Authors (including presenting author) :
LAU WH(1), Li CC (1)(2), Ng SH (1)(2), Mak WY (1)(2), Wong KM(1)(2), YIP KY(1)(2), LEUNG SH(1)(2), Hui LC(1)(2), LAM TM (1)(2),TSE TK(1)(2), Chen C(1) (2), KO SH (1)(2) Li YC (1)(2)
Affiliation :
KCC Department of Family Medicine & Primary Health Care (KCC FM & PHC)
Introduction :
Type 2 diabetes mellitus (T2DM) is a prevalent chronic disease in primary healthcare, with approximately 632,000 patients receiving care at KCC General Outpatient Clinics (GOPCs) in 2024.Despite the challenges posed by the high volume and complexity of diabetes cases, around 66.9% of patients have achieved key performance indicators (KPIs) with HbA1c levels below 7%(Statistics & Data Science Department, HAHO, 2024).However, there remains a concerning trend, with 0.53% of patients experiencing severe hypoglycemia requiring emergency care in hospitals from 2023 to 2024 (Statistics and Data Science Department, HAHO,2024). HbA1c is the gold standard for KPIs; however, it has limitation in detecting glucose variability, nocturnal, and asymptomatic hypoglycemia. Additionally, finger prick glucose testing provides limited blood glucose values and is unreliable for non-compliance and low motivated diabetes patients. Continuous Glucose Monitoring (CGM) is an advanced technology that offers real-time glucose readings and has emerged as an alternative tool for proactive management of hypoglycemia and hyperglycemia (ADA, 2021).
Objectives :
Implementation of CGM project started at KCC GOPCs in Q1 2022. The project aims to 1) Utilize advanced CGM technology 2) Enhance hypoglycemia management, minimizing associated diabetes complications and reducing hospital admissions; 3) Facilitate early detection of glucose variability and interventions to prevent complications from hyperglycemia and hypoglycemia; 4) Empower patients to achieve optimal glycemic control and prevent hypoglycemia; and 5) Ensure service quality in diabetes management.
Methodology :
The CGM project implementation follows a phased and proactive team approach, starting with a pilot in 2 main GOPCs and scaling up to 10 KCC community based GOPCs by Q3 2022. Target and focus groups for CGM include DM patients on insulin treatment with persistent hypoglycemia , on multiple insulin regimen with poor DM control (latest HbA1c≥ 8%),young DM patients aged ≤ 60 with poor diabetes control (latest HbA1c levels ≥ 10% ) ,those DM patients with extreme discrepancies between finger pricks Self-monitoring blood glucose and HbA1c values, and DM patients participating in sports or high-risk, occupations needing to avoid hypoglycemia. The indicated cases are selected and referred by senior family medicine doctors during consultations. Workflow promulgation and practical CGM training are provided to frontline diabetes link nurses and doctors through webinars, case conferences, and on-site training at QEH and OLMH diabetes centers. Timely nurse interventions, telehealth and doctor consultations are arranged, covering CGM sensors application, CGM reports interpretation, medication adjustment, insulin dose titration, patient education, and hypoglycemia prevention. The effectiveness of CGM implementation is evaluated by assessing clinical parameters, health behaviors, and the episodes of hypoglycemia and hyperglycemia. Feedback collection from staff and patients and further research on CGM are regularly reviewed to refine protocols, guidelines, and training programs.
Result & Outcome :
A total of 328 diabetes patients were recruited for CGMs from 1Q 2022 to 4Q 2024, with the majority (84.8%) on insulin therapy due to hypoglycemia. Positive outcomes included high patient satisfaction (97.6%) and staff job satisfaction (99.8%). Preliminary data analysis showed positive improvements in clinical HbA1c indicators (70.2%) within 6-9 months, around 65 % of patients requiring insulin dose titration. Additionally, 78.4% of patients reported a decrease in hypoglycemia frequency, and over 89.3% expressed a better understanding of blood glucose readings and diabetes management, leading to increased engagement in lifestyle modifications and reduced diabetes-related complications. In conclusion, implementation of CGM technology at KCC Family and Primary Health Care GOPCs has produced positive clinical outcomes, enhanced diabetes management and service quality.
