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): :
Research and Innovations (new projects / technology / innovations / service models)
Authors (including presenting author) :
Lau WH(1),Koo W Y(1)(2),Li CC(1)(2),Yip KY(1)(2),Leung SH(1)(2),Lam TM(1)(2),Tse T K(1)(2),Ko SH(1)(2),Chen C(1)(2),Li Y C(1)(2)
Affiliation :
KCC Department of Family Medicine & General Out Patient Clinics
Introduction :
Type 2 diabetes (T2DM) is a prevalent chronic disease in primary healthcare, with around 59,000 patients receiving care at KCC GOPCs in 2023. Despite the challenges posed by the high volume and complexity of diabetes cases, approximately 65.2% of DM patients have achieved key performance indicators (KPIs) with HbA1c levels below 7%. However, there is still a concerning trend where 0.55% of DM patients experienced severe hypoglycemia and required emergency care in hospitals from 2021 to 2022. HbA1c is the gold standard for KPI, but it has limitations in detecting glucose variability, nocturnal and asymptomatic hypoglycemia. Moreover, SMBG is not reliable from non-compliance patients. Continuous Glucose Monitoring (CGM) has emerged as an alternative tool, enabling proactive hypoglycemia and hyperglycemia management (ADA, 2019). CGM implementation at KCC GOPCs started in 1Q 2022.
Objectives :
1)Enhance hypoglycemia management, minimizing associated risks and reducing hospital admissions. 2)Early detection of glucose variability and intervention to prevent complications from hyperglycemia and hypoglycemia. 3)Empower patients to achieve optimal glycemic control and prevent hypoglycemia. 4)Ensure service quality in DM management.
Methodology :
CGM implementations is in a phased and proactive team approach, starting with a pilot in two main GOPCs and scaling up to all GOPCs by 3Q2022.The target groups for CGM are DM patients on insulin with persistent hypoglycemia and young DM patients with HbA1c levels above 10%.Workflow promulgation and practical CGM training were provided to frontline nurses and doctors through webinars, case conferences, and on-site visits in QEH and OLMH DM centers. Timely Nurse interventions and doctor consultations were arranged, covering application, report interpretation, medication adjustment, insulin dose titration, patient education, and hypoglycemia prevention. The effectiveness of CGM implementation was evaluated by assessing clinical parameters, health behaviors, and the episodes of hypoglycemia and hyperglycemia. feedback collection from staff and patients and further research on CGMs were regularly reviewed to refine protocols, guidelines, and training programs.
Result & Outcome :
Total of 187 diabetes patients were recruited, with the majority (95.6%) being on insulin therapy due to hypoglycemia. Positive outcomes included high patient satisfaction (99.8%) and staff job satisfaction (99.6%). Preliminary data analysis showed positive improvements in clinical HbA1c indicators (67%) within 6-9 months.63% of patients were required for insulin dose titration. Additionally, 78.5% of patients decreased hypoglycemia frequency and over 90% of patients increased engagement in lifestyle modifications and reducing diabetes-related distress. In conclusion, the implementation of CGM has enhanced diabetes management and service quality at KCC GOPCs.
