Authors (including presenting author) :
LEUNG SM (1), KWAN YMJ (1), LEUNG HSS (2), MAK KP (2), WONG KK (2), FONG L (2), CHAN SKE (1), POON MY (1)
Affiliation :
(1) Centre for Diabetes Education and Management, Our Lady of Maryknoll Hospital.
(2) Department of Medicine & Geriatrics, Our Lady of Maryknoll Hospital.
Introduction :
According to the Diabetes Mellitus (DM) workload statistics from Hospital Authority, the projected number of DM patients will reach 627,000 in 20241. The DM Target Active Intervention (TAI) program is designed to enhance service capacity and specialty-based care planning. Targeted DM patients are stratified according to the complexity of the disease progress to receive corresponding care.
Objectives :
Early detection and prompt management delivery to patients with early stage of Diabetes Kidney Disease (DKD) and associated risk factors are effective strategies to decrease the progression of DKD. A newly developed 2-session education class incorporated with self-efficacy theory and empowerment theory is designed to empower participants’ self-management through self-directed behavior changes through realistic goal settings, ongoing support for goal attainment, and addressing patients’ psychosocial concern.
Methodology :
Participants with type 2 DM complicated with stage G3a to G3b DKD were recruited from 4/2020 to 3/2021 through metabolic risk assessment in a nurse-led DM clinic in OLMH. Targeted participants were invited to join 2 non-identical group-based education sessions conducted by diabetes nurses. Before starting the class, participants were given a graphic reminder to illustrate their current stages of DKD categorized by Kidney Disease Improving Global Outcomes (KDIGO) 2021 classification. At the end of session 1, a goal setting form was designed to facilitate participants to implement individualized action plan to optimize their glycemic and blood pressure control. The level of achievement would be evaluated and further discussed in session 2.
Result & Outcome :
Outcome evaluation included the change of eGFR, HbA1c at baseline (T0) & 2-3 months(T1). Paired Sample t Test was used to compare their mean differences before & after the intervention. Per-protocol analysis was conducted as a sensitive analysis to identify the effects of intervention among participants who received 2 education sessions. A self-developed 6-item questionnaire was used to address their feedbacks through post-intervention telephone interviews. Majority of participants had reported“Satisfied” on the overall satisfaction level (Group 1: 100% vs Group 2: 83%). The feedbacks from Group 1 had demonstrated out-weighted benefit in improving their psychosocial concerns on disease management (Group 1: 70% vs Group 2: 50%). More than 70% of them recognized the normal blood pressure range (Group 1: 74% vs Group 2: 92%), whereas more efforts should be paid to remind their target HbA1c and eGFR levels (HbA1c, Group 1: 45% vs Group 2: 50%; eGFR, Group 1: 40% vs Group 2:: 17%). Total 127 participants were recruited, 80 of them had attended 2 education sessions (Group 1), whereas 20 participants attended first session only. The mean age of Group 1 was 69.2±6.8, with 51% were male. Their mean duration of being diagnosed type 2 DM were 20.9±8.8. The baseline HbA1c level was 7.2±0.7, and eGFR level of Group 1 was the lowest as compared with those attend first session (Group 2) and defaulted (Group 3) (Group 1: 46.5±9.1 vs Group 2: 50.4±11.2 vs Group 3: 50.0±8.3). The baseline demographic & clinical characteristics of participants (Group 1) showed no statistically significant difference among the group. It was alarming that 44% of them had already developed stage G3b DKD as compared with Group 2 (25%) and Group 3 (33%).By the end of study, participants from Group 1 had showed no reduction in HbA1c level(Group 1: 7.2±0.7 vs 7.3±0.9).A compelling effect was found with statistically significant improvement in eGFR level in Group 1 (46.5±9.1 vs 48.6±11.1, p=0.011).
