Authors (including presenting author) :
Lau WH(1), Wong MT(1), Tsang KY(1), Chung WH(1), Lai ML (1), Leung SY(1), Chiu WH(1), Leung KW (1)
Affiliation :
1) Department of Family Medicine, NTEC
Introduction :
Type 2 diabetes is a progressive condition that requires adjusting the treatment plan over time. As the disease progress, insulin may be added to attain the target glycemic control. Initiation of insulin therapy is a common treatment regime for patients who fail to achieve glycemic targets in the General Out-patient Clinics (GOPCs). However, due to the high demand, Family Medicine specialist can only review the insulin dose every 16 weeks, which may lead to delay in achieving treatment target. Therefore, a protocol driven nurse-led insulin titration program (NIT) was piloted in Fanling Family Medicine Centre of New Territories East Cluster from August 2020 with the aim to titrate the insulin dosage to reach optimal glucose level before subsequent doctor consultation.
Objectives :
-To ensure that patients achieve glycemic target with minimal risk of hypoglycaemia. -To empower patients with the management and monitoring of insulin therapy.
Methodology :
The program started with an insulin titration protocol developed with the conjoined effort of Family Medicine specialist and Diabetes nurse specialist. The content of the program included empowerment of the patients who required insulin with self-monitoring blood glucose,compliance of the medication regime and other lifestyle modifications. The program was designed to deliver 4 nurse face-to-face interviews supplemented with phone follow up before the doctor’s review. Nurse titrated the insulin dosage according to protocol and phone follow up the compliance and response. The HbA1c change of the NIT program was compared with the patients in the same period of the previous year without NIT (control)
Result & Outcome :
A total of 36 patients were recruited to the NIT program between 1/8/2020 and 30/4/2021. The average HbA1c of the NIT program patient reduced from 9.531% at 1st doctor visit to 8.519% at 2nd doctor visit (i.e. -1.012%), while the control group patients reduced from 9.414% at 1st doctor visit to 8.961% at 2nd doctor visit (i.e. -0.453%). The results showed that a protocol-driven nurse-led insulin titration program may help to improve glycemic control in patients initiated insulin therapy
