Authors (including presenting author) :
Chui OL(1), Chan OY(2), Hui SS(1), Chan KW(2), Hung HF(2), Chung CH(2), Chau SM(2)
Affiliation :
(1) Specialist Out-patient Clinic, Princess Margaret Hospital (2) Department of Medicine & Geriatrics, Princess Margaret Hospital
Introduction :
Continuous Glucose Monitoring (CGM) system is effective in improving diabetes control and strengthen patient empowerment. We have conducted a pilot CGM program to explore the use of CGM and telemedicine in the outpatient setting in Hong Kong.
Objectives :
To evaluate the effectiveness of using CGM on diabetes control and patient empowerment; to explore patients' willingness and feasibility of using CGM at the outpatient setting; to explore the use of CGM with telemedicine in diabetes care delivery
Methodology :
Data was collected from March 2021 to May 2022. Inclusion criteria were Type 1 or Type 2 Diabetes Mellitus patients who were having insulin therapy, CGM-naive, using smart phone and regularly follow up at Diabetic Clinic. 50 diabetic patients were recruited to enter our program for six months, in which they received 2 CGM sensors, attend six diabetes nurse education sessions and phone contacts; and two endocrinologist consultation clinic at third and sixth month. Blood for Glycated Haemogliobin (HbA1c)were taken and they need to fill in 4 questionnaires for evaluation.
Result & Outcome :
Results: There was a significant mean reduction in HbA1c from 8.61% (± 1.56%, p<0.002) to 7.93% (± 1.27%, p< 0.001) at third month and kept at 7.94% (± 1.24%, p< 0.004) at sixth month. There was also a significant increase in patients with favorable Time Below Range <3.0 mmol/L (Target <1% of time) at sixth month (from 26.5% to 67.5%, p<0.001). In DDSS-17, the mean item score of overall diabetes related stress had been reduced from 2.9 (± 0.7) to 2.7 (± 0.7), p= 0.035; while the mean item score of the distress related to emotional burden reduced from 3.4 (± 1.0) to 3.1 (± 0.9), p=0.014. Patients who were neutral about CGM trustworthiness (score 3.2 ± 0.8) in GMSS were open to use CGM (score 3.9 ± 0.6) and were more inclined to agree CGM could replace SMBG (score 2.4 ± 1.1). 84.1% patients would continue to use CGM in future and 77.3% of patients preferred to use CGM more than SMBG. In QETS, 93.2% of patients expressed they feel comfortable (mean item score 4.2 ± 0.6) to discuss with health care professionals about diabetes control with the aid of CGM during phone follow-up, 79.5% of patients agreed telehealth is an acceptable way to receive healthcare service and 84.1% of them were satisfied with telehealth system (mean item score 4.1± 0.7). Outcome: This pilot study showed that the use of CGM in diabetes patients have statistical significantly improvement in diabetes control in three months without having extra emotional or behavioral stress and a reduction in time with severe hypoglycemia, and these beneficial effects were sustained for 6 months. Diabetes patients also showed acceptance to use telemedicine in diabetes care delivery. Our pilot study showed promising results in establishing the benefits and role of CGM in outpatient diabetes care and care delivery using telemedicine. In the future, we would further explore and solidify the use of CGM in primary care setting and inpatient care setting.
