DiCE Program – Taiwan (August 2019)

TOPIC 1: Diabetes In The Western Pacific Region: What Are We Missing

Jun Sing-Wang, M.D., Ph.D.
Endocrinologist

The goal of treatment for patients with diabetes is to maintain glycemic control to prevent or delay diabetes micro- and macro-vascular complications. Unfortunately, it’s not easy to maintain glycemic control over time due to progressive β-cell dysfunction along with the prolonged disease duration.

There are additional barriers (such as hypoglycemia and barriers to insulin injection) that make maintaining glycemic control difficult in patients with diabetes. Moreover, there are some differences in the pathogenesis of type 2 diabetes between Asians and Caucasians. Thus individualized treatment is clinically important in treating a disease with heterogeneous phenotypes.

There are several new glucose-lowering drugs that “might” improve diabetes treatment. In this talk, I would like to discuss the challenges in treating type 2 diabetes in the Western Pacific Region, and whether new drugs help improve diabetes care and decrease risk of complications.

Jun Sing-Wang, M.D., Ph.D.

Endocrinologist

Dr. Wang obtained his medical degree from Taipei Medical College (Taipei Taiwan) in 2001. After graduation, he completed his resident training at Taichung Veteran General Hospital. Afterward he has worked as attending physician since 2009 at the Division of Endocrinology and Metabolism of Taichung Veteran General Hospital. He had recently graduated from the Doctoral Program of the Institute of Clinical Medicine at National Yang-Ming University (Taipei Taiwan) in 2018.

Dr. Wang actively participates in many medical societies in Taiwan, including Taiwan Society of Internal Medicine, The Endocrine Society of the R.O.C (Taiwan), the Diabetes Association of the R.O.C (Taiwan), and Taiwanese Association of Diabetes Educators. Now he holds the position of the Deputy Secretary General of the Diabetes Association of the Republic of China (Taiwan).

Dr. Wang continuously contributes to clinical practice and researches. He is interested in researches related to diabetes, metabolism, and cardiovascular diseases. He has published several papers in some famous journals, such as Diabetes Care, Diabetes Metab Res Rev, Diabetes Res Clin Pract, …etc. He also joins in many international, multi-centered phase III, as well as phase IV, studies in the field of endocrinology and metabolism.

TOPIC 2: Management of Diabetes Complications: Retinopathy and Diabetic Foot

Yi Jing-Sheen, M.D.
Endocrinologist

Diabetes is a growing threat because of its increased incidence and prevalence. Chronic complications of diabetes including retinopathy, neuropathy, peripheral arterial disease, cardiovascular diseases and diabetic foot disease which associated with neuropathy and peripheral arterial disease. Diabetes and diabetes-related complications caused a high economic burden on patients, their families, and society.

Diabetes is associated with damage to the blood vessels in the retina and leading to subsequent diabetic retinopathy, which can lead to scarring and cell loss in the retina. Diabetic retinopathy is one of the leading cause of permanent vision loss. Peripheral neuropathy is one of the most prevalent chronic complications of diabetes. The early detection of diabetic peripheral neuropathy is a challenge due to the heterogeneous presentation of its symptoms. Previous studies have reported that peripheral neuropathy affects approximately half of diabetes patients and up to half of diabetic peripheral neuropathy cases are asymptomatic. Diabetic neuropathy is a critical health issue that requires special attention. Peripheral arterial disease and neuropathy are responsible for diabetic foot diseases and amputations. Furthermore, diabetes patients may have reduced life expectancy because of an increased risk of cerebrovascular and coronary artery diseases. Early detection and early prevention of these chronic complications to avoid disability of patients with diabetes were challenges for diabetes management.

We will introduce these recent developments in screen and prevent diabetic chronic complications and the clinical guideline for risk control. Furthermore, we will share our successful experiences in establishing “one stop shop” for outpatient, institution-wide glycemic management systems, and the “multidisciplinary team” for diabetic foot car of TCVGH.

Yi Jing-Sheen, M.D.

Endocrinologist

EDUCATION
1992-1999 China Medical University, Taichung, Taiwan (Bachelor degree)
2009-2011 Department of Health Services Administration, China Medical University, Taiwan (Master degree)

EXPERIENCE
Resident of Internal Medicine, China Medical university (July 2000 to July 2001)
Resident of Internal Medicine, Taichung Hospital, Department of Health, Executive Yuan, Taiwan (September 2001 to June 2005)
Chief Resident of Division of Endocrinology and Metabolism, Taichung Veterans General Hospital (July 2005 to July 2007)
Adjunct Attending doctor of Division of Endocrinology and Metabolism, Taichung Veterans General Hospital (Oct 2009 to July 2011)
Attending doctor of Division of Endocrinology and Metabolism, Taichung Hospital, Ministry of Health and Welfare, Taiwan (Oct 2007 till March 2017)
Deputy director of Division of Medical Research and Education, Taichung Hospital, Ministry of Health and Welfare, Taiwan (September 2011 till December 2012)
Attending doctor of Division of Endocrinology and Metabolism, Department of Internal Medicine, Taichung Veterans General Hospital (March 2017 till now).

Taichung Veterans General Hospital

Division of Endocrinology and Metabolism, Department of Internal Medicine

No. 1650號, Section 4, Taiwan Boulevard, Xitun District, Taichung City, Taiwan 407

The Division of Endocrinology and Metabolism, one of units of Department of Internal Medicine, Taichung Veterans General Hospital, was founded in 1982. Major missions and duties are medical services for outpatient, inpatient, and the emergency department. We also reply to consultations, participate in clinical teaching, and carry out clinical and basic researches.

There are currently 9 attending physicians, 3 chief residents, and 7 technicians in our division. All of our attending physicians specialize in endocrinology and metabolism disorders. Outpatient services are provided daily from Monday to Saturday, with around 5,000 outpatient visits per month. Eight ordinary hospital beds were provided for inpatient and two another isolation beds for high doses of radioactive iodine treatment. We strive to provide comprehensive training program for our resident doctors and medical students. Out division is also an accredited training hospital for subspecialty of endocrinology and metabolism by the Endocrine Society and Diabetes Association of the Republic of China (Taiwan). We also actively participate in both the basic and many international clinical studies.

We founded the Diabetes Care Center in 1997, under commission of the Department of Health (now Ministry of Health and Welfare). By integrating diabetes specialists, nurses, and dieticians, our diabetes care center aims to provide comprehensive and holistic care and deliver self-management education for diabetic patients. Our Diabetes Care Center has been accredited as the “International Diabetes Federation Centre of Education” since 2017, and awarded as “Certified International Diabetes Federation Centre of Excellence in Diabetes Care”. To actively engage in activities International Diabetes Federation, we help the several events of translation of short course of Diabetes Prevention Module in Chinese. We are major contribution to develop booklet of disaster program for Western Pacific Region of International Diabetes Federation. The international diabetes preceptorship has been held annually in our diabetes center to improve professional capability, to share experience of diabetes care, and to develop mutual benefits of diabetes care system among countries in Asia.

Further Reading on TVGH’s Division of Endocrinology and Metabolism:
http://www1.vghtc.gov.tw/GipOpenWeb/wSite/ct?xItem=64273&ctNode=56141&mp=8