The First Diabetes Eye Disease Fusion Ward in Shanghai Founded in Shanghai General Hospital

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“I came to the hospital for my eye disease. It was out of my expectation that an endocrinologist could came to check my illness”. At the ophthalmology ward of Shanghai General Hospital, Ms. Zhang, 47 years old, was very surprised. She is a diabetic who lost her vision due to bilateral diabetes retinopathy (DR).

There are many patients like Ms. Zhang. In China, the number of patients with diabetes is huge, and various complications related to it seriously threaten the health of patients. DR is one of them. This serious and irreversible blindness caused by diabetes is also the main cause of blindness in the working population. Research data shows that the probability of DR of diabetes patients with a course of disease more than 15 years is nearly 85%; When the disease course exceeds 20 years, the incidence rate reaches almost 100%.

For patients with complicated diabetes eye disease accompanied by poor blood glucose control and in urgent need of surgery, the diabetes eye disease fusion ward in the city has been officially put into use in Shanghai General Hospital. The integration ward focuses on co management and co treatment by ophthalmology and endocrinology, to explore a new one-stop diagnosis and treatment model for complicated and difficult diabetes patients with eye diseases.

"One bed for all departments" to improve diagnosis and treatment efficiency

"The patient's condition in both eyes is very poor, and if they want to preserve their vision, they must undergo vitrectomy surgery." Liu Kun, Deputy Director of the Ophthalmology Clinical Medical Center and Director of the Fundus and Retina Department at the Shanghai General Hospital mentioned Ms. Zhang’s treatment.

Surgery is imminent, but her fasting blood sugar before admission indicated that her blood sugar reached 17.8 millimoles per liter, nearly three times the normal value, which does not meet the surgical conditions. First go to the endocrinology department for diabetes control, and then go to the ophthalmology department for surgery? Will prolonged diagnosis and treatment time worsen vision loss?  Dr. Liu Kun offered a solution: the newly opened diabetes eye disease integration ward in the hospital could solve these two problems in a one-stop way.

Liu Kun said, many DR patients progress to the late stage, often with multiple systemic complications, making surgical difficulty and perioperative safety a huge challenge. According to the traditional diagnosis and treatment process, patients need to first go to the endocrinology department to assess complications, control blood sugar, and wait for their overall condition to stabilize before going to the ophthalmology department for ophthalmic treatment. As a result, not only is the treatment cycle long, medical expenses high, but the patient's medical experience is also poor.

"We want to break through this relatively single medical treatment model, integrate resources based on the needs of patients, and leverage the advantages of comprehensive hospitals." After preliminary planning, Liu Kun and Wang Yufan, the director of the Endocrine Metabolism Department of Shanghai General Hospital, agreed, "Let's get it done."

In the ophthalmic ward, Ms. Zhang received meticulous treatment from two teams. In just 2 days, her blood sugar reached the standard. Quickly, the Liu Kun team conducted surgery to remove the accumulated blood in the vitreous cavity and successfully preserved Ms. Zhang's vision.

Now the ophthalmology department of Shanghai General Hospital follows the model of "one bed for all departments". In short, the department can provide as many fusion beds as there are patients who need fusion diagnosis and treatment. As of now, 26 patients have experienced integrated services, with an average length of stay of 4.5 days, which is nearly one-third shorter than before. In addition to Liu Kun's team, multiple medical teams in the ophthalmology department also joined in to serve patients with complicated diabetes eye diseases and greatly improve the diagnosis and treatment efficiency.

One-stop management in disease prevention and control

Mr. Wang, 53 years old, came from another province to Shanghai specifically to find Liu Kun due to swelling and pain in his right eye accompanied by dark shadows. Upon examination, it was found that there was blood accumulation in the right anterior chamber, large neovascularization of the iris, and a large amount of blood accumulation in the vitreous cavity.

"I have undergone multiple ophthalmic surgeries in other hospital, but unfortunately, my blood sugar fluctuated and the eye lesions were severe, resulting in unsatisfactory results of the surgery. The condition continued to recur. On the day of admission, Mr. Wang had unbearable eye pain and couldn't sleep well.". The ophthalmology and endocrinology teams actively collaborate on treatment, and joint ward rounds are carried out by doctors, clinical pharmacists, and blood glucose management nurses from both teams after surgery.

"Thank you to the medical team for their careful treatment. I was successfully discharged from the hospital on the first day after surgery. To Mr. Wang's surprise, in addition to solving his eye problems, the endocrinology department also warned him of other health hazards."

"In addition to diabetes fundus disease, the team also found that the patients had diabetes kidney disease, coronary heart disease, hyperlipidemia and other conditions." Wang Yufan said that through continuous blood glucose monitoring, the team also found that Mr. Wang had unconscious hypoglycemia at night. After active adjustment of the treatment plan, his blood sugar is now stable, and other diseases are also under one-stop management.

Before the opening of the diabetes eye disease fusion ward, the ophthalmology department and the endocrinology department jointly opened a diabetes eye disease blood glucose management clinic. After ophthalmic examination and assessment, the endocrinologist will conduct metabolic assessment and adjust the treatment plan, the full-time nurse will provide lifestyle guidance and follow-up, and the pharmacist will provide medication guidance to patients with diabetes eye disease to provide all-round services.

"In many cases, there is a 'time difference' for patients to see doctors." Wang Yufan told reporters that it was relatively late when diabetes patients had eye disease and found the ophthalmology department, while in the endocrinology department, many patients have not had related complications, which is a good time to intervene in management in advance, so that the benefits of treatment will be greater.

The reporter learned in the interview that in March this year, the diabetes eye disease blood glucose management clinic of the hospital will also be upgraded, and a diabetes eye disease MDT expert clinic will be established, where ophthalmologists, endocrinologists, and clinical pharmacists will sit together to check patients and achieve one-stop service and comprehensive diagnosis and treatment.