To combat the silent epidemic of young-onset diabetes (YOD), The Chinese University of Hong Kong (CUHK) is launching a four-year DNA testing programme funded with an approved donation of over HK$61 million from The Hong Kong Jockey Club Charities Trust. The programme aims to screen 9,000 adults aged 18 to 44 to identify those with a genetic predisposition to YOD. Its objective is to identify those at high risk of developing diabetes in the next decade to prevent or delay onset of the disease.

 

This pioneering initiative, the Jockey Club Precision Prevention Programme on Young Onset Diabetes, is spearheaded by the Hong Kong Institute of Diabetes and Obesity at CUHK, in collaboration with the Asia Diabetes Foundation (ADF), St James’ Settlement (SJS), and a network of community healthcare professionals.

 

 

The four-year Jockey Club Precision Prevention Programme on Young Onset Diabetes is spearheaded by the Hong Kong Institute of Diabetes and Obesity at CUHK, in collaboration with the Asia Diabetes Foundation, St James’ Settlement, and a network of community healthcare professionals, with an approved donation of over HK$61 million from the The Hong Kong Jockey Club Charities Trust.

One in five adults with diabetes is diagnosed before the age of 40

Everyone has a unique set of genetic codes inherited from their parents, forming a blueprint for personal traits and predisposition to various diseases, including diabetes. Early identification of  genetically-predisposed individuals, and equipping them solutions to prevent or delay the onset of diabetes and its complications, can help them live healthier and longer.

Age, obesity and family history are major risk factors for diabetes. However, the lifetime risk of diabetes is one in three, and the majority of individuals classed as overweight or with obesity do not develop diabetes. On the other hand, prediabetes and diabetes are not uncommon in young and often lean individuals, particularly those with a family history. Diabetes is a silent and progressive condition. In genetically predisposed individuals, insulin function may already be impaired up to six years before the onset of diabetes, providing a golden opportunity to reverse the trajectory of silent glucose deterioration.

“Young-onset diabetes is a silent killer globally. In Hong Kong, one in ten adults has diabetes, and one in five adults with the disease has YOD diagnosed before the age of 40. More than ten years ago, CUHK first reported that the mortality rate in individuals with YOD is 1.5 to two times higher than in their older-onset peers, with recurrent hospitalisations due to physical and mental illnesses. These young individuals have a reduced capacity to secrete insulin to keep blood glucose within a normal range when challenged by risk factors such as obesity, smoking and emotional stress. The complex interactions between genetic and lifecourse factors lead to early onset of diabetes and a rapid trajectory of glucose deterioration, culminating in premature death, multiple disabilities and poor quality of life,” said Professor Andrea Luk On-yan from CU Medicine’s Department of Medicine and Therapeutics and researcher of the Jockey Club Precision Prevention Programme on Young Onset Diabetes.

Undergo saliva-based DNA testing to enable precise prevention and control of YOD

The Jockey Club Precision Prevention Programme on Young Onset Diabetes commenced in May 2024. The four-year programme aims to screen 9,000 adults aged 18 to 44 to identify those at high risk of developing diabetes in the next decade to prevent or delay the onset of diabetes. Individuals must have no diagnosis of diabetes and possess at least one diabetes risk factor (for example: central obesity/ overweight, family history of diabetes, smoking history, history of hypertension/ hyperglycaemia/ abnormal lipid profile/ cardiovascular disease/ fatty liver).

Individuals undergo saliva-based DNA testing, which combines genetic markers with other risk factors through an algorithm to identify individuals with a genetic predisposition to diabetes. Those with high risk will undergo additional urine and blood testing, including a 75-gram oral glucose tolerance test. Individuals found to have diabetes or prediabetes will be additionally tested for autoimmune and/or insulin markers and be referred to community primary care physicians for subsidised treatment. Individuals found to have prediabetes will also receive health support. All high-risk beneficiaries will receive support from a multidisciplinary team at ADF and SJS, including digital support, continuous glucose monitoring device and weighing scale. 

Miss Ho (right) has a family history of diabetes and has long suffered from hand tremors and fatigue. She joined the CUHK screening programme in March this year and was found to be at high risk of diabetes. After further testing, she was diagnosed with young-onset diabetes. She says now she keeps track of her blood glucose regularly and actively maintain a healthy lifestyle and diet. Her blood glucose control has much improved.

CUHK performs modelling and analysis to evaluate the overall effectiveness of the programme

“The community-based programme also aims to enhance public awareness and health literacy. Apart from evaluating the experience, perspectives and outcomes of participants, we will perform modelling and cost-effectiveness analysis to guide future healthcare practice and policy aimed at reducing hospitalisation costs and productivity losses due to YOD,” said Professor Juliana Lui Nga-man, Assistant Professor and health economist from CU Medicine’s Department of Medicine and Therapeutics and co-principal researcher of the Jockey Club Precision Prevention Programme on Young Onset Diabetes.

“Since 1995, CUHK has researched extensively into the causes, trajectories and consequences of diabetes and developed solutions for prevention and treatment. During the last three decades, we have discovered and validated hundreds of Asian-specific genetic markers for diabetes, many of which are implicated in synthesis, secretion and actions of insulin. By combining these genetic markers with other modifiable and non-modifiable risk factors, we have developed multi-sequencing tests and algorithms to identify the genetically predisposed individuals for early intervention. Diabetes is preventable and treatable. The challenge lies in treatment of the right person at the right time by the right people in the right setting and with the right strategy. This is the essence of precision medicine. Support by The Hong Kong Jockey Club Charities Trust and by joining forces, we aim to translate this wealth of knowledge into a sustainable solution through transforming self-management, clinical practice and policy focusing on prevention of young-onset diabetes,” said Professor Juliana Chan Chung-ngor, Director of the Hong Kong Institute of Diabetes and Obesity, CUHK and principal researcher of the Jockey Club Precision Prevention Programme on Young Onset Diabetes.

The programme is now open for recruitment. Interested and eligible individuals can register via the following website: https://jc-pppyod.adf.org.hk/