KDA pushes for severity-based diabetes care to reform delivery system

Diabetes is not just a chronic disease. As the complexity of treatment and medical needs vary depending on the patient's condition, establishing severity-based treatment standards and reorganizing the medical delivery system based on them has become an urgent national task.

The Korean Diabetes Association (KDA) has begun to establish a severity-based diabetes care system.

At a policy forum in Gyeongju, North Gyeongsang Province, last month, experts agreed that the current classification system, which categorizes diabetes as type 1 or type 2, is insufficient to provide customized care given the diversity and complexity of the disease.

The consensus is that patients should be treated at the right institution based on their severity to improve the efficiency of the healthcare system, and government policies should be aligned to support this.

Establishing the concept of ‘severe diabetes’ is a starting point for reorganizing the healthcare delivery system

Diabetes is internationally categorized into type 1 and type 2. Still, in clinical practice, patients with type 2 diabetes are treated very differently depending on the degree to which they need insulin treatment and whether they have complications. However, these differences are not currently reflected in health insurance or healthcare policies.

For example, there are patients with type 2 diabetes who become insulin-dependent after pancreatectomy or require multiple insulin treatments. Still, they are excluded from policy support because they are not type 1.

Diabetes is a disease with a broad spectrum, and the current structure, which does not differentiate medical expenses according to the patient's condition and treatment complexity, is problematic,” said Dr. Han Jung-hoon, director of primary care at the KDA. “If a severity classification is established, it will be possible to treat mild cases at primary care centers and severe cases at higher-level institutions and refer them back.”

Even severe patients can be neglected due to tertiary general hospital restructuring

Last year, the government's project to restructure tertiary general hospitals also sparked the diabetes severity debate.

Fortunately, the government, which was promoting a severely ill patient-centered medical care system, announced plans to review the severity classification system and upgrade type 1 diabetes to severe (specialty care disease group) “regardless of complications” and “regardless of type 1 or 2 if accompanied by acute complications such as ketoacidosis.”

However, many diabetes patients are still excluded from tertiary general hospital care.

Patients with type 2 diabetes who cannot control their blood sugar for an extended period despite active treatment or those who require multiple insulin treatments due to permanent dysfunction or destruction of beta cells require not only the care of an endocrinologist but also the active intervention of a diabetes management team (nursing, nutrition, and others), but hospitals still shun them.

“For patients with severe diabetes who require a multidisciplinary approach, it takes several times as long as general medical treatment and educational counseling is essential, but the current fee does not reflect this,” said Dr. Kim Soo-kyung, insurance director of the KDA (professor of endocrinology at CHA University Bundang Medical Center). “If the fee for medical treatment and educational counseling is not improved, tertiary hospitals will be reluctant to treat severe patients.”

Establishing a sustainable delivery system, referral system, and division of roles

According to healthcare big data, about half of patients with type 1 diabetes are treated at the hospital level. This demonstrates the reality that higher-rated hospitals don't just see sicker patients. People with diabetes often visit tertiary hospitals because they don't have the proper care in their neighborhood.

Experts agree that to solve this problem, it is essential to clarify the roles of each medical institution and establish an institutionalized referral system. In particular, it was emphasized that collaboration between endocrinology and other medical departments should be activated.

"In Korea, where most doctors are qualified as specialists, roles, and fees should go hand in hand," Kim, the insurance director, said, explaining that the original purpose of the delivery system is to ensure that the appropriate institution manages certain diseases according to the level of care required.

Real change is needed to overcome the limitations of the current ‘chronic disease management system’

The government aimed to build a management system centered on primary healthcare institutions through the Chronic Disease Management System. Still, it has been limited by low participation rates and lack of effectiveness. Experts suggest that a “severity-based comprehensive system” that reflects the patient's condition and treatment course is needed rather than a fragmented system.

Tertiary general hospitals focus on treating severe patients, while community hospitals focus on comprehensive management, including preventing complications and diabetes in pre-diabetic patients. However, the system should complement the collaboration between endocrinologists and other medical specialties and between tertiary general hospitals and smaller institutions. They also emphasize that the role of endocrinologists should be increased within such a system.

Currently, the KDA organizes a task force on severe diabetes and is preparing to establish severity criteria this year and link it to government policies. It will go beyond clinical guidelines and be a foundation for effective and sustainable diabetes management.