Background:
Diabetes care is beyond descriptions with terms such as challenging, complex, costly and confounded for the patients, the physicians and healthcare systems. Proportions of achieved treatment targets in the world for HbA1c < 7.0% (< 53 mmol/mol), blood pressure < 140/90 mmHg and low-density lipoprotein cholesterol are still lower than desired. In developing countries in Asia, Latin America and Eastern Europe, only 3.5% of people with type 2 diabetes are able to attain all three recommended targets. Simulation models have suggested that significant cost might be incurred in persistent suboptimal disease control. More importantly, the ultimate purpose of diabetes care is also about achieving patient outcomes that are regarded as important at different stages of life. Psycho-education and psychological interventions may improve HbA1c to the extent that is comparable to dietary modification and oral glucose-lowering medications.
However, the best investment for quality and cost-effective diabetes care will be at the primary medical care level because most patients are in the early disease stage and highest returns of effort is more likely through metabolic legacy effect and vascular memory. This can be achieved in three stages: Short-term (within one year), medium-term (within three years) and long-term (three to five years). Quality assurance initiatives and continuous clinical service evaluations will ensure the sustainment of an effective and efficient diabetes care. Improving and achieving effective and efficient diabetes care at the primary care setting will require high-quality clinical and medical research. A high-quality diabetes care research is one that fulfills the epidemiological principles of efficiency, validity and precision in the whole research process. Quality research also consists of researching on relevant topics, unbiased data analysis and complete reporting. Clinical evidence would have no esteem of legalistic evidence if the research was not conducted with credibility and free from conflict of interest. Studies on the link between nutrition and metabolism are also welcome.
In addition. integrating digital health technologies in a patient-centered care framework in diabetes management is increasingly a challenge. Digital health interventions encompassing the e-health initiatives, telehealth programs, telemedicine and mobile health (mHealth) apps may contribute to efforts that address the challenges that limit the achievement of treatment targets and health system goals. More research on the use of digital health in primary diabetes care should include 1) accountability in coverage of the target population, 2) accessibility of and availability of health facilities, and availability of human resources, 3) contact and continuous coverage of the target population for treatment, 4) effective coverage with quality medical and clinical care, and 5) affordability of the digital interventions of apps. Despite technological and virtual reality advancement in clinical care, the old principles of medicine are here to stay that uphold the dignity of patients, mutual trusts between the doctor, patient and society.
Details for Authors:
This Research Topic welcomes Case Report, Clinical Trial, Editorial, General Commentary, Hypothesis and Theory, Methods, Mini Review, Opinion, Original Research, Perspective, Policy and Practice Reviews, Review, Systematic Review and Technology and Code. The relevance of the study topics and the robustness of the methods will be assessed by the editors.
This Research Topic is part two of a two-part series - please also see the collection "Achieving Effective Management and Treatment of Diabetes Mellitus in Future Primary Care"