Fight against diabetes gains ground in Japan

Projects to improve the prevention and treatment of diabetes, and curb the increasing medical costs surrounding the disease, have been garnering attention recently. Many of these projects emphasise improving relationships between family doctors, specialists and patients.

Carna Project, which was started by Carna Health Support, a cooperative organisation involving Kyushu University Hospital and private companies, aims to promote preventive steps against aggravating diabetes. Currently, nine doctors, some of who are not specialists in diabetes, and a total of 20 patients ranging in age from their 20s to their 80s are registered with Carna Project.

The launch of a Carna Project call centre in 2008 has seen improved levels of communication with patients. Managed by nurses and external community health workers, the call center is responsible for contacting patients prior to consultations to ask them to report any changes in health conditions.

Between consultations, the call center mails patients printed data from up to their last five visits, including results of blood tests and weight checks in graph and chart form.

The data, which is sent to patients to encourage them to better manage their blood glucose levels, also includes comments from the doctors who treated them, along with the doctors' photos.

A 61-year-old diabetic housewife who visits the university hospital once a month said of her doctor's comments: "[When I read them,] I sometimes break into a cold sweat. But I'm encouraged by the comments."

The Carna Project call center also periodically mails questionnaires to patients to help them gain a better understanding of diabetes. The call center follows up with a phone call to discuss the questionnaire; any uncertainties the patient has about their health are relayed to the patient's doctor.

Close contact with doctors

Carna Health Support is planning to form before the end of fiscal 2011 a business partnership with the Fukuoka prefectural chapter of the Japan Health Insurance Association, which provides medical cover to small and midsize companies. The venture plans to interview about 300 people who suspect they may have diabetes but do not currently receive treatment, and urge them to seek treatment from their local doctors and to register with the Carna Project call center service.

Naoki Nakajima, an associate professor at Kyushu University, said: "We'll conduct treatment plans tailored to each patient, while establishing strong relationships with their family doctors."

Localised action in Kanto

In Chiba Prefecture, Chiba University Hospital, Juntendo University Urayasu Hospital and Kameda Medical Center are planning to form a joint project before the end of fiscal 2011 that will facilitate the sharing of diabetes patients' data among specialists and family doctors.

The project plans to better analyze data by categorising patients into several groups to decide the best course of action. Key categories include those only doing exercise or diet therapies, those taking oral medication or insulin injections, and those who have diabetic complications.

In Shinagawa Ward, Tokyo, NTT Medical Center Tokyo is acting as secretariat of a panel set up to study a collaboration between medical institutions in the southern part of the ward for treating diabetes. The panel is discussing how to expand usage of common medical information in the local community, and has the participation of local dentists and pharmacists.

Acute diabetes causes serious complications such as kidney failure. However, because there are no subjective symptoms in the early stages of the disease, 40 per cent of people who strongly suspect they have diabetes do not seek medical treatment.

According to a 2007 government survey on public health and nutrition, the combined amount of people suffering from diabetes and people who potentially suffer from diabetes is estimated at 22.1 million. If the disease becomes aggravated in a person and they require artificial dialysis, that person's annual medical costs can be expected to reach 5 million yen (S$78,800).

Preventive measures against the aggravation of diabetes in local communities should be established as soon as possible.