Letters to the Editor, October 24, 2016
Good glucose control is important
We read with concern the article in Post Magazine (“Second opinions”, September 18).
The table of “Major reversals” suggested diabetes patients are now seldom advised to aim for a glycated haemoglobin (HbA1c) below 7 per cent; however, this is not the case.
The Action to Control Cardiovascular Risk in Diabetes (ACCORD) trial did highlight that among high-risk patients with pre-existing cardiovascular disease, intensive treatment to a very low glucose target (aiming at an HbA1c target of less than 6 per cent) was associated with harm.
Nevertheless, it is important to note that this study comprised a unique patient population and the conclusions should not be generalised to all patients with type 2 diabetes. Importantly, several other studies, such as the ADVANCE trial, reported more favourable outcomes among patients who received more intensive treatment.
Improved blood glucose control reduces the risk of eye and kidney damage in patients with diabetes. Furthermore, a recent report from the ACCORD trial concluded that “raised blood glucose is a modifiable risk factor for ischaemic heart disease”.
Current professional guidelines from the American Diabetes Association and the European Association for the Study of Diabetes still advocate an HbA1c target of less than 7 per cent in general. This should be further adjusted and potentially set at a more strict target, in patients with recently diagnosed disease, without comorbidities, and without established complications. The Hong Kong Reference Framework for Diabetes Care for Adults in Primary Care Settings, a local practice guideline published in 2010, also concluded that an HbA1c goal of less than 7 per cent is “in general appropriate”.
It noted that lower A1c values can be considered for selected younger individuals with a short history of diabetes. A more lenient A1c target may be appropriate for certain individuals if advanced complications are already present.
The current approach to treatment of diabetes emphasises treatment should be individualised for each patient, and includes comprehensive assessment and control of cardiovascular risk factors including blood glucose, blood pressure and lipids.
Given the large burden of diabetes and the potentially devastating consequences of diabetic complications, we cannot afford to encourage complacency among patients with diabetes.
The recommendation in the article that patients should no longer strive for good glucose control (that is, aim for HbA1c less than 7 per cent), is potentially harmful for patients.
Professor Ronald C.W. Ma, president, Hong Kong Society of Endocrinology, Metabolism and Reproduction; Dr Chow Wing-sun, president, Diabetes Hongkong
Parallel traders still causing major problem
In order to address the problem of parallel trading, it was agreed that multiple-entry individual visit endorsements for Shenzhen residents would be changed and they would be limited to one visit per week.
However, this policy has not had the desired effect.
Parallel trading has remained a serious problem in Hong Kong.
Initially, after the policy was implemented, there was a drop in the number of parallel traders who were coming over the border from the mainland.
However, this shortfall was soon dealt with, as more Hong Kong residents and people from South Asia got involved in the trade. So, the one visit per week restriction has failed to stem the tide of these traders.
Even after the implementation of the visa restriction, property prices in Sheung Shui, the worst blackspot for the traders, have continued to increase.
A vicious cycle has been created, for example, with so many pharmacies opening to meet the demand for products like milk formula. So, in effect, the situation has actually become worse than before.
Therefore, it is time for the government to evaluate what is happening and come up with new policies to curb the problem of the parallel traders.
It should blacklist them so that they are forbidden to enter Hong Kong and not allowed to leave if they clearly have goods in bulk for trading.
Parallel traders should also face heavy punishment through the courts and this can hopefully act as a deterrent.
Winnas Wong, Tseung Kwan O
Help elderly who lose touch with society
I refer to the article (“Psychological health rates low for elderly”, October 6).
Some elderly citizens do have mental health issues and I agree with those who argue that it is important to help them deal with the fast-paced modern society of Hong Kong.
When they are no longer working, many lose their connection with the rest of society and this can result in depression.
The government should help them do voluntary or part-time work if they wish and if they feel they are becoming reclusive, especially if they have grown-up children who have left home.
One area where they could be helped with retraining is teaching them computer skills. This would help keep them in touch with the rest of society and could lead to their being able to find some part-time work. In this way they could reconnect with society and hopefully lead more rewarding lives.
Children can also help their grandparents, explaining how they can use smartphones for social networking.
My father told me that my grandmother was interested in learning how to use a smartphone and so I helped her. After a while she told me could look at YouTube and interact with her sons through WhatsApp.
Young people need to make the effort to communicate more with the elderly and introduce them to the latest apps and online games. We need to try and bridge the gap between the elderly and our modern society.
Venus Chan, Sha Tin
Large eateries can introduce green initiative
Fast food restaurants such as McDonald’s and Tong Kee Bao Dim waste a lot of paper bags and plastic utensils that they give to customers every day.
These chains should encourage customers to bring their own containers and reusable cutlery. They could be rewarded with discounts and maybe an extra portion of food and this would act as an incentive to join the scheme. It could also hopefully raise their awareness about the environment.
The firms would not then have to buy such huge quantities of bags and plastic utensils.
Emily Leung Choi-yan, Tseung Kwan O
We all must cut back on use of air cons
People should be trying to cut back on their use of air conditioners in Hong Kong to help counter the damaging effects of global warming.
We should, wherever possible, use electric fans instead of the air con. Obviously you are still using electricity, but a fan will consume far less energy than the average air
Fans are very effective at cooling the air if they are located in a well-ventilated room, even if it is hot outside.
We should also take advantage of natural airflow, such as sea breezes.
And on hot days a healthy way to keep cool is to drink a lot of cold water. This can help you regulate your internal body temperature.
We all need to use less electricity, because the damage caused by global warming is irreversible. So we all have to act in an effort to save the planet. And we should not delay these initiatives but act now.
Rainbow Wong, Hang Hau