Evaluation of diabetes prevention and control activities

The diabetes prevention and control activities currently carried out for the public in my country have effectively reduced the disease cognitive bias of the target population. The screening coverage of high-risk groups has increased by 27%-42% compared with 5 years ago. However, the effectiveness of activities carried out by different scenarios and different entities can vary by more than 3 times. Universal evaluation standards have not yet been formed. "Emphasis on science popularization but neglect of follow-up" and "emphasis on cities but not counties" are the most prominent common problems at this stage.

Last year, I stayed with a disease control team in a county community in western Zhejiang for three months. I just happened to catch up with the local annual diabetes prevention and control special project. There were two days of free clinics and popular science lectures. More than 200 people were crowded on site. They measured blood sugar, distributed handbooks, and signed health commitments. The process was very smooth. The on-site questionnaires and knowledge points were spot-checked with an accuracy rate of 85%. It was an excellent project according to traditional assessment standards. However, after three months of follow-up, we found that less than 30 people actually adjusted their diet and tested their blood sugar regularly as required by the manual. The rest either sold the manual as scrap or thought, "I don't need to worry about it if I don't feel sick now." The previous excitement seemed to have left the impression of measuring blood sugar.

What’s interesting is that the evaluation of prevention and control activities in public health circles is now divided into two groups, and no one can convince the other. One is the "process-oriented" evaluation used by most grassroots disease control companies. It depends on how many activities you hold in a year, how many people you cover, how many promotional materials you send out, and the accuracy of on-site questionnaires. This set of standards is easy to implement and the assessment cost is low. After all, grassroots manpower is not enough. If every activity is followed up for half a year, it will be too busy. The other school is the "outcome-oriented" evaluation commonly used in universities and scientific research projects, which requires tracking changes in glycated hemoglobin, lifestyle adjustment rates, conversion rates of high-risk groups, and even long-term complication rates for at least 6 months. This set of standards is accurate enough, but the labor cost is 5 to 8 times that of process evaluation, and ordinary districts and counties simply cannot afford it.

Don't tell me, the gap between these two sets of standards can be ridiculously large when it comes to a traffic-oriented online activity. Last year, an Internet health platform hosted a diabetes science live broadcast, invited a well-known endocrinologist, and sent out 100,000 red envelopes to attract traffic. In the end, the number of views exceeded 120,000, and the number of barrage interactions was hundreds of thousands. It was a phenomenal event based on process indicators. However, a third-party agency later conducted a survey and found that less than 5% of the audience could accurately state the core knowledge point of "fasting blood sugar ≥7.0mmol/L requires medical treatment." Most people returned the red envelope after receiving the red envelope, and did not even remember what the doctor said.

Many people think that diabetes prevention and control only provides services to the elderly. In fact, the biggest gap now lies in young people. We did a free screening in an Internet industrial park in Hangzhou the year before last. Among the respondents aged 25 to 35, 18% had high fasting blood sugar. More than 80% of them did not know that they were in a high-risk group and had never participated in any diabetes-related science popularization activities. They would neither go to the community to listen to lectures nor watch short health science popularization videos for middle-aged and elderly people. Most prevention and control activities on the market now simply cannot reach this group of people.

I have been doing diabetes prevention and control activities for almost 6 years. To be honest, the most effective thing is not the large-scale lectures with great vigor. It is the "Sugar Friendly Kitchen" held by about ten people in the community. One afternoon a week, everyone cooks low-GI home-cooked dishes and talks about how to control sugar and how to control them while cooking. There are no too technical terms for monitoring blood sugar. It is all about sharing experiences among patients. Last year, we tracked the three pilot communities. People who participated in the "Sugar Friendly Kitchen" for more than half a year saw an average glycated hemoglobin drop of 0.8%, which is better than taking many auxiliary blood sugar-lowering products. Of course, some people say that this model is too niche, covers a small number of people, has high per capita costs, and is not suitable for large-scale promotion. This is correct. After all, underdeveloped counties and districts cannot even get the manpower for basic screening, so it is a luxury to talk about refined activities.

Nowadays, many people always talk about the need to establish unified evaluation standards for prevention and control activities, but I think there is no need to impose it. After all, disease control resources and population disease structures in different regions are very different. In remote counties, if basic screening is done first and the diabetics and high-risk groups who are unaware of their disease are screened out, the goal has been achieved. ； If first- and second-tier cities have sufficient resources, they can conduct more refined follow-up visits and community activities, and just keep an eye on the long-term outcome. Diabetes prevention and control is inherently a slow effort. There is no need to immobilize everyone with a set of standards. Activities that can truly solve local problems are good activities.