Proposed Topic (Most preferred): :
Clinical Safety and Quality Service I (Projects aiming to improve efficiency and effectiveness of care delivery to meet international standards)
Proposed Topic (Second preferred): :
Research and Innovations (new projects / technology / innovations / service models)
Authors (including presenting author) :
Mak MY(1), Lai YL(1), Tam G(1), Hung SY(2), Po Y(1), Cheung K(2), Leung WM(2), Wong M(2), Kng C(1)
Affiliation :
(1) Community Healthcare Services, Hong Kong East Cluster, (2)Family Medicine & Primary Health Care, Hong Kong East Cluster
Introduction :
In Enhanced Community Nursing Services (ECNS), most diabetic patients were referred from clinical and primary care settings for post-discharged DM care or suboptimal diabetes control with hypoglycaemia. Acutely, patients may experience hypoglycaemic episodes resulting in dizziness, falls and even coma. Patients may also be affected by hyperglycaemic episodes resulting in a hyperosmolar hyperglycaemic state or diabetic ketoacidosis. Despite the advent of newer hypoglycaemic medications to provide better glycaemic control, only 30% of patients with DM are meeting the HbA1c goal set forth by the American Diabetes Association. Continuous glucose monitoring (CGM) is a known technology that provides patients with the insight needed to achieve glycaemic control and to respond quickly to their glucose levels. Since 2022, there was a collaboration between Family Medicine (FM) and CNS on enhancing ECNS Pathway with CGM. It aimed to improve patients’ glycaemic control without increasing hypoglycaemia, particularly older adults with long duration of DM.
Objectives :
To study the effect of CGM use on glycemic parameters in patients with Type 2 DM. Furthermore, the glycemic response of individuals with and without using CGM after 8-week of ECNS education was also evaluated.
Methodology :
We retrospectively studied 70 adult patients referred from clinical and primary care settings. Three consecutive HbA1c, prior to and after 4 and 16 weeks of ECNS, were collected. Of those, 36 had been referred from FM for CGM, 32 completed the 1st and 2nd 14-day CGM using Freestyle Libre. The use of CGM prior to and after ECNS were analyzed for CGM metrics.
Result & Outcome :
Both HbA1c obtained after ECNS (without CGM) decreased significantly compared to baseline (9.21±2.79% vs 8.23±1.62%; P=0.019 & 9.21±2.79% vs 7.78±1.51%; P=0.001). Of those using CGM, the HbA1c obtained after 16 weeks decreased significantly compared to baseline (8.56±1.5% vs 7.54±0.79%; P<0.001). Patients with baseline HbA1c > 7% showed even more robust reduction after the 2nd CGM when compared to baseline and after the 1st CGM (8.9±1.4% vs 7.7±0.8%; P<0.001 & 8.3±0.9% vs 7.7±0.8%; P<0.001). On comparison of CGM metrics, there was a significant reduction in time spent in hypoglycemia (<3.9mmol/L) including severe hypoglycemia (<3mmol/L) (6±4.8% vs 4±3.4%; P=0.019 & 3.8±6.1% vs 1.8±3.4%; P=0.014). Time spent in severe hyperglycemia (>13.9mmol/L) was also decreased significantly (7.4±10.5% vs 3.8±4.3%; P=0.042) with CGM use. Conclusion: The study was demonstrated that CGM technology is practical to use and with special benefit to older adults on community home care.
