Authors (including presenting author) :
LAU WH(1),HUI LC(1)(2),TSE TK(1)(2),KOO WY(1)(2),YIP KY(1)(2),LEUNG SH(1)(2),KWAN K M(1)(2),CHEN XRC(1)(2),Li YC (1)(2)
Affiliation :
KCC Department of Family Medicine & General Out Patient Clinic
Introduction :
Type 2 diabetes (T2DM) is one of the most common chronic diseases in the primary healthcare setting. There are around 58000 DM patients were under the care of KCC General Outpatient Clinics in 2022.Hypoglycemia is one of the high-risk acute complications of T2DM and it is a major barrier to achieve optimal glycemic control. The consequences of hypoglycemia include increasing risks of cardiovascular complications, cognitive impairment, fall and mortality, affecting quality of life, and increasing health care cost. To strive for a balance of good glycemic control and hypoglycemia risks, proactive strategies and management in hypoglycemia prevention were implemented in KCC GOPCs from 3Q 2019.
Objectives :
1.To identify high-risk groups of hypoglycemia among T2DM patients in KCC GOPCs. 2.To enhance service quality in the prevention and management of hypoglycemia. 3.To ensure timely management of hypoglycemia among T2 DM patients. 4.To empower T2DM patients and family members and caregivers on the prevention and management of hypoglycemia. 5.To reduce the incidence of severe hypoglycemia and hospital admission among T2DM patients.
Methodology :
Implementation of proactive strategies in a three-pronged approach: 1.Patients with high-risk DM medications:T2DM patient list with HbA1C<5.5 % and who were using sulphonylurea or insulin were retrieved from the CDARS periodically. Responsible doctors would adjust medication management plan to avoid the progression of medication related hypoglycemia. 2.Patients with history of severe hypoglycemia(SHG):Lists of T2DM patients who had history of severe hypoglycemia and hospital admission in the past one year were delivered to individual clinics. Data lists and precipitating factors were explored for arrangement of nursing-based interventions to patients and carers within 3 months, and reviewed for any recurrent hypoglycemia in 6 months. 3.Patients with on site high-risk of hypoglycemia :T2DM patients who had clinic Hstix or serum fasting glucose reading less than 3.9mmol/L were identified, immediate onsite hypoglycemia education and timely clinical management would be provided. On the other hand, ongoing service training, clinical practice alignment, and guideline of “Management of hypoglycemia in KCC community-based GOPCs" were endorsed and uploaded to the department website. Starting from 1Q 2022, the pilot technological strategy of continuous glucose monitoring (CGM) was introduced for the enhancement of hypoglycemia management in KCC GOPCs. The strategies were engaged to all front-line doctors, nurses and supporting staff via departmental-wide promulgations.
Result & Outcome :
There are positive outcomes and the ultimate objectives are achieved. From 3Q 2019 to 4Q 2022, 1510 of Type 2 DM patients were detected with hypoglycemia upon GOPCs follow-up appointment and timely onsite immediate hypoglycemia education was provided. 88% of severe hypoglycemia patients had attended nurse intervention sessions. The top three predisposing factors of hypoglycemia were related to diet, medication and sick day.86 % of those patients reported no recurrent hypoglycemia in 6 months. The overall patient feedbacks are positive and encouraging. In addition, the headcount of hypoglycemia admission dropped from 355 to 279 from 2Q 2018 to 2Q 2021 despite a gradual increase in T2DM patient load yearly (about 5%). Similarly, the hypoglycemia hospital admission rate was significantly dropped from 0.69% to 0.49%. (P< 0.001).From 1Q 2022, 78 of DM patients with persistent hypoglycemia were referred to perform continuous glucose monitoring program. In conclusion, implementation of proactive hypoglycemia strategies increasing patients' awareness of hypoglycemia, empowering staffs, patients and carers on prevention and management of hypoglycemia, enhancing service quality and patient safety, and decreasing hospital admission rate with the aim to ensure quality and safety patient care in the primary health care setting and bringing better health to our community.
