[Local medical treatment]Diabetes impacts the national economy. The government advocates early diagnosis and treatment for people with diabetes

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Text by He Jianxing Organized by Liang Yingxiu

The burden of diabetes management on a country’s economy can be called a “time bomb”, and a little carelessness in management can trigger the rise and fall of a country. This is by no means alarmist.

In other words, when a person is diagnosed with diabetes, not only does his chance of suffering from cardiovascular disease and chronic kidney disease increase, but this interlocking plot also has a huge impact on the future development of the country.

(Kuala Lumpur News) Taking Malaysia as an example, the government bears 70% of the medical expenses for the health of our people, and the biggest burden is the management of chronic diseases.

Taking diabetes as an example, the basic treatment cost in public health includes every test, follow-up consultation and drug collection. If it reaches a more serious stage, you may need to be admitted to the hospital, or receive cardiovascular treatment such as targeted drugs, vascular examinations such as angiography or An electrocardiogram, etc., and treatments include angioplasty or heart bypass surgery.

Not only that, but most people with diabetes will also suffer from impaired kidney function. If it reaches a severe stage, it may even require long-term dialysis or kidney transplantation. Therefore, it is not an exaggeration to regard diabetes as the source of subsequent complications.

The detection age has been lowered by 35 years

Associate Professor Lim Lee Ling, Consultant of the Department of Endocrinology at the University of Malaya Medical Center pointed out that in view of this, the Ministry of Health of our country issued the latest guidelines for the treatment of diabetes in 2022, that is, men and women over the age of 35 should meet several conditions, including obesity and body mass If the index (BMI) exceeds 23, family history of diabetes, high blood pressure, high cholesterol, cardiovascular disease, chronic kidney disease (CKD), or women with diabetes during pregnancy, early detection of early diabetes is required.

“The biggest reason for lowering the testing age from 40 to 35 is that diabetes has been found to be younger in recent years. However, the response has not been satisfactory so far, or it is still related to COVID-19 and the general public believes that 35 is still healthy. phases.”

“Actually, Malaysia is not the only country that has the trend of rejuvenation of diabetes. Looking around the world, this trend of rejuvenation is everywhere. Take the United States as an example. On the one hand, diabetes rejuvenation seems to be a global problem, and it has attracted more and more attention from governments around the world. The main reason is as mentioned above, that is, it is a country’s economic time bomb.”

Diabetic friend postpones follow-up consultation due to epidemic situation

If a person doesn’t care about his condition, and doesn’t even know that he has early-stage diabetes, what dangers or problems will it cause? The answer is to lead to more serious diseases and increase medical expenses. Take the first situation as an example, when a person’s diabetes is getting more and more serious but they don’t know or care about it, then they will move towards more serious conditions, such as early-stage diabetes.

According to an earlier British study, the patient has “reversed diabetes” through a one-year diet adjustment and exercise, and changed his daily routine. However, if the diabetic does not know that his health has turned red , or don’t care, then drug intervention is required to control the condition.

“In fact, the damage caused by the outbreak of COVID-19 is affecting the management of diabetes bit by bit,

One of them is that the follow-up consultation of sugar friends is postponed,

As a result, some latent injuries emerged during this period,

Early detection of latent damage such as urine protein,

Diabetic retinopathy, etc. are diabetes management,

A very important part. “

“If it is ignored, it is equivalent to missing the golden period that can change the outcome, because urine protein is a precursor to kidney failure, so if it can be detected and intervened early, it is expected to avoid the emergence of chronic kidney disease.”

In addition, the suspension of follow-up visits caused by the epidemic also indirectly increased public health expenses. For example, a diabetic patient already had chronic kidney disease (CKD), but because the follow-up visits were delayed, he ignored his own condition. As a result, the glomerular filtration rate The estimated value (eGFR) dropped very quickly, even to the stage of kidney failure, and finally he had to choose kidney dialysis to prolong his life.

The condition of each diabetic patient is closely related to public health. In addition to medical expenses, it will also affect manpower deployment, including requiring more medical staff to participate in diabetes management, and affect other patients in need, such as facing cancer and emergency treatment. Even patients with infectious diseases, etc.

diseases in the same group

She pointed out that another popular myth about diabetes is to treat it as a single disease. In fact, this is not correct. As mentioned before, diabetes, cardiovascular disease and chronic kidney disease should be regarded as ” Diseases under the same group”, that is to say, with diabetes, there will be heart failure, myocardial infarction or chronic kidney disease, etc., and only in this way can more people “stay away” from diabetes.

Otherwise, for the general public, diabetes is nothing more than a “no big deal” chronic disease, and it is not prevented.

As the COVID-19 epidemic has eased, the postponed follow-up visits for diabetes in major public hospitals have almost returned to normal. Diabetic friends can go for follow-up visits according to the date given by the hospital. However, it is undeniable that there are still patients who are still reluctant to go to I felt a little scared for the follow-up visit in the hospital because I was worried about infection.

For this reason, the University of Malaya Medical Center (PPUM) specially provides telemedicine (telemedicine) such as telephone consultation services for diabetic patients with stable conditions, so that these diabetic patients who have “good results” in the past 6 to 12 months do not need to travel to the hospital, that is, You can meet with the doctor for a follow-up visit by phone or other 3C products.

Usually this kind of diabetes patients do not need to make major drug adjustments. Therefore, the hospital will provide such convenience after weighing the situation. However, if the “results” of the sugar patients in the past are not satisfactory, they must continue to return to the hospital for follow-up visits and give more treatment. More counseling on managing diabetes.

She said that in addition to telemedicine follow-up consultations, public hospitals now also allow people with diabetes to have follow-up consultations at government clinics (klinik kesihatan) near their homes, which reduces the crowding of hospitals and, secondly, has family medicine in most government clinics. Doctors also share the burden of diabetes follow-up visits in public hospitals.

In order to help more people with diabetes willing to come back for follow-up visits automatically, public hospitals are really painstaking. The purpose is to prevent the disease of people with diabetes from getting worse. However, the efforts of medical staff still need the cooperation of people with diabetes. the efforts of the medical staff.

Covers different specialties Diabetes Care Unit

Since 2013, the University of Malaya Medical Center has established a Diabetes Care Unit (DCU), which covers different specialists (including diabetes specialists, endocrinology, orthopedics, ophthalmology and rehabilitation), and has received management Specially trained nurses in diabetes and other units.

Its mission is to put the purpose of early detection and prevention into action.

First of all, the nurse will personally call and make an appointment for the early diabetic patients who have been detected before. After inviting them to come, different doctors will conduct a detailed examination of the patient’s body parts. For example, the ophthalmologist will check whether his retina is damaged. As for diabetes Experts and endocrinologists will check in detail whether there are any neglected wounds, etc., and then hand over to the orthopedic doctor for inspection and treatment of the wounds.

Proactive contact with initial patients

“In other words, in one appointment, the patient will be checked by several specialists in person, and then the next treatment or observation will be arranged according to the situation. Generally, if the patient is fine, he only needs to come back for a review in 10 to 12 months. .”

Lin Liling said that the establishment of the Diabetes Care Unit is also to benefit more people with diabetes. It is different from ordinary follow-up visits because the nurses in the unit will call him in person, which is equivalent to an extra layer of reminders, and also makes people with diabetes feel that they are being treated. Caring, this is another good news for sugar lovers, making them feel that it is necessary to come back for a follow-up visit instead of choosing to escape.

So what are your plans for managing diabetes in the future? As a doctor, she believes that it is necessary to change the existing model, that is, no longer waiting for people with diabetes to seek medical treatment, but actively reaching out to patients who may have early-stage diabetes.

“Of course, this is not an easy task. It requires more funds and manpower, such as through questionnaires to find out who may be potential early-stage diabetes patients, and then collect more data for observation. Therefore, more NGOs are needed. (NGO) roll out community screening to ‘reach’ them.”

Hospital physical examination center cooperation

In addition, she also hopes that public hospitals and medical examination centers can establish a bridge of communication. In fact, long before the outbreak of the epidemic, the public has become more and more aware of health and understands the importance of physical examinations. The center conducted a physical examination and found that he had early-stage diabetes, but he stayed there. He didn’t know which doctor to consult for further treatment or management, and these data were important channels to contact more early-stage diabetics.

As for national policies, our country is one of the countries that has implemented sugary drinks tax. Take Mexico, the first country to implement sugary tax, as an example. It remains to be observed whether taxation on sugar-sweetened beverages can improve the current situation where 1 out of 5 people is a sugar lover.

“The government may also consider promoting more public transportation or building more parks. I believe these measures can curb the rising trend of the number of people with diabetes in our country, but it will take time to see the effect.”

Article Li Yingzi “Ming Pao”

Waist circumference men up to 90 women 80cm Central obesity increases chronic disease risk

The Hong Kong government and the Department of Sports Science of CUHK jointly conducted the “Territory-wide Community Physical Fitness Survey”, collecting data from July 2021 to December 2022, including arranging citizens to take physical fitness tests, filling out questionnaires to explain physical activity habits and lifestyles, and analyzing 8419 samples.

Adults aged 17 to 79 and the elderly group had a higher central obesity rate, 34.3% of women and 26.6% of men had central obesity, that is, the waist circumference of men was 90 cm, and the waist circumference of women was 80 cm. Among them, the obesity rate among the 70 to 79-year-old is the highest among other age groups, with 57.2% of women and 38.5% of men.

WHO: 150 minutes of moderate to vigorous exercise per week

In terms of physical activity, more than half of adults (53.8%) did not meet the WHO’s recommendation of at least 150 minutes of moderate to vigorous exercise per week.

The age group with a higher rate of insufficient exercise was men aged 40 to 59, 61% of whom did not meet the WHO recommendation, and women aged 20 to 39, 67.8% of whom did not meet the standard.

Academics: Advocate the increase of online courses such as running yoga

Xu Shiquan, a professor of the Department of Sports Science at CUHK, said that the central obesity of adults deserves attention, as there is a greater risk of diabetes and heart disease.

He said that most adults do less exercise due to “lack of time”. Stakeholders are suggested to organize more online courses, such as running and yoga workshops, which are popular among adults, and allow citizens to calculate their physical activity through mobile applications Is it enough.

In addition, the survey showed that 66.3% and 50.7% of children (ages 7 to 11) and adolescents (ages 12 to 16) did not meet the WHO recommendation, which is to do an average of one hour of moderate to high-intensity physical activity per day per week. Some school children said Because of “too busy with homework”.

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