Page 137 - Hospital Authority Convention 2017

Service Enhancement Presentations

F3.5 Clinical Safety and Quality Service I 14:30 Room 421

Multi-centre Collaboration Project: Evaluation on the Effectiveness of Diabetes Nurse Clinic in Treating Patient
Who Needs Initiation of Insulin Therapy
1
2
Leung LYE , Leung YSA , Mok PHM 3 HOSPITAL AUTHORITY CONVENTION 2017
3
1 Queen Mary Hospital, Yan Chai Hospital, United Christian Hospital, Hong Kong
2
Introduction
Clinicians are facing challenges when advising patients with type 2 DM to start insulin. Resistance on initiating insulin therapy
includes both psychological and knowledge based barriers. Hence referring patients to Diabetes Nurse Clinic (DMNC) for
insulin initiation is regularly practised in Hong Kong. However, inadequate studies were conducted to evaluate these nurse-
led DM intervention.

Objective
To evaluate the effect of DMNC on diabetic patient who needs initiation of insulin therapy.
Methodology
It was a multi-centred, and pre- and post-intervention evaluation, which was done from November 2014 to June 2015. 130
patients, who have been referred to DMNC for starting insulin therapy, were recruited from Yan Chai Hospital (YCH), United
Christian Hospital (UCH) and Queen Mary Hospital (QMH). Participants received Diabetes Self-management Education (DSME)
with instruction of insulin administration to patients and/or their care-givers in DMNC.

Results

The 130 participants had a mean age of 60.5 years old (SD=11.8, range=27 to 87), with a duration of DM at a mean of 11.9 + 9.2 Tuesday, 16 May
years. Their mean total contact time in DMNC was 147.2 + 66.0 minutes.

For glycaemic control, there was a significant reduction in HbA1c level at the end of the intervention (10.1 + 2.1% at baseline
versus 7.9 + 1.2% at the end of intervention, p<0.001). In view of other metabolic risk factors, there was significant reduction
in triglycerides (p<0.001), LDL cholesterol (p=0.04) and significant improvement in the HDL cholesterol (p=0.014). However,
there was a minor but significant increase in body mass index at the end of the intervention (mean increase=0.2190, 95%
CI=0.4376 to 0.0001, p=0.05).

To measure the effect of DMNC interventions on participant’s distress level, there was significant improvement (p<0.01) on
the Diabetes Distress Screening Scale (DDSS) at the end of the study. There was also significant improvement (p <0.01) on
Insulin Related Stress Score (IRSS), which measured participants’ distress level specific to insulin therapy.

For desirable diabetes-related behaviour changes, Summary of Diabetes Self-Care Activities (SDSCA) indicated a significant
improvements on general diet (p=0.004), DM specific diet (p=0.020), self-monitoring of blood glucose (p=0.001) and
hypoglycaemia management (p<0.001).

Conclusion
Apart from improving clinical outcomes, DMNC is also effective in decreasing distress levels and facilitating desirable
lifestyle modification of diabetes patient who needs initiation of insulin therapy. DMNC as a routine medical care is therefore
recommended.

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