Proposed Topic (Most preferred): :
Clinical Safety and Quality Service II (Projects aiming to enhance clinical safety and outcomes, clinical governance / risk management)
Proposed Topic (Second preferred): :
Clinical Safety and Quality Service I (Projects aiming to improve efficiency and effectiveness of care delivery to meet international standards)
Authors (including presenting author) :
Chang LF(1), Sin PY (1), Lau KO (2)
Affiliation :
(1) Department of Medicine, Diabetes & Endocrine Centre, Queen Elizabeth Hospital
(2) Department of Medicine, Diabetes & Endocrine Centre, Kwong Wah Hospital
Introduction :
Lipohypertrophy (LH) is a common skin complication among patients using insulin and it can worsen glycemic control and increase risk of hypoglycemia. Improper injection technique: needle reuse, improper injection site rotation and inappropriate needle size contribute to LH. LH can be detected by visual inspection and manual palpation, with improved injection practice, LH can be resolved and prevented. An evidence-based structured patient education program on manual detection, management and prevention of LH advocated by AHKDN was introduced to QEH DM center since June 2023.
Objectives :
1. To promulgate evidence-based method to detect LH
2. To evaluate the effectiveness of a structured patient education program on management and prevention LH
Methodology :
Study period: 1/6/2023-8/1/2024
Recruitment period: 1/6/2023-13/7/2023
Twenty patients using insulin with LH were recruited from the MRAM report education class.
Firstly, patients were educated on risk factors and consequences of LH as well as proper injection technique to prevent and manage LH. Secondly, they were assessed by 2 diabetes nurses, trained and qualified on palpation method, to detect LH. Thirdly, patients were required to redemonstrate the palpation method to identify the LH themselves.
Then two nurse clinic visits after class were arranged for them: i) at one month after for insulin titration if needed; and ii) at 6 months after for reviewing the condition of LH and injection technique and practice.
Result & Outcome :
Thirteen patients have improved injection practice after education: i) needle reuse was reduced from 31% to 15%; ii) systematic injection site rotation was increased from 15% to 77%; iii) appropriate needle (4mm or 5mm) use was increased from 77% to 92%. No new LH was developed during the study period.
Eleven out of 13 patients had their LH size reduced by 50% to fully resolved. Two patients had their LH remained the same size. One patient was found still injecting onto the LH area, the other has his LH improved from severely bulging out and tender to flat and moderately soft.
Conclusion
The above results showed that evidence-based method in detecting LH and structured education program is effective in management and prevention of LH. However, the small sample size and short study period limits its representativeness.
