China-JD Program: A Multi-centre Demonstration Project to Evaluate the Effectiveness and Acceptability of the Joint Asia Diabetes Evaluation (JADE) and DIAbetes MONitoring Database (DIAMOND) Programs in Asian Type 2 Diabetic Patients

Diabetes is now a pandemic disease affecting 5-10% of global population. More than 60% of affected people will come from Asia with the number expected to increase from 85 million in 2005 to 132 million in 2010 in Asia alone. On average, diabetes reduces life expectancy by 10-12 years. While stroke, heart disease and kidney failure account for more than 50% of global deaths, 30-50% of patients with these conditions have diabetes as a major contributing factor. In contrast to the West, the main increase in diabetes prevalence in Asia will occur in the young to middle aged population. On average, 17 million people die from stroke and heart disease on a yearly basis. Of these, 11 million occur in Asia, affecting many young parents and economically active people.

Despite their devastating nature, many diabetic complications can be prevented and managed effectively to preserve health, reduce disabilities and improve quality of life. However, there are multiple barriers in the implementation of quality diabetes care. These include insufficient knowledge base of health care professionals, fragmented nature of health care systems, lack of reimbursement for outpatient procedures including therapeutic patient education, poor compliance to treatment in part due to the silent nature of diabetes and associated complications as well as the complex nature of care protocols. The latter include periodic evaluation of clinical and laboratory parameters and the need for people with diabetes to adhere to long term medications and self care.

While optimal management of risk factors and treatment to targets can substantially reduce the risk of diabetes associated complications, the challenge lies in the effective translation of this evidence to clinical practice. Since mid 1990s, inspired by the benefits of structured care, made possible during the conduct of clinical trials, the CUHK Diabetes Care & Research Group has developed prototypes of structured care protocols including an annual comprehensive assessment using a doctor-nurse-physician assistant team. Consistent with international data, these prototypes substantially improve rates of treatment compliance and attainment of multiple treatment targets resulting in reduced death and cardio-renal complication rates.

The Joint Asia Diabetes Evaluation (JADE) Program is a web-based disease management program conceptualized, developed and tested by the Asia Diabetes Foundation (ADF) since 2007, supported by a MSD educational grant. The objectives of the JADE Program include:

1. to promote collective learning and sharing of best practices in diabetes based on regionally relevant evidence
2. to increase regional awareness about the magnitude of diabetes and its preventable nature through education, ongoing data collection and implementation of evidence-based guidelines
3. to establish a regional diabetes registry
4. to collect the evidence base to inform relevant stakeholders including public, people with diabetes, health care professionals, policy makers and payors to change policies and practices in order to make quality diabetes care accessible, sustainable and affordable.