16-Living-With-Chronic-Disease.md

16. How to live after being diagnosed with a chronic disease

This section looks at overall mortality rates and the associated costs. A chronic disease diagnosis is not the end of the story — what truly matters is how to manage it over the decades that follow.

1. Take medication exactly as prescribed — don’t stop just because you feel better

• Cost: There’s no cost at all; in fact, it saves money on future treatment for complications. Taking the pills each day takes only a few minutes. The real challenge is sticking to the regimen every single day.
• In plain terms: People who consistently follow their doctor’s instructions when taking medication have roughly half the risk of dying during the same period compared to those who take it intermittently. This figure should be viewed with some caution. Even individuals who take fake pills consistently also have lower mortality rates, which suggests part of the benefit stems from the fact that people who stick to any medication routine tend to be more health-conscious overall. Still, the risks of skipping doses are well documented — especially for blood pressure drugs, anticoagulants, and anti-rejection medications.
• Benefit: This finding comes from a meta-analysis that pooled data from 21 separate studies involving 46,847 participants. Compared to those who took medication irregularly, people who followed their prescription exactly had roughly 44% lower risk of dying during the same timeframe. The raw odds ratio was 0.56, with a 95% confidence interval ranging from 0.50 to 0.63; this interval represents the range within which the true value is likely to fall. When only treatments with proven effectiveness were considered, the risk reduction was about 45% (odds ratio 0.55, 95% CI 0.49–0.62).
• Evidence grade: A
• Notes: This is a somewhat controversial figure and one of the numbers in this guide that requires extra caution. In the same meta-analysis, individuals who consistently took placebos also showed a lower mortality rate (odds ratio 0.56, 95% CI 0.43–0.74). This indicates that a significant portion of the benefit is attributable to the “healthy adherer effect” — the tendency of people who stick to any kind of medication routine to generally maintain healthier habits. Nevertheless, the risks associated with discontinuing medication are very real, particularly for blood pressure drugs, anticoagulants, and anti-rejection medications.
• Sources:Simpson SH, Eurich DT, Majumdar SR, et al. (2006). A meta-analysis of the association between adherence to drug therapy and mortality. BMJ, 333(7557), 15. https://doi.org/10.1136/bmj.38875.675486.55

2. First get outpatient chronic disease certification, then register for cross-regional medical care — hypertension, diabetes, cancer radiotherapy/chemotherapy, dialysis, and anti-rejection treatment can then be covered by yibao across regions

• Cost: No cost at all. You can complete the cross-regional medical registration once, right from your phone, via the yibao app before you travel.

• In plain terms: Patients with hypertension, diabetes, outpatient radiotherapy/chemotherapy for malignant tumors, dialysis for uremia, and anti-rejection treatment after organ transplants can now use their yibao coverage for outpatient care anywhere in the country. They won’t need to pay out-of-pocket first and then seek reimbursement back home. However, this only works if they first obtain outpatient chronic disease certification in their home region, then register for cross-regional medical care. Both steps are required for it to take effect.

• Benefit: According to official documents from the National Healthcare Security Administration, this system is now largely in place. The exact wording reads: “Cross-regional direct settlement of outpatient expenses for five chronic conditions — hypertension, diabetes, radiotherapy/chemotherapy for malignant tumors, dialysis for uremia, and anti-rejection treatment after organ transplants — is now largely accessible at the county level.” “Accessible at the county level” means this service is available county-wide. The documents also mention plans to add five more conditions to this list in the future.

• Evidence grade: A

• Notes: Both steps are mandatory: first get outpatient chronic disease certification in your home region, then register for cross-regional medical care. Progress on adding those five new conditions varies by region; exact details are determined by local healthcare security authorities.

• Sources:国家医保局办公室、财政部办公厅 (2024). 关于稳妥有序扩大跨省直接结算门诊慢特病病种范围的通知（医保办发〔2024〕19 号）. https://www.gov.cn/zhengce/zhengceku/202409/content_6974467.htm

3. Follow the intervals recommended by your doctor for follow‑up visits, and record every measurement in the same notebook.

• Cost: Each checkup costs anywhere from a few dozen to several hundred yuan. A trip to the hospital and waiting for results also takes some time. The main difficulty is that you must go regularly, which can easily be put off.
• In plain terms: For chronic diseases, it’s the trends over time that matter, not any single measurement. Write down the date, the measurement, the medication you’re taking, and its dosage in one place. When you switch doctors, you can show this record so you won’t need to repeat tests or pay for them again.
• Benefit: What matters for chronic conditions is how these values change over time. Keeping them all in one spot also means you won’t have to redo tests or spend extra money when you change medical providers.
• Evidence grade: C
• Notes: Be sure to record at least four items each time: the date, the measurement value, the medication being used, and its dosage. Taking a photo of the lab report with your phone works just as well. The key is to keep everything in the same place rather than scattering it across multiple notes.
• Sources:作者经验，无直接文献

4. Don’t stop proper treatment to try folk remedies or supplements

• Cost: No cost at all; you even save money you’d otherwise spend on supplements. It takes no extra time. The hard part is resisting repeated pressure from others to give it a try.
• In plain terms: The risks of stopping treatment are well known, while the benefits of folk remedies and supplements are uncertain. This means trading a definite harm for an uncertain gain. If you want to try supplements, talk to your doctor first. Some supplements can alter blood levels of anticoagulants and anti-rejection drugs.
• Benefit: The dangers of discontinuing treatment are clear, while the advantages of folk remedies remain unproven. This book lists several common types of ineffective supplements in Chapter 6.
• Evidence grade: C
• Notes: Always consult your doctor before trying any supplements. Certain supplements may interact with prescription medications, affecting concentrations of anticoagulants and anti-rejection drugs in the bloodstream.
• Sources:作者经验，无直接文献；相关证据见第 6 节

5. For patients with stable chronic conditions, community clinics can issue up to 12 weeks’ worth of medication at one time

• Cost: There is no cost involved. Simply ask at your local community health center whether they can issue a long-term prescription.
• In plain terms: For individuals whose condition remains stable and whose medication regimen has not changed, community health centers can provide enough medication to last 12 weeks. This eliminates the need to travel to a larger hospital each month just to get a prescription and wait in line. Within the same insurance region, the reimbursement rate at these community clinics is typically about 10 percentage points higher than at higher-level hospitals.
• Benefit: Patients no longer have to make monthly trips to larger hospitals just to get their prescriptions. In the same insurance region, the reimbursement rate at community clinics is generally roughly 10 percentage points higher than at higher-level hospitals.
• Evidence grade: A
• Notes: Whether a patient meets the criteria is determined by the doctor; generally, this applies to individuals with a confirmed diagnosis and a stable medication plan. The medication itself remains the same; what is saved is the time and cost of making monthly trips to the hospital. If a specific medication is not available at the clinic, ask about their medication shortage registry and delivery options.
• Sources:国务院办公厅 (2026). 关于加快建设分级诊疗体系的若干措施. https://www.gov.cn/zhengce/zhengceku/202604/content_7065031.htm：「对于符合条件的慢性病患者，基层医疗卫生机构单次可开具不超过12周用药的长期处方。」；同文「原则上统筹地区内医疗卫生机构住院报销比例逐级拉开10个百分点左右的差距」，并要求上级医院在基层开设高血压、糖尿病、慢性阻塞性肺疾病等常见病慢性病门诊

6. Before signing up for a family doctor in your community, find out which services are covered by yibao and which you’ll have to pay for out of pocket

• Cost: There’s no cost involved. Asking a few questions before you sign up takes just a minute.
• In plain terms: The standard package of basic services is covered by yibao as required. Any customized service packages must be paid for entirely by the patient. When someone offers an “upgrade package,” be sure to ask whether it’s a basic or customized package, whether it’s officially registered, and how much it costs per year.
• Benefit: The basic service package is paid for by yibao per regulations. Customized packages require full out‑of‑pocket payment and must also be registered with the county‑level health authority.
• Evidence grade: A
• Notes: The real value of signing up lies in having a doctor follow your health over the long term, not in the number of services included. When offered an “upgrade package,” ask three key questions: is it a basic or customized package, is it registered, and what’s the annual cost?
• Sources:国务院办公厅 (2026). 关于加快建设分级诊疗体系的若干措施. https://www.gov.cn/zhengce/zhengceku/202604/content_7065031.htm：「加强基层门诊付费与签约服务政策联动，基本服务包按规定纳入医保支付；个性化服务包由签约基层医疗卫生机构按程序向县级卫生健康部门备案，费用由个人支付。」

7. Get a dilated eye exam right after a diabetes diagnosis, then follow your doctor’s recommended schedule; check your feet once a year.

• Cost: A single dilated eye exam costs anywhere from a few dozen to several hundred yuan. Foot exams are usually included in routine outpatient visits, so they don’t incur extra charges. The real challenge is remembering to get these checks done even when neither your eyes nor feet feel any discomfort.
• In plain terms: Diabetes can damage both the retina and feet, but there are almost no noticeable symptoms until the damage becomes severe enough to cause vision loss or foot ulcers. Early detection makes treatment possible. For type 2 diabetes, a dilated eye exam should be done right after diagnosis; for type 1 diabetes, it’s recommended to start five years after onset. If previous tests showed no issues and blood sugar levels remain well-controlled, the interval can be extended to once every one or two years. Foot checks should be done annually.
• Benefit: Retinal damage caused by diabetes is known as diabetic retinopathy, while damage to the feet is called diabetic foot disease. Both conditions rarely show any symptoms until they reach an advanced stage. Detecting them early gives patients a much better chance of effective treatment. Once vision is lost or foot ulcers develop, it’s usually too late to reverse the damage.
• Evidence grade: A
• Notes: Type 2 diabetics should get a dilated eye exam right after diagnosis; type 1 diabetics should start five years after onset. The difference exists because type 2 diabetes often develops gradually over several years without obvious signs. If previous tests showed no problems and blood sugar stays under control, the interval can be extended to once every one to two years. People who notice reduced sensation in their feet should inspect the soles daily, even using a mirror if needed.
• Sources:美国糖尿病学会 (2026). 糖尿病诊疗标准 2026·第 12 章 视网膜病变、神经病变与足部护理. Diabetes Care：「People with type 2 diabetes should have an initial dilated and comprehensive eye examination by an ophthalmologist or optometrist at the time of the diabetes diagnosis.」「Adults with type 1 diabetes should have an initial dilated and comprehensive eye examination by an ophthalmologist or optometrist 5 years after the onset of diabetes.」「If there is no evidence of retinopathy from one or more annual eye exams and glycemic indicators are within the goal range, then screening every 1–2 years may be considered.」「Perform a comprehensive foot evaluation at least annually to identify risk factors for ulcers and amputations.」https://doi.org/10.2337/dc26-S012

8. People who have had kidney stones should drink 2.5–3 liters of water daily and keep salt intake under 6 grams

• Cost: There is no cost at all. Simply make drinking water a daily habit. On days when you sweat a lot, you’ll need even more water — the hard part is remembering to do this every day.
• In plain terms: Roughly one in four people who have had a kidney stone will develop another one within five years. In a study of 199 people who had just experienced their first calcium stone episode, one group was instructed to drink enough water every day. Over five years, 12% of this group had a recurrence, compared to 27% of the control group that received no special instructions. UK guidelines recommend drinking 2.5–3 liters of water daily while keeping salt intake under 6 grams. Exactly 99 participants took part in this trial.
• Benefit: This is a five-year randomized controlled trial involving 199 patients with idiopathic calcium stones — meaning no underlying cause could be identified. Participants were split into two groups: one group drank at least 2 liters of water daily, while the other received no special intervention. After five years, 12.1% of the water-drinking group had a recurrence, versus 27.0% in the control group (P=0.008). A lower P value indicates a less likely chance that this difference occurred by random chance. The average time to recurrence was 38.7±13.2 months for the water group versus 25.1±16.4 months for the control group (P=0.016). Baseline 24-hour urine volume measurements showed that stone patients produced significantly less urine than healthy individuals: men produced 1,057±238 mL versus 1,401±562 mL in healthy men (P<0.0001), and women produced 990±230 mL versus 1,239±440 mL (P<0.001). NICE guideline NG118, section 1.8.1, offers several recommendations: adults should drink 2.5–3 liters daily, while children and teens should drink 1–2 liters based on age. Adding fresh lemon juice to water is encouraged, and carbonated drinks should be avoided. Adults must also keep daily salt intake under 6 grams.
• Evidence grade: A
• Notes: This measure reduces recurrence rates by roughly 55% at zero cost, making it the most cost-effective recommendation in this section according to our ranking criteria. The key metric to monitor is 24-hour urine volume, which should reach at least 2–2.5 liters — not simply the amount of water you drink. People who sweat heavily or work in hot environments need to drink even more. This trial involved only patients experiencing their first idiopathic calcium stone episode; different types of stones — such as uric acid, infection-related, or cystine stones — require different treatment approaches. Anyone with a history of kidney stones should undergo a stone composition analysis and a 24-hour urine test to determine whether medication is needed. Do not cut calcium intake to prevent stones; see section 6, item 21 for more details. Severe flank or abdominal pain during a stone episode requires immediate medical attention — drinking more water alone will not resolve it. Non-painful blood in the urine may indicate other conditions; see section 1, item 27 for further information.
• Sources:Borghi L, Meschi T, Amato F, Briganti A, Novarini A, Giannini A (1996). Urinary volume, water and recurrences in idiopathic calcium nephrolithiasis: a 5-year randomized prospective study. The Journal of Urology, 155(3), 839-843. https://doi.org/10.1016/s0022-5347(01)66321-3；National Institute for Health and Care Excellence (2019). Renal and ureteric stones: assessment and management. NICE guideline NG118，第 1.8.1 条. https://www.nice.org.uk/guidance/ng118/chapter/Recommendations

9. Long-term use of uric acid-lowering drugs after a gout diagnosis to keep blood uric acid below 360 µmol/L

• Cost: Allopurinol costs only a few to several dozen yuan per month. In the beginning, blood uric acid levels must be checked every few weeks to adjust the dosage; once stable, checks can be done every few months. For the first 3 to 6 months, a separate medication to prevent gout attacks must also be taken. The real challenge is remembering to take these drugs consistently even when there are no symptoms.

• In plain terms: The proper way to manage gout is to take uric acid-lowering drugs long-term to keep levels below 360 µmol/L; these should not be taken only during flare-ups. In a UK trial involving 517 participants, 95% of those whose treatment was adjusted according to medical targets achieved this level after two years, compared to only 30% of those receiving standard care. Even after reaching the target, medication must not be stopped. Diet alone cannot bring levels down to this point, and abstaining from alcohol only lowers them by 1.6 mg/dL. A total of 211 participants remained free of gout attacks over a five-year follow-up period after discontinuing medication.

• Benefit: This is a randomized controlled trial with 517 adult participants who had experienced gout attacks within the previous 12 months. One group received guidance from nurses who explained the condition and adjusted their medication to meet the target level; the other group continued to receive standard care from general practitioners. After two years, 95% of the intervention group had blood uric acid levels below 360 µmol/L (6 mg/dL), compared to just 30% of the control group. This represents a 3.18-fold increase in the likelihood of success (RR 3.18, 95% CI 2.42–4.18; this range indicates statistical reliability), with a P-value of less than 0.0001. Secondary outcomes such as attack frequency, presence of tophi, and quality of life also improved significantly in the intervention group. Each additional year of healthy life, adjusted for quality of life, cost approximately £5,066. A follow-up survey of 438 participants yielded a response rate of 82%; median attack frequency was 0 per year in the target-achieving group versus 1 per year in the control group (P<0.001). The proportion of participants still taking uric acid-lowering drugs was 1.19 times higher in the intervention group (adjusted RR 1.19, 1.09–1.30). The 2020 American College of Rheumatology guidelines strongly recommend starting such treatment for three groups: those with visible tophi, those showing bone damage on imaging, and those experiencing at least two attacks per year. The recommended approach involves continuous monitoring and dosage adjustment until levels drop below 6 mg/dL; allopurinol is the first-line choice, especially for patients with stage 3 or higher chronic kidney disease, with an initial dose of no more than 100 mg per day. Anti-inflammatory preventive drugs must also be taken for at least 3 to 6 months. Observational data from the same study showed that after successful long-term control, 87% of patients who discontinued medication still maintained levels below 7 mg/dL; however, only 13% remained free of attacks over a five-year follow-up period. Dietary interventions have limited impact: abstaining from alcohol lowers levels by just 1.6 mg/dL, while one serving of beer raises them by 0.16 mg/dL. Healthier diets such as Mediterranean or DASH diets produce even smaller effects.

• Evidence grade: A

• Notes: Han Chinese individuals should consider testing for HLA-B*5801 before starting allopurinol. This gene variant occurs in 7.4% of Han Chinese, Korean, and Thai populations, compared to only 0.7% of white and Hispanic individuals. Asians and African Americans face a threefold higher risk of allopurinol hypersensitivity syndrome, a potentially fatal condition involving widespread skin peeling; thus, the 2020 American College of Rheumatology guidelines advise genetic testing for these groups. Initiating uric acid-lowering therapy may temporarily increase attack frequency, so guidelines mandate concurrent use of anti-inflammatory preventive drugs for the first 3 to 6 months. Stopping medication due to increased pain is a common mistake; instead, additional anti-inflammatory drugs should be used as directed. Target levels of <6 mg/dL roughly correspond to 360 µmol/L, though Chinese medical reports typically use µmol/L units. Elevated uric acid levels without any prior attacks represent a different clinical scenario, discussed in Section 6, Item 19. Further details on sugary drinks and alcohol can be found in Section 2, Items 7 and 20.

• Sources:Doherty M, Jenkins W, Richardson H, et al. (2018). Efficacy and cost-effectiveness of nurse-led care involving education and engagement of patients and a treat-to-target urate-lowering strategy versus usual care for gout: a randomised controlled trial. Lancet, 392(10156), 1403-1412. https://doi.org/10.1016/S0140-6736(18)32158-5；Abhishek A, Jenkins W, La-Crette J, Fernandes G, Doherty M (2020). Nurse-led care is preferred over GP-led care of gout and improves gout outcomes: results of Nottingham Gout Treatment Trial follow-up study. Rheumatology, 59(3), 575-579. https://doi.org/10.1093/rheumatology/kez333；FitzGerald JD, Dalbeth N, Mikuls T, et al. (2020). 2020 American College of Rheumatology Guideline for the Management of Gout. Arthritis Care & Research, 72(6), 744-760. https://doi.org/10.1002/acr.24180