Diabetes in Hong Kong: What You Should Know

Diabetes is one of the most common chronic diseases, and millions of people are living with it worldwide. It is also a growing concern in Hong Kong. Indeed it puts a significant burden on the public healthcare system and individual health costs, due to the complications it can cause. Here is your complete guide to diabetes in Hong Kong, with all the details and resources you need.

What is Diabetes (Diabetes Mellitus)?

Blood sugar, or glucose is a substance that the human body needs for energy and the brain for fuel. Insulin, secreted by the pancreas, is a hormone that maintains optimal glucose level by facilitating the use and storage of glucose in the body. Diabetes Mellitus or Diabetes, is a group of malfunctions and diseases, which manifest as raised glucose levels. 

There are 2 types of Diabetes:

  • Type 1: it usually starts in childhood and is genetically inherited. Children are at a greater risk if their family members have it. Type 1 diabetes is due to insufficient insulin production, so patients have to inject insulin every day to ensure their body can control the blood glucose level. 
  • Type 2: it is by far the most common type of diabetes in adults (90% globally) and is largely caused by unhealthy lifestyles. Because body cells no longer respond or are less responsive to insulin, the level of blood glucose rises. 

Poorly managed diabetes can lead to shock or death in acute attacks, but normally it brings diverse health issues like retinopathy or nephropathy. Pre-diabetes and gestational diabetes also occur, but these are two reversible forms of diabetes which might or might not go away by themselves with time.

Key figures 

In 2017, about 425 million people, meaning 8.8% of the adult population, suffered from diabetes in the world. Diabetes affects men and women equally, and increases the risk of early death by 2 times. Current trends suggest that diabetes prevalence will continue to rise. 

Diabetes statistics in Hong Kong

Diabetes is a major cause of morbidity and mortality in Hong Kong. It is the 10th most common cause of death in Hong Kong, killing around 400 – 500 people each year. 

A recent study shows that diabetic patients in Hong Kong can be as young as 3 year olds. Sadly, one in ten Hong Kong people suffers from diabetes, of which one fifth is below 40 years of age. It is estimated that the total number of diabetic adults in Hong Kong will increase from 700,000 currently to nearly a million by 2030.

In China, the number of people diagnosed with diabetes is now the highest in the world as the disease affects approximately over 100 million people, especially elders. The prevalence of diabetes nearly doubled in the past few decades. Today, one in three diabetic adults in the world lives in China. 

Signs and symptoms 

Diabetes is very often diagnosed because of the signs and symptoms that a patient experiences. These can include:

  • Increased thirst
  • Frequent urination
  • Increased hunger or appetite
  • Rapid and unexplained weight loss
  • Sweet or fruity-smelling urine due to the presence of ketones
  • Fatigue
  • Slow-healing sores
  • Frequent gum, skin and vaginal infections
  • Blurred vision

Common complications 

Diabetes mellitus affects almost the entire body mainly driven by uncontrolled high blood glucose level. Common complications of Type 1 and Type 2 diabetes are:

  1. Diabetic Neuropathy: It is the most common complication in which nerves are damaged. Symptoms are numbness and pain in hands and feet. Consequences include sensory loss, damage to limbs with possibility of amputation, impotence in men and foot ulcers. 
  2. Diabetic Nephropathy: Small blood vessels in the kidneys are damaged. Because the kidneys are responsible for filtering body wastes so they can be removed in urine, this function is impaired and potentially lead to death. There are no early warning signs but tiredness and confusion can happen gradually. 
  3. Diabetic retinopathy: Small blood vessels at the back layer of the eye are damaged, leading to blurry vision and even blindness. 
  4. Diabetes Ketoacidosis: It usually happens in Type 1 diabetes. Large amounts of ketones (acids in the blood) build up as a result of fat breaking down to provide energy because glucose cannot be utilized without enough insulin. Symptoms are nausea, vomiting and sweet-smelling breath. 
  5. Coronary heart disease and stroke

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Causes of Diabetes

Both Type 1 and Type 2 can appear at any age, but Type 1 is more common among children and youngsters, while Type 2 mostly starts in middle-aged and older adults. 

For Type 1, there is no known cause to this autoimmune disease. The body’s immune system mistakenly attacks the pancreas so no insulin can be produced. Genetic factors and family history may also play a role. 

For Type 2, unhealthy lifestyle such as physical inactivity, high fat and sugar diet, and obesity are the main factors – which makes it preventable. This said, risks of developing Type 2 diabetes are higher if there is a family history. 

Prevention 

Making conscious efforts can delay the onset and control the disease, especially in Type 2 Diabetes Mellitus.

  • Eat healthy foods that have lower fat content and higher fibre content. Green leafy vegetables, fruits and whole grains are an excellent choice. Also, high sugar foods must be avoided.
  • Keep your weight under control, as obesity and Type 2 diabetes has a very close positive correlation.
  • Regular exercise, even for 20-30 minutes every day, 5 times a week, is a great preventive measure.
  • Medication is some cases, like if you are pre-diabetic or borderline diabetic, it can help to keep Type 2 Diabetes Mellitus at bay.

Screening of Diabetes

Screening of diabetes is essential in Hong Kong, because the rate of incidence is very high. Screening helps for early detection, and sometimes helps stop the progression to diabetes mellitus (from pre-diabetes). The most common mechanisms are collecting and testing a urine sample for ketones, and blood tests that are done both on an empty and full stomach. 

You can find here some guidelines about screening in Hong Kong for Diabetes Mellitus. If risk factors are present, screening must be repeated every 12 months, and if not, every three years after 45 years of age. Risk-based screening is prevalent in Hong Kong.

FPG or fasting plasma glucose is the main test involved in such screening programmes.

Where to get Diabetes screening in Hong Kong?

In Hong Kong, the prevalence of diabetes among adults is about 10%. Hospital Authority manages about 40% of the patients with diabetes (in one of its public sector facilities), who have one or more complications. You can get screened for diabetes mellitus in most of the private hospitals and clinics in Hong Kong. Non-governmental organizations such as Diabetes Hong Kong also provides screening for diabetes complications.

In 1995, The Chinese University of Hong Kong (CUHK) and Prince of Wales Hospital (PWH) jointly pioneered a research-driven quality improvement programme to understand the causes and consequences of diabetes and improve the quality of ambulatory diabetes care. This involved a diabetes nurse-coordinated comprehensive risk assessment programme, in which patient data on risk factors and complications were collected prospectively to establish the Hong Kong Diabetes Registry (HKDR).

The Complete Guide to Body Checks in Hong Kong | at Every Age

How to manage it?

Diabetes cannot be treated per se; it needs to be managed. Often, one or more of the following options for the management of diabetes are clubbed together for better results.

Type 1 Diabetes Management:

The goal is to keep the blood sugar levels as close to normal as possible to prevent unwanted complications. Multiple insulin injections remain the most effective and most common line of treatment.

Furthermore, the management tricks mentioned below for Type 2 Diabetes are also helpful in Type 1 diabetes.

Type 2 Diabetes Management:

  1. Weight loss: Active weight loss mechanisms like exercise, diet control, etc.
  2. Regular Exercise: Even if you are not obese, diabetes requires regular exercise to keep the muscles fit and strong. Muscular dystrophy is a common side effect of diabetes.
  3. Medication: The oldest one and still commonly prescribed is metformin, that works by lowering glucose production by the liver, and by improving the body’s sensitivity to insulin at the same time.

There are newer classes of drugs such as:  

  • Thiazolidinediones:  like metformin, make the body’s tissues more sensitive to insulin. 
  • DPP4-inhibitors: they inhibit glucagon release, which in turn increases insulin secretion, decreases gastric emptying, and decreases blood glucose levels. 
  • GLP-1 receptor agonists: they are injectable medications that slow digestion and help lower blood sugar levels. Their use is often associated with weight loss. 
  • SGLT2 inhibitors: these drugs prevent the kidneys from reabsorbing sugar into the blood. Instead, the sugar is excreted in the urine. 

Other older classes of drugs include sulfonylureas meglitinides. 

  1. Insulin Therapy: You may need insulin injection if your diabetes does not improve even with strict lifestyle management and oral medications. For Type 2 diabetes, mostly one single long-acting shot is given in the night.
  2. Blood Sugar monitoring: This is an important step in Type 2 diabetes management, as this can help the doctor figure out the progression and stage of your disease from time to time, and also ease out drug charting.

Gestational Diabetes Management:

In case you are diagnosed with diabetes during pregnancy, you will have to follow a very strict monitoring schedule, especially in the last three months of the pregnancy. Usually gestational diabetes goes away by itself after the delivery, however in the meantime, injections are given usually prior to meals, and sweets in any form are to be avoided so as to maintain the right blood sugar levels. The child is also tested multiple times, for 36 to 48 hours after birth, to check for signs of diabetes and there is a risk of the infant going in shock immediately after the birth, so an Intravenous line is pre-inserted as a precaution in case of an emergency. Check the guidelines for gestational diabetes in Hong Kong here.

Self – Monitoring Blood Glucose:

Self – monitoring blood glucose (SMBG) with a portable glucose meter is an important part of management for diabetic patients to prevent hypoglycemia (blood glucose level is too low). If you are on multiple insulin injections, you are advised to test your blood sugar level before meals, before and after exercise and at bedtime. Click here for more details on the procedures.  

Other important issues 

Diabetic foot care 

You should bear in mind that foot examination is critical in avoiding possible amputation in the future as an elevated sugar blood level increases risk of neuropathy, infection and peripheral arterial diseases that worsens ulcers. To keep your feet healthy, you should 

  • Check your feet regularly
  • Wash feet every day with warm water
  • Apply moisturizing lotions to feet to avoid cracks
  • Never walk barefoot
  • Maintain good control of your diabetes

Driving

Low glucose level, retinopathy and neuropathy in diabetes are what makes driving dangerous for diabetic patients. According to the Hong Kong Transport Department, you are eligible for applying for a driving license if your diabetes is well-controlled but you should notify the Department. Consult your doctor if you have any worries. 

Travelling

Travelling with diabetes can be quite confusing sometimes as you are in completely different time zones, so your medication routine will probably be messed up. It is essential to inform your pharmacist or doctor so they can make the best changes for you. 

What is the cost of Diabetes treatment in Hong Kong?

Cost of Diabetes treatment in Hong Kong’s Public Sector:

For eligible persons with a HKID card, the cost for a specialist outpatient clinic is $135 for first attendance, $80 per next attendance, $15 per drug item. 

For non-eligible persons without a HKID card, the cost for a specialist outpatient service is $1,190 per day.

Beware of waiting times which can be very long in the public sector.

For details, call the Hospital Authority at 2300 6555.

Cost of Diabetes treatment in Hong Kong’s Private Sector: 

Cost of diabetes treatment in the private sector would be determined according to the condition of the patient. Different types and stages of the disease require different treatment procedures therefore it is best to consult a doctor and discuss the options that best suit your situation. Generally, consultations cost around $1000 to $3000 excluding medication fees. 

* All amounts are in HKD and were last updated in July 2019. No responsibility is accepted for any inaccuracies, errors, or omissions. It is always best to call ahead to make sure the information is still up-to-date.

Does insurance usually diabetes treatment in Hong Kong?

According to AD MediLink, diabetes treatment is usually reimbursed by insurance providers under inpatient and outpatient benefits. Generally, high-end medical plans will reimburse in full without any sub-limit whereas local plans will have sub-limits. Also note that high-end plans may cap reimbursements for the routine management of chronic conditions such as diabetes. If you have any health insurance questions, contact an expert at [email protected] 

Useful resources about Diabetes in Hong Kong:

This article was reviewed by Dr. Ernest Li 李恒輝醫生 on July 16, 2019. Dr. Ernest Li is a Hong Kong based Chinese Canadian Gastroenterologist and Hepatologist. After graduating in Physics at McGill University, Dr. Li studied medicine at the Chinese University of Hong Kong. He then received 12 years of training at government hospitals, and achieved specialist qualifications in gastroenterology, hepatology and internal medicine. Currently, he is a private practitioner with an office in Central, and also a part-time associate consultant for Hospital Authority.