceeds the capability of conventional assessments.

There is no radical cure for diabetes, and no invasive surgery can be applied. Helping patients to control the disease and to get a life is what the HKIDO has been striving for. The institute receives commendation from the International Diabetes Federation for its patient-oriented approach in research, assessment, education and care, and has been one of the officially recognized centres of education.

Data from the International Diabetes Federation, 2014

  • 387 million people in the world (age 20 to 79) living with diabetes; prevalence 8.3%
  • 179 million people (46.3%) with diabetes are undiagnosed
  • 4.9 million deaths; every 7 seconds a person dies from diabetes
  • USD 612 billion dollars in health expenditure—11% of total spending
  • Expected number of people with diabetes by 2035: 592 million
  • Number of children who developed type 1 diabetes in 2013: over 79,000



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