# 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 - 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. - 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. ### 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 - 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）. - 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. ### 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 - Sources:作者经验，无直接文献 - 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. ### 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 - Sources:作者经验，无直接文献；相关证据见第 6 节 - 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. ### 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: Individuals whose conditions remain stable and whose medication regimens have not changed can obtain enough medication for 12 weeks from a community health center in one visit. 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, reimbursement rates at community-level clinics are typically about 10 percentage points higher than those at higher-tier hospitals. - Benefit: Patients no longer need to make monthly trips to larger hospitals just to obtain prescriptions. In the same insurance region, reimbursement rates at community clinics are generally roughly 10 percentage points higher than at higher-tier hospitals. - Evidence grade: A - 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. ：「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；同文「三级医院要聚焦急危重症和疑难复杂疾病，加强转诊会诊和住院服务，逐步酌减常见病复诊和诊断明确、病情稳定的慢性病等普通门诊」，「并将专家团队普通门诊向基层医疗卫生机构延伸」 - Notes: Whether a patient meets the criteria is determined by the physician; generally, this applies to individuals with a confirmed diagnosis and a stable medication regimen. The actual medication remains the same; what is saved is the time and cost of monthly trips to the hospital and associated fees. If a specific medication is unavailable at a community clinic, patients can inquire about medication shortage registries and delivery services. The same policy also calls for tertiary hospitals to gradually reduce routine outpatient services for such chronic conditions, with those services being transferred to community clinics instead. Relying on larger hospitals solely for prescription refills will become increasingly difficult in the future. ### 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 - 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. ：「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。」 - 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? ### 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 - 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.」 - 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. ### 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 - 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. ；National Institute for Health and Care Excellence (2019). Renal and ureteric stones: assessment and management. NICE guideline NG118，第 1.8.1 条. - 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. 〔100〕 〔100〕 ### 9. Long‑term use of uric‑acid‑lowering drugs after a gout diagnosis to keep levels below 360 µmol/L - Cost: Allopurinol costs only a few to several tens of yuan per month. At first, blood uric‑acid levels must be checked every few weeks to adjust the dose; once stable, checks can be done every few months. For the first 3–6 months, a second medication to prevent flare‑ups is also required. The difficulty lies in the fact that patients must keep taking it even when they feel no pain. - In plain terms: Gout requires lifelong use of uric‑acid‑lowering drugs to keep levels under 360 µmol/L; painkillers alone are insufficient. In a study where nurses helped patients adjust their dose based on lab results, 95 % reached the target after two years, compared with only 30 % of patients seen by regular doctors. Even after reaching the target, medication must not be stopped. Diet changes alone cannot bring levels down to this point, and abstaining from alcohol lowers them by just 1.6 mg/dL. - Benefit: In a randomized controlled trial of 517 adults who had experienced gout attacks within the previous 12 months, one group received nurse‑led education and dose adjustments to achieve the target level, while the other continued routine care. After two years, 95 % of the intervention group versus 30 % of the control group had uric‑acid levels below 360 µmol/L (6 mg/dL). The odds of success were 3.18 times higher in the intervention group (RR 3.18, 95 % CI 2.42–4.18; P < 0.0001). Secondary outcomes — attack frequency, tophus formation, and quality of life — also improved. Each additional quality‑adjusted life year gained cost £5,066. Follow‑up data showed that 82 % of participants reported zero attacks in the previous year, versus a median of one attack for the control group (P < 0.001). The proportion still on therapy was 1.19 times higher in the intervention group (adjusted RR 1.19, 1.09–1.30). The 2020 American College of Rheumatology guidelines recommend uric‑acid‑lowering therapy for patients with tophi, bone erosion on imaging, or ≥2 attacks per year; the target is <6 mg/dL, achieved by regular monitoring and dose titration, with allopurinol as first‑line therapy, especially for those with stage 3 or higher chronic kidney disease. Anti‑inflammatory prophylaxis is advised for 3–6 months at initiation. Observational data indicate that after successful control, many patients can discontinue medication without relapse; however, only 13 % remained flare‑free over five years. Alcohol restriction lowers uric‑acid levels by 1.6 mg/dL, while a single beer raises them by 0.16 mg/dL; healthier diets have far smaller effects. Debate persists over optimal drug choice: allopurinol is favored for its efficacy, safety, and low cost, though patients with cardiovascular disease or recent events may be switched to other agents per FDA warnings. The CARES trial linked allopurinol to a 22 % higher risk of all‑cause mortality (HR 1.22) and a 34 % higher risk of cardiovascular death (HR 1.34) versus allopurinol; the European FAST trial found no such increase. Urine alkalinization is not recommended for uricosuric agents due to lack of evidence. Adequate hydration is essential, especially for patients with kidney stones or advanced CKD. - Evidence grade: A - 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. ；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. ；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. ；White WB, Saag KG, Becker MA, et al.; CARES Investigators (2018). Cardiovascular Safety of Febuxostat or Allopurinol in Patients with Gout. New England Journal of Medicine, 378(13), 1200-1210. ；Mackenzie IS, Ford I, Nuki G, et al.; FAST Study Group (2020). Long-term cardiovascular safety of febuxostat compared with allopurinol in patients with gout (FAST): a multicentre, prospective, randomised, open-label, non-inferiority trial. Lancet, 396(10264), 1745-1757. ；中华医学会内分泌学分会 (2020). 中国高尿酸血症与痛风诊疗指南(2019). 中华内分泌代谢杂志, 36(1), 1-13. - Notes: Controversy exists: different countries recommend different first‑line drugs. The U.S. guideline favors allopurinol and advises avoiding febuxostat in patients with cardiovascular disease, whereas the FAST trial found no increased risk with febuxostat. Probenecid, another uricosuric agent, is available in China. Chinese guidelines (2019 and 2024 updates) provide separate recommendations on drug selection and urine alkalinization; they suggest that sodium bicarbonate may be unnecessary, but hydration remains crucial. **Han Chinese individuals should be screened for HLA‑B*5801 before starting allopurinol**; carriers account for 7.4 % of Han Chinese, 0.7 % of Caucasians and Hispanics, and have a three‑fold higher risk of allopurinol‑induced hypersensitivity syndrome, a potentially fatal condition involving extensive skin peeling. The 2020 ACR guidelines recommend screening for these groups. Initiation of therapy can temporarily increase flare‑ups, so anti‑inflammatory prophylaxis for 3–6 months is mandatory; discontinuing uric‑acid‑lowering drugs because of pain is a common cause of treatment failure. When an attack occurs, additional anti‑inflammatory medication should be added per medical advice, not the uric‑acid‑lowering drug. Target levels are expressed as <6 mg/dL (≈360 µmol/L); Chinese labs typically report µmol/L. Asymptomatic hyperuricemia is addressed separately in Section 6, Item 19. Sugar‑sweetened beverages and alcohol are discussed in Section 2, Items 7 and 19. 〔100〕 〔100〕 〔438〕 〔211〕 〔6190〕 〔1.01〕 〔1.47〕 〔1.03〕 〔1.03〕 〔1.73〕 〔6128〕 〔60〕 〔0.85〕 〔7.2〕 〔8.6〕