Analysis of early clinical indicator improvements among patients with pre-diabetes, type 2 diabetes mellitus, and hypertension in the Chronic Disease Co-Care Pilot Scheme of the Hong Kong Special Administrative Region, China
10.3760/cma.j.cn114798-20250619-00784
- VernacularTitle:香港特别行政区《慢性疾病共同治理先导计划》中糖尿病前期、2型糖尿病及高血压患者早期临床指标改善情况分析
- Author:
Mak Ivy LYNN
1
;
Lee Ming HIN
;
Jiayue ZHANG
;
Linda CHAN
;
Martin ROLAND
;
David BISHAI
;
Michael KIDD
Author Information
1. 香港大学李嘉诚医学院家庭医学及基层医疗学系，香港特别行政区 999077
- Collective Name:Wong Zoey Cho Ting;Xu Vivian Ya Hui;Kan Alissa Nok Man;Liu Kiki Sze Nga;Yu Esther Yee Tak;Ha Tony King Hang;Wong William Chi Wai;Tse Emily Tsui Yee;NG Amy Pui Pui;Choi Edmond Pui Hang;Lam Cindy Lo Kuen;Wan Eric Yuk Fai
- Publication Type:Journal Article
- Keywords:
Diabetes mellitus;
Hypertension;
General practitioner;
Chronic disease management;
Chronic disease screening
- From:
Chinese Journal of General Practitioners
2025;24(12):1482-1495
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To analyze early improvements in clinical indicators among patients with pre-diabetes (pre-DM), type 2 diabetes mellitus (T2DM), and hypertension (HT) participating in the Chronic Disease Co-Care (CDCC) Pilot Scheme in the Hong Kong Special Administrative Region of the People′s Republic of China (HKSAR). Methods:This longitudinal study enrolled participants with pre-DM, T2DM, and HT who participated in the CDCC Pilot Scheme between November 2023 and May 2024. Baseline clinical data was collected. All participants were managed followed standardized protocols: family doctors issued prescriptions in accordance with the Hong Kong Reference Framework by the Health Bureau of the Government of the HKSAR, District Health Centre (DHC) and DHC Express provided health education, and personalized counseling by allied health professionals (nurses, optometrists, and dietitians). During the screening phase, screening costs, including consultations and related laboratory investigations, were fully covered by the Government of the HKSAR, while partial subsidies were available during the treatment phase. Participants were followed for 6 months. Primary outcomes were glycated hemoglobin A1c (HbA1c) for pre-DM and T2DM, and blood pressure for HT. Secondary outcomes included body mass index (BMI), triglycerides (TG), total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), and the Framingham model-based 10-year cardiovascular risk score. Changes in clinical indicators from baseline to 6 months were analyzed using a linear mixed model, with subgroup analyses by age, sex, and baseline Framingham 10-year cardiovascular disease risk score. Results:A total of 3 910 participants were included in the study, comprising 903 (23.1%) with pre-DM, 478 (12.2%) with T2DM, and 2 529 (64.7%) with HT. Pre-DM participants had an age of (61.4±7.0) years with 641 (71.0%) females; T2DM participants had an age of (60.4±7.4) years with 247 (51.7%) females; HT participants had an age of (60.8±7.9) years with 1 237 (48.9%) females. At 6 months, HbA1c levels declined in the pre-DM and T2DM groups by -0.09% (95% CI:-0.10%--0.07%) and -1.06% (95% CI:-1.21%--0.91%), respectively. In the HT group, systolic blood pressure decreased by 15.3 mmHg (1 mmHg=0.133 kPa) (95% CI:-16.0--14.6 mmHg) and diastolic blood pressure by 8.6 mmHg (95% CI:-9.0--8.1 mmHg). BMI decreased in the three groups, with the largest reduction in the T2DM group (-1.04 kg/m 2, 95% CI:-1.22--0.86 kg/m 2). TC, TG, and LDL-C levels decreased in the three groups (all P<0.05). Subgroup analysis revealed that among HT participants, individuals with a baseline Framingham 10-year cardiovascular disease risk of ≥20% experienced greater reductions in blood pressure compared to those with a risk <20% ( P<0.05). Additionally, male participants demonstrated significantly lower diastolic blood pressure than female participants ( P<0.05). Among participants with T2DM, males exhibited greater reductions in HbA1c levels than females, and participants aged 45-64 years showed significantly lower HbA1c levels compared to those aged 65 years and older (both P<0.05). Conclusions:In the early phase of the CDCC Pilot Scheme, glycemic, blood pressure, lipid, and BMI indicators improved among patients with pre-DM, T2DM, and HT. These effects were particularly pronounced in males and in individuals younger than 65 years of age.
