BACKGROUND AND RATIONALE:
In Hong Kong, 1 in 10 adults have diabetes. In hospital-based clinic setting, 1 in 5
adults with diabetes were diagnosed before the age of 40, i.e. young-onset diabetes
(YOD). The latter is the major driver of recurrent hospitalizations, critical illnesses
and premature death. Compared to fasting plasma glucose (FPG) or HbA1c, 2-hour PG is
needed to detect impaired glucose tolerance (IGT) and diabetes (DM). Besides, 2-h PG is
more robust than FPG or HbA1c in predicting major events and death. The selection of
participants with IGT for intervention is based on the positive effects of lifestyle
modification and metformin only in individuals with IGT and not in individuals with
isolated IFG in randomized clinical trials. Besides, there is strong familial tendency of
YOD and based on our published and in-house 20-year prospective data in a workforce, 80%
of people who developed DM came from 20-30% of individuals with high genetic risk
unmasked by modifiable risk factors such as obesity and smoking.
In this implementation project, investigators shall use a 2-stepped approach to identify
adults aged between 18 and 44 (inclusive) with genetic predisposition to undergo yearly
OGTT to diagnose IGT and diabetes early for intervention. Investigators shall apply the
proprietary DForesee (DF) risk algorithm including clinical and biogenetic risk factors
to select the top 25% of participants at the highest risk for IGT or diabetes in next 10
years to undergo yearly OGTT accompanied by a risk-based intervention program.
STUDY DESIGN AND METHODS:
By using quasi-experimental design based on an evidence-based multi-component strategy,
investigators aim to detect and delay the onset of diabetes in adults aged less than 45
years. Investigators aim to identify 9,000 adults aged between 18 and 44 years
(inclusive) in community- and clinic settings during a 2-year period, followed by 2 years
of risk-stratified intervention. Investigators shall use clinical and biogenetic
assessment including DNA testing, capillary blood test and administration of
questionnaires to classify participants to high risk and low risk progressors. All
participants will receive risk-based intervention. Low risk progressors will receive a
personalized report indicating their genetic and modifiable risk explained by nurses and
with repeated clinical and biogenetic assessment at year 2. The high risk progressors
will additionally undergo annual oral glucose tolerance test to detect diabetes and
impaired glucose tolerance (IGT) and will receive a personalized report explained by
doctors. All participants will be offered regular access to webinars for education and
empowerment for 2 years. The high risk group will additionally receive a 2-year
risk-stratified intervention with different combinations of care interventions. These
include clinical and laboratory assessment for comprehensive evaluation of
cardiovascular-kidney-metabolic risks, medical and nurse consultations, empowerment by
health messages, webinars, face-to-face workshops, subsidies for medications and
self-monitoring tools (e.g. CGM devices for IGT and DM groups only, weighing scale for
all high risk progressors) to motivate behavioural change.
INCLUSION and EXCLUSION CRITERIA Age 18-44 (inclusive) years without known diabetes, at
least one risk factor for diabetes and with usual place of residence in Hong Kong, The
risk factors for diabetes include central or general obesity, family history of diabetes,
smoking history, history of hypertension, high blood glucose level, abnormal lipid level/
vascular disease, or fatty liver, history of gestational diabetes polycystic ovary
syndrome or delivery of baby≥ 4kg (for women only), less than 150mins of physical
activity every week.
People with known diabetes or conditions considered to be unsuitable by the project team
including illiteracy will be excluded.
OUTCOME MEASURES The outcomes will be analysed within the REAIM framework (reach,
effectiveness, adoption, implementation and maintenance), progresssion to prediabetes or
diabetes, patient reported outcomes and cost effectiveness.