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[Column] Korea should do better in diabetes managementPark Tae-sun, Professor of the Endocrinology Department at Chonbuk National University Hospital
  • By Park Tae-sun
  • Published 2019.11.08 15:57
  • Updated 2019.11.08 20:28
  • comments 0

Each year, November 14 is marked as World Diabetes Day, designated by the United Nations. The day is even more significant because it marks the birthday of Frederick Banting, whose work led to the use of insulin.

Most people are well aware that the number of diabetes patients is surging. However, people do not seem to know well that the number of patients with diabetes complications is also increasing rapidly.

Park Tae-sun, Professor of the Endocrinology Department at Chonbuk National University Hospital

According to Korean Diabetes Association, the prevalence of diabetes is 14.4 percent among people aged 30 or more, and 29.8 percent among those aged 65 or more. However, the share of patients reaching the diabetes control target is only 25.1 percent, a pitiable figure, based on the criteria of glycated hemoglobin less than 6.5 percent.

A 2018 report on chronic diseases showed that the nation spent 3.12 trillion won ($2.69 billion) on hypertension treatment, and the hypertension control target reaching rate went up to 71.1 percent. Although the medical cost for diabetes hit 2.22 trillion won, the percentage of diabetes patients who achieved the target control rate stood only at 23.1 percent.

At a tertiary hospital, one in six inpatients is those who accompany diabetes. These people stay at hospitals longer, spend more money on hospitalization, and are more likely to be admitted again.

Korea spent a significant amount of money to treat diabetes and ran a pilot program for the prevention and management of the disease. Then, why can’t the nation make progress in managing diabetes better?

The next statement shows well the disappointing results of our efforts: “It is not a blood sugar controlling drug that is most important in diabetes management.” That is, diabetic patients should admit that taking medications alone cannot yield a good outcome.

Physicians must warn patients that depending on drugs while keeping the old lifestyle could raise blood sugar levels even higher. In some cases, patients use unverified alternative therapies and think they have done enough to treat the disease.

Reasons may vary why a person develops diabetes, but diabetes management should be the same – the first is diet, the second is exercise, and the third is medication.

It takes only a couple of seconds to say, “Change your lifestyle,” to diabetic patients. The problem is doctors do not provide enough education and consultation to make sure patients do as told, find an obstacle, and help them overcome it.

When can we admit that the reason Korea is failing in diabetes control and having a high rate of hospitalization for diabetes is doctors have failed to educate patients, prevent the disease, and conduct blood sugar monitoring when seeing patients?

In 2017, the OECD said Korea ranked second in hospitalization caused by diabetes in adults, next to Mexico. Out of 100,000 people, 281 were hospitalized due to diabetes in Korea.

In the United Kingdom, where only 73 out of 100,000 get hospitalized because of diabetes, the authorities built a system to monitor hospitalized diabetic patients 10 years ago, and have announced data on diabetes control every year.

In contrast, more than 200,000 people get admitted to a hospital due to diabetes or diabetic complications per year in Korea, but the nation fails to monitor them. Instead, Korea is wasting money and time looking for outpatients with diabetes.

In Taiwan, where an insurance system and the medical environment are most similar to those in Korea, 15 per 1,000 people are hospitalized patients with avoidable diabetes, versus 32 per 1,000 in Korea. This example shows how a government policy for diabetes could change the outcome of diabetes prevention efforts.

We need a radical change in the diabetes policy direction. So far, our policy has focused only on where to manage diabetic patients, not how to manage them, regarding the disease as a minor illness. Changing the policy will be the key to keep Korea from being called “an underdeveloped nation in diabetes management,” and gladly celebrate the World Diabetes Day.

pts@jbnu.ac.kr

<© Korea Biomedical Review, All rights reserved.>

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