Proposed Topic (Most preferred): :
Clinical Safety and Quality Service III (Projects aiming at quality service to patients and their carers)
Authors (including presenting author) :
CHAN SOY; CHAN HM; HUI SSC; POON CY; YIP LF
Affiliation :
Princess Margaret Hospital
Introduction :
Diabetes Mellitus (DM) is often comorbid with macrovascular and microvascular complications, contributing the greatest challenges to health care system. The management of DM requires ongoing lifestyle modification, treatment adherence and clinical follow-up. COVID-19 outbreak and isolation made patients unable to access the health care institution. With advancement of technology, telehealth and CGM not only provides another option to enhance patient accessibility and empowerment on DM management but also help in reduction of congestion of out-patient clinic and risk of cross infection.
Objectives :
To investigate the impact of telehealth on self-management and glycaemic control among patients with DM on CGM To evaluate the acceptability of Telehealth as an alternative care delivery in DM Nurse Clinic
Methodology :
Data was collected from June 2022 to May 2023. Eligible participants were adult DM patients using insulin with Haemoglobin A1c (HbA1c) >7.5%. Participants were arranged the 1st Telehealth DM nurse follow-up 1-week after starting CGM, thereafter regular follow-up 3-4 sessions in 26-week. Participants follow-up Endocrinologist and DM nurse joint clinic at the 12-week. CGM report was reviewed to assist hypoglycaemic prevention, lifestyle modification and medication adjustment. HbA1c was checked at the 0-, 3- and 6-month. Satisfaction survey on Telehealth; pre/post questionnaires on Summary of Diabetes Self-Care Activities Assessment (SDSC-14 Modified) and Diabetes Distress Scale-17 (DDS-17) were completed to evaluate the lifestyle and diabetes distress change.
Result & Outcome :
Among 28 enrolled participants, the mean age was 47.2+/-16.8 years; 10 (35.7%) were male, 18 (64.3%) were female. The mean HbA1c reduced from 9.5+/-2.2% at baseline to 7.9+/-1.4% at 3-month and 7.8+/-1.6% at 6-month (Ps<0.001). CGM metrics were consistent with findings with mean time in range (3.9-10.0 mmol/L) increased from 57% to 77%. 26 participants completed pre/post questionnaires on SDSC-14 modified and DDS-17, the mean score of hypoglycaemia management improved from 4.0+/-3.2 to 6.0+/-1.9 (p=0.005), exercise activity improved from 2.6+/-2.0 to 3.1+/-1.9 (p=0.046), medication adherence improved from 6.8+/-1.4 to 7.2+/-0.3 (p=0.039); and the mean score of Regimen-related distress reduced from 3.4+1.0 to 3.1+1.0 (p=0.034). 25 participants completed the Satisfactory Survey on Telehealth and average score was 4.4+/-0.5 out of 5. The study demonstrated telehealth provides positive outcomes on improvement of glycaemic control and self-management. The participants accepted telehealth as another alternative care and has potential to use in other DM populations.
