Abstract

Comparing diabetes mellitus care in a major city in China to a major city in South East Asia

Author(s): W Lim, YT Fong, YL Chua, BK Tay & SY Goh

Aim: There is a worldwide increasing prevalence of diabetes mellitus. Although everyone has the same aim to achieve good glycaemic control, diabetes mellitus care is largely variable across the world. Diabetes mellitus care imposes a significant economic burden on the national healthcare system. Inpatient care accounts for the bulk of healthcare cost for patients with diabetes mellitus and these patients have an increased risk of recurrent hospitalizations. There is a need to seek continual improvement in our care for diabetes mellitus and there is much to learn from best practices in various countries. Medical exchange programs are useful for identifying similarities and differences between institutions and allow adaptation of good medical practices. Methods: This is a descriptive, cross-sectional study comparing diabetes mellitus care in two tertiary hospitals, one in Shanghai, China and the other in Singapore. Comparisons are based on independent observations and interviews with medical doctors during a medical exchange program in September 2016. Results: There was stark difference in the inpatient diabetes mellitus care. In Shanghai, subcutaneous continuous insulin infusion therapy, continuous glucose monitoring (CGM) and eight-point capillary glucose level checks were routinely used for inpatient glycaemic control. However, in Singapore, subcutaneous continuous insulin infusion therapy and CGM are used mainly in the outpatient setting. Conclusion: Compared to basal-bolus insulin regimens, subcutaneous continuous insulin infusion therapy would best mimic endogenous insulin secretion. However, its use for inpatient glycaemic control still lacks conclusive evidence about benefits and safety, and should be evaluated on a larger scale.