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Health Feature - Diabetes Mellitus













Diabetes Mellitus

Diabetes mellitus is a chronic illness. Obesity (particularly central obesity), aging and urbanization of lifestyle including unhealthy eating habit and lack of exercise are all contributory factors to rising rates of diabetes.

When the pancreas declines and fails to secrete adequate insulin, or the cells in the body develop resistance to the action of insulin, glucose in the blood circulation can no longer enter the cell effectively, resulting in high blood glucose concentration. On a long term basis, high blood glucose can damage nerves, small and large blood vessels, resulting in complications affecting the kidney, heart, brain, eye and feet.


Prevalence of diabetes mellitus

Diabetes has attracted the world's attention due to its growing global prevalence. It is estimated that there are about 177 millions diabetic patients worldwide. By the year 2030, the projected prevalence will be nearly doubled and reach 370 millions.

In Hong Kong, over 90% of people with diabetes have type 2 disease. The prevalence has increased from approximately 4.5% in 1990 to 10% recently. That means one in ten people in Hong Kong suffers from diabetes mellitus.


Diabetes complications

Since the symptoms of diabetes are usually silent before complications supervene, like many other countries, more than half of the people with diabetes in Hong Kong are not aware of their disease state. This often leads to late presentation with complications which are often preventable and treatable.

Diabetes mellitus is not a benign condition due to its associated complications. Prolonged exposure to high blood sugar, high blood pressure, high blood fat levels, made worse by overweight/obesity and smoking will lead to damages to blood vessels and nerves, causing multiple organ damage. Every year, around 3.3 million people die of diabetes related complications. That is, 8700 people each day or ??every minute, one person dies from of diabetes related complications.

Diseases or complications related to diabetes include:

  1. eye - cataract, glaucoma, retinal vessels damage (¡§diabetic retinopathy¡¨)
  2. kidney - proteinuria, kidney damage which may lead to peritoneal dialysis or haemodialysis
  3. heart - coronary heart disease, heart failure, arrhythmia (irregular heart rate)
  4. brain - stroke
  5. feet - nerve damage of the feet (leading to pain, numbness or abnormal sensation); blockage of blood vessels of feet (leading to amputation)
  6. impotence in men - resulting in sexual dysfunction, i.e. failure of penile erection
  7. infection - poor wound healing and proneness to infections, e.g. skin, urinary tract and respiratory infections.
  8. teeth - gum diseases and dental problems
  9. pregnancy - malformation of fetus or abortion

How to reduce the chance to have diabetes complications?

According to the results of a number of large scale studies (DCCT, UKPDS), the better the control of blood sugar levels, the lower the chance to develop diabetes related complications.

Goals Optimal level
HbA1c 7%
Blood pressure 130/80 mmHg
Total cholesterol 4.5 mmol/L
Low-density lipoprotein cholesterol 2.6 mmol/L
High-density lipoprotein cholesterol 1.1 mmol/L
Triglyceride 1.5 mmol/L
Urine albumin-creatinine ratio Men: 2.5 mg/mmol
Women: 3.5 mg/mmol
Exercise At least 150 minutes per week
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Note: different organizations have recommended different target goals. For those who are interested to learn more, please visit the websites as follows:

http://www.idf.org
http://www.diabetes.org/home.jsp
http://www.diabetes-hk.org/b5_home.asp
http://www.wpdd.org/downloads/brochure.pdf
http://www.hkfrdd.org/

Diabetes management

It is important to note that people with diabetes need to be motivated to improve diabetes care through self management and collaboration with the health care team. Modalities of treatment include:

  1. nutritionally balanced diet
  2. exercise
  3. drugs ¡V people with diet often need oral medications and sometime insulin to control blood sugar level
  4. lose weight if overweight, maintain normal body weight and avoid gaining weight if possible and
  5. self monitoring of blood sugar level
  6. stop smoking
  7. regular follow up by doctors and nurses
  8. periodic diabetes complications screening
  9. diabetes education

Diabetes complications screening

  • blood investigations include blood sugar level, HbA1c, blood lipids level, renal and liver function tests, etc.
  • urine investigations include albumin to creatinine ratio
  • blood pressure measurements
  • fundus examination
  • feet examination

Diabetes Mellitus and Endocrine Centre (DMEC) at the Prince of Wales Hospital

  • DMEC (previously known as the Metabolic Investigation Unit, MIU) was established in 1985. Since 1994, the MIU was expanded and relocated to the present site of the DMEC to deliver a wide range of services to patients with diabetes and other endocrine diseases. Our centre has a homely dˆmcor to make all patients feel at ease when they visit our centre.
  • Our centre is mainly led by nurses at the Prince of Wales Hospital. Our clinical staff includes 8 endocrinologists, 2 nurse specialists, 3 registered nurse educators, clerical staff and clinic assistants. Our care, assessment and education services are open to all in-patients and out-patients as well as patients from the paediatric and obstetric departments.
  • One of the main functions of the Centre is to provide a range of services to our diabetic patients. These include therapeutic diabetes education, complications screening, telephone follow-up and counseling services and endocrine investigations,. In addition, we improve patient care through professional training and education by providing various in-job training courses to medical and nursing staff .
  • In 1996, our team was bestowed ¡§the Hospital Authority (HA) Outstanding Award¡¨ and our diabetes care program was awarded as one of the Best HA Hospital Programs.
  • Since 1998, our centre has set up support groups for patients with diabetes and endocrine diseases. To date, we have formed 3 patient support groups with different themes to help diabetic patients and their family members.

Our services include:

  • Nurse clinic ¡V mainly provide diabetes education, titration of insulin or other medications under supervision of our doctors

                                    Diabetes Mellitus Support Groups

    Diabetes Mellitus Support Groups     Diabetes Mellitus Support Groups

  • Diabetes complications screening
  • Special clinics by endocrinologists ¡V mainly provide services for gestational diabetes.
  • Shared Care Programme with community doctors
  • Patient Support Groups
  • Endocrine investigations

Diabetes nurses ¡V services include:

  1. Diabetes education
    • In-patients
    • Out-patients
    • Group education (for elderly, middle-aged, adolescents)
    • Outpatient insulin injection classs followed by nurse telephone calls for dosage titration or individual therapeutic education class.
    • Telephone follow-up: include counseling on interpretation and management of low and hight blood glucose reasings at home, insulin titration, sick days management etc.
  2. Education for medical and nursing staff
    • Include enrolled nurses, student nurses, medical students and overseas visitors (doctors and nurses)
  3. Standize nursing guidelines for diabetes care.
  4. Public education and health promotion in collaboration with other organizations to increase awareness of diabetes and related conditions.
Diabetes Mellitus image 5         Diabetes Mellitus image 6


PWH Diabetic Patients Support Groups

  1. Intensive Insulin Therapy
  2. Obesity Management ¡V in collaboration with Community Rehabilitation Network
  3. Type 2 diabetic patients

Diabetes Mellitus image 7     Diabetes Mellitus image 8    

 Diabetes Mellitus image 9     Diabetes Mellitus image 10


Contact us

Our centre is located at Flat B, 8/F, Block B, Staff Quarters, Prince of Wales Hospital, Shatin, Hong Kong.

Tel: 2632 3149
Fax: 2632 4595