INTRODUCTION
Diabetes is a world renowned killer and is one of the causes of death that is leading in the world. (Elfein) There is no cure for diabetes and it is a chronic health condition. Diabetes is distinguished between Type I diabetes (DM I) and Type 2 diabetes (DM II) along with gestational diabetes.(Thom2) The DM I entails high levels of glucose that floods the body due to the lack of ability to produce insulin. The DM II and gestational entails of the body's inability to utilize the insulin to regulate its blood sugar levels.(THo2)
Worldwide in the year 2019, there are about 463 million people diagnosed and afflicted with the chronic disease of diabetes.(Thom2) In 2019, most of that 463 million are diabetic patients derived from China, then India, then followed by the United States.(thom2)
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It is estimated that diabetes killed over 1.6 million people in 2016. (Elfein) The non communicable disease of diabetes causes the death toll to be high in China due to lack of sufficient and appropriate treatment of its affected population.(eflein) Diabetes is ranked as such a non communicable disease around the world that it is predicted that India’s population will account for 134 million people having diabetes by the year 2045.(elfin, Thom3) Yet as it stands, China has the world’s largest accounted population of folks with diabetes. (ELfein, Thoma3) It is estimated that China has about 116 million people diagnosed with diabetes.(Elfein Thoma3, Lou) The 116 million people is what causes China to rank higher than any other country in the world.(Elfin, thoma3, Lou)
In China during the 2019 year, there was a significant age group of people between 20 and 70 years old that had diabetes. (Thoma3) Of that age group China has an estimated 28.7 thousand has Type 1 diabetes (DM I) of which are children up to 14 years of age. (Thoma3) The remaining group of about 114 million people have Type II diabetes (DM II). (Lou)
REVIEW OF LITERATURE
There is a major health care challenge for policy makers in China because they have already extended healthcare insurance to its constituents over the past decade, yet more is needed.(Lou) It is estimated that China nationally spends approximately 8.5% on health care costs managing diabetes not including complications deemed from diabetes. (lou,natl/interl,natl)
China is highly interested to gaining control over its diabetes problem for fear of the high costs of diabetes care is draining their monetary gains.(lou) While China has the highest amount of diabetes in its population, Germany, Mexico, and Portugal had the highest rates in healthcare cost expenditure. However, China spent more on healthcare diabetes related costs which is over half of the amount spent by the entire Western Pacific region.(thom2)
DISCUSSION
Risks
Skolnik states that lifestyle is to blame significantly for risk factors of noncommunicable diseases. (skolnik) Skolnik relates that lifestyles can be self controlled by people.(skolnik) The risks for diabetes have increased over the years yet obesity remains the largest risk for obtaining diabetes (elfein). Other risks include diet, physical activity, tobacco use, alcohol, family history, genetics, infections, and other environmental influences. (skol, Thoma)
Design an Intervention to Improve the Health of Those Affected by This Condition
China prefers to gain control over its diabetes healthcare challenge because they feel that all the wealth that they have gained over the past 30 years will be debunked due to all the expense that would come from increased dialysis needed for its affected population.(Lou)
Why? Why such a chronic problem in China? It is thought that due to the aftermath of the Great Famine during 1958-1962 in China helped to contribute to the socioeconomic and cultural determinants contributing to diabetes.(Luo) There was a transition period of transitioning diet and genetics factors transcending causing a generational shift.(Hu) In China’s larger inner cities, while the parents worked the grandparents usually were left to take care and raise the grandchildren. (luo) All the while those grandparents had experienced the Great Famine and therefore the grandparents likely stocked pile, eat dense high calorie foods to ward off starvation. (luo) Coupled with having low activity due to advanced age the kids likely were not able to expend as much energy as neighboring kids. Hence this combination gave rise to increased risks for diabetes not only for the grandparents, but also for the grandchildren and the parents since the parents often ate what the grandparents prepared for meals.(luo)
In essence a retraining and rethinking must take place to break generational habits and thinking.
Detail Short Term Goals of the Intervention
In the short term interventional plans are to utilize artificial intelligence and data to help promote healthier well being, detect and gain control over diseases that are chronic in nature in areas that are most impacted.(Luo) Primary care providers are to be used to promote healthier lifestyles, including diet, regular exercise,weight management, including decreasing tobacco use and controlling alcohol use.(luo) People are known to look to their leaders for guidance, so the Chinese CDC takes leadership and responsibility and has championed local governments (eg, propaganda, women’s federation, educators as well as top county officials) to help with the overall coordination and promotion of well being.(luo) Overall despite its challenges and disparities this method of promoting and education of a healthier lifestyle has been on track to be successful.(jin) In order to control diabetes it is important to learn about disparities, learn about diabetes awareness amongst the population, and proper treatment of diabetes.(luo) It is imperative to have health promotion, testing and monitoring tools in place and teaching as well as allowing people to self manage while having standardized approaches to controlling diabetes.(Luo)
Long-Term Goals of the Intervention
In the long term goals and plans for intervention are to further the use of artificial intelligence (AI) and data to continue to extend the efforts of promoting even healthier well beings, to detect diabetes and gain control and manage diabetes in areas that are most impacted well into the future.(luo) There must also be an integration of integrating academic medical centers and hospitals with the most effective primary care.(luo) There must be a promotion of Chinese goals such as healthcare reform, to include upgrading the primary care workforce all the while reducing inequalities in access to healthcare as in any country around the world.(Luo) There will be an upward of partnership and trust building amongst the community, including patient care providers to provide basic services such as routine blood tests, urinalysis and electrocardiography for the patients. This will help support the primary care healthcare worker shortage which will help fuel the trajectory of diabetes in China. As patients reap the rewards or healthier living they too will inspire more health care workers in the field to help control and reduce diabetes in the Chinese population.(Luo)
Another strategy is to continue the use and promote artificial intelligence as tools. Some examples would be patient self-management tools (eg, activity and dietary tracking devices and improved glucose sensors), automated retinal screening, predictive population risk stratification. Also should be included are artificial intelligent activity trackers and smartphone applications, as these have a trajectory to improve and prevent DM II by encouraging healthier behaviors that prevent diabetes. These devices will promote physical activity and dietary changes during the times when patients would need it most during the day to day routines. (Luo) Also, use of connected sensors or mobile applications that will improve and promote better daily monitoring of patients with DM II.(fag) Also utilize the AI by way of telehealth such as Alibaba’s Dia Doc, that was launched in 2018. (lou) The Dia Doc has the capability to doctors, specialists, higher officials, all while utilizing guidelines to treat patients while helping to promote healthier living, education and decreasing diabetes. ( lou, Peas)
References
- Elflein J. Number of people with diabetes, by country 2019. Statista website. www.statista.com. Published December 10, 2019. Accessed November 4, 2020.
- Thomala LL. Estimated number of adults with diabetes in China 2015-2045. Statista website. www.statista.com. Published Jul 9, 2020. Accessed November 5, 2020.
- Thomala LL. Estimated number of diabetics in China 2019, by age group. Statista website. www.statista.com. Published Jun 10, 2020. Accessed November 5, 2020.
- Skolnik, R. Noncommunicable diseases. In: Mawhiney L, Alakel N, ed. Global Health 101. 3rd ed. Burlington, MA: Jones and Bartlett Learning;2016:365-400.
- Luo Z, Fabre G, Rodwin VG. Meeting the challenge of diabetes in China. Int J Health Policy Manag. 2020; 9(2): 47–52. doi: 10.15171/ijhpm.2019.80
- National Commission of Health and Family Planning. Chinese national statistical yearbook of health and family planning. China, Beijing: Peking Union Medical College Press; 2017.
- International Diabetes Federation. IDF Diabetes Atlas. 8th ed. Published 2017. Accessed November 6, 2020.
- National Commission of Health. Chinese national statistical yearbook of health. China, Beijing: Peking Union Medical College Press; 2018.
- Hu C, Jia W. Diabetes in China: Epidemiology and genetic risk factors and their clinical utility in personalized medication. Diabetes. 2018 ; 67(1):3-11.
- Jin RR, Li JJ, Zhang J, et al. Management programs on diabetes among Chinese adults in the National Demonstration Areas for Comprehensive Prevention and Control of Non-communicable Diseases. 2018; 39(4):407-411.
- Fagherazzi G, Ravaud P. Digital diabetes: Perspectives for diabetes prevention, management and research. Diabetes Metab. 2019; 45(4):322-329.
- Peas Q, Ni D. Ali Health developed the first diabetes AI physician. Science and Technology Innovation Board website. www.news.cnstock.com. Published 2018. Accessed November 7, 2020.
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