Background
Diabetes mellitus is a metabolic disorder characterized by excessive glucose levels and less insulin or absent of insulin hormone in the blood circulation [
1]. As one of the world’s most prevalent diseases, diabetes is an expanding global health problem [
2]. The number of cases with diabetes has more than quadrupled during the past 3 decades in the world, rising from 108 million in 1980 to 422 million in 2014, and the global prevalence of diabetes has risen from 4.7% in 1980 to 8.5% in 2014 among adults over 18 years of age [
3]. In addition, the number of people with diabetes is going to be projected to 642 million across the world by 2040 [
4], which predominantly occur in low and middle-income countries [
5]. As a major cause of blindness, kidney failure, heart attacks, stroke and lower limb amputation, diabetes was estimated to cause 1.6 million direct deaths in 2016, and identified by WHO as the seventh leading cause of death in 2016 [
6].
China is the most affected country by diabetes over the world, and currently, more than 114 million people are estimated to have diabetes in China [
7]. During the past 30 years, the prevalence of diabetes has shown a dramatic rise in China, with less than 1% in 1980, 5.5% in 2001, 9.7% in 2008, and 10.9% in 2013 [
8‐
12]. Therefore, diabetes is widely accepted as a big challenge for China in the twenty-first century, which has the greatest prevalence as well as the largest absolute disease burden of diabetes in the world [
13].
Since its advent, both the number of Internet users and Internet access rate has continued to increase across the world during the past 3 decades (
https://www.internetworldstats.com/stats.htm). Currently, the Internet is a major information tool, both in people’s professional and private lives. and the advent of Internet has given rise to the exponential growth of information resources which has invariably provided a wider means of access to professional in meeting their immediate information needs [
14]. Among the Internet users, most use the Internet to seek online health-related information from general public health-related websites and discussion groups [
15].
According to the China Internet Network Information Center, the number of Internet users in China reached 802 million in 2018, and the Internet penetration rate was 57.7% [
16]. The Internet has become an important carrier for consumers to express their health information needs and search for health information. Furthermore, patients with chronic diseases are more willing to share experiences and seek help via the Internet [
15]. In order to meet the needs of the market, there are a large number of websites, apps and discussion groups created in China that start offering online disease and health counseling services for consumers [
17]. As a result, these sites have accumulated a large number of disease-related questions, from which we can mine a lot of valuable information about what the patients are concerned, and health providers like hospitals can make use of these questions raised by patients to improve their services such as patient health education, patient follow-up,et al.. However, there are no Internet-based analyses of health information needs pertaining to diabetes in China until now. Hereby, we report the health information needs regarding diabetes mellitus in China based on “39 Health”
(http://www.39.net/), a leading website for Chinese people seeking disease and health information.
In some previous study, Haihong Guo et el. analyzed hypertension-related questions, which studied a very limited amount of data of 2000 questions [
18]. Zongcheng Jia et el. studied cancer-related questions with a data of 1000 questions [
19]. As far as we are concerned, there is occasionality in the distribution of such a small amount of data, which in general can not represent the reality. And with the development of artificial intelligence, some traditional machine learning algorithm like SVMs and Naive Bayesian have been used to classify questions by feeding some features as BOW or TF-IDF extracted from the dataset into the algorithm [
20], which is not using the state of art technology.
To analyze the diabetes-related questions, we used a convolutional neural network to classify these questions, which is capable of capturing semantic level information. Based on the results of the classifier, we have further explored the hidden information in the data.
Discussion
According to the latest epidemiological survey, the prevalence of adult diabetes in China has reached 10.9% in 2013, and the prevalence of pre-diabetes has also reached 35.7%,and the prevalence of diabetes in adults younger than 40 years old was 5.9%,However, the treatment rate of diabetes in China is only 32.2%, and the control rate of diabetes is only 49.2% [
10]. Because diabetes is a long-term chronic disease, the daily behavior and self-management ability of patients is one of the keys to the control of diabetes, The patients who receive self-management education of diabetes had better control of blood sugar than those without education. At the same time, they had more positive attitude, scientific knowledge of diabetes and better self-management behavior of diabetes [
25]. Therefore, health education for diabetic patients or high-risk groups of diabetes should be strengthened in the future.
With the development of information technology, more and more patients with diabetics and their families are willing to get health information through the Internet to confirm the diagnosis of disease, patients’ physical condition, to share experiences in treatment, diet control, and to obtain social emotional support, so as to learn self-management of diabetes [
14]. According to the Europe digital health reports published in 2014, 75% of Europeans believe that the Internet is a good resource for seeking health information [
15]. Wagner and colleagues [
26] found that 52% of patients with diabetic would look for health informationthrough the Internet. Our study shows that the number of online questions about diabetes mellitus from 2003 to 2017 is on the rise except 2010 to 2012 and 2015 to 2016, In 2017, the number of online questions about diabetes mellitus was more than 10 times that of 2007. This shows that domestic consumers are increasingly searching for health information about diabetes through the Internet, and female consumers are more willing to ask questions online than male consumers.
Many studies have also shown that online health-related knowledge can influence individual health decisions and behaviors [
27]. on one hand,To study the diabetes health problems of consumers can let medical service providers understand their needs and provide better health care services;On the other hand, public information on diabetes health problems is largely influenced by medical service providers, such as treatment, drugs, diet and exercise. In order to understand these problems, consumers often ask for help in the internet, therefore, Understanding the needs of patients who have diabetics and what kind of problems they are anxious about are crucial for doctors, hospitals and other health care providers, which can be used to ameliorate patient education service and help patients to improve their disease management skills.
The diabetes problems on the internet were classfied into 12 topics by Zhang and Zhao [
28]:etiology and pathophysiology, signs and symptoms, diagnosis and examination, organs and body parts, complications and related diseases, drug treatment, treatment, health education and information resources, prognosis, society and culture, lifestyle and nutrition. Nutrition, diagnosis and examination Symptoms and related diseases are the three topics most frequently mentioned by consumers. Foxand Duggan [
29] and others found that the most topics for diabetic searched by patients were weight loss or weight control. This article divides the diabetes problem into nine categories:diagnosis, treatment, lifestyle, complication, maternity related, prognosis, health provider choosing, prevention, others. The analysis results show that domestic consumers are mainly concerned about the diagnosis of diabetes, treatment, lifestyle, complication, maternity related, Although this study suggests that all consumers pay more and more attention to diabetes lifestyle, only 1.23% of the questions about diabetes prevention, which indicates that The purpose of most consumers is not to know how to prevent diabetes, but to confirm the diagnosis to others after finding diabetic signals or to consult diabetics about their current treatment.
There is no difference in the concerns of different genders, but the concerns of different age groups are different.. Young people are more concerned about maternity-related issues, who are at an age suitable for childbearing. They may worry about problems like whether diabetes will be passed on to children or whether people with diabetes have fertility. While older people are more concerned about treatment and complications to alleviate the impact of diabetes on life. Many people in this age are using oral medication or insulin therapy. They are more eager to know the drug usage, efficacy and adverse reactions.
As the treatment of diabetes, insulin, metformin, Xiaoke pill and gliclazide were the most frequently asked drugs. Insulin plays important roles in controlling hyperglycemia. Compared with oral medicine, insulin therapy involves more links, such as drug selection, treatment plan, injection device, injection technology, SMBG, action based on blood sugar monitoring results, etc. [
25,
30] Patients who begin to use insulin should master self-management skills related to insulin therapy through targeted education, understand the risk factors, symptoms and self-rescue measures of hypoglycemia,. Therefore, diabetic patients and their families have more problems in this regard,which suggests that health providers should teach patients and relevant medical staff more knowledge of insulin, so as to improve their attitude towards diabetes.
In terms of oral hypoglycemic drugs, metformin is the most concerned drug,which shows that the status of metformin in treatment is increasingly recognized, and metformin should be recommended as the first choice for diabetes treatment in chinese diabetes gudline. Xiaoke Pill is a kind of Chinese patent medicine, which is favored by many consumers because of the cheap price. Xiaoke Pill has the same hypoglycemic effect as glibenclamide, Compared with glibenclamide, Xiaoke Pill has a lower risk of hypoglycemia and a more significant effect on improving TCM symptoms related to diabetes mellitus [
31]. As for other oral medicines, with the increase of years, more and more new hypoglycemic drugs have been used in clinical practice, but the public’s attention to new drugs has not increased significantly, suggesting that doctors should be more active in the application of new diabetic drugs.
In terms of diabetic complications, consumers pay more attention to diabetic eye diseases, followed by diabetic nephropathy and diabetic foot. This is not consistent with that the common complications of diabetes in hospitalsare diabetic cardiovascular disease, diabetic nephropathy and diabetic foot [
32]. It may be related to the way we collect data (for example, some questions about diabetic cardiovascular complications may be classified into the heart Department. In the classification of complications, consumers pay more attention to the diagnosis and treatment of complications, but pay little attention to how to prevent complications, suggesting that medical professionals should give more guidance to patients in the prevention of diabetic complications.
The advantage of this study is that the data of health problems are all collected from 39 Health websites, which span a wide range of time and are collected without filters. It may represent the true distribution of diabetes-related problems among consumers to some extent. However, there are also some shortcomings in this study: first, There is no relevant analysis of the geographical and economic situation of the online questioners,second,the problems related to sports are not counted; last, there is no further detailed analysis of drug treatment problem of consumer concerns such as side effects, usage, adverse reactions, etc. It needs to be supplemented and improved in future studies.
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