Authors (including presenting author) :
Go TT (1)(2), Ho MMH (2), Chau PH (2), Kwong SK (1), Wang HL (1), Ko WK (1)
Affiliation :
(1)Department of Family Medicine and Primary Health Care, Queen Mary Hospital, (2)School of Nursing, LKS Faculty of Medicine, The University of Hong Kong
Introduction :
Insulin treatment should be initiated in Type 2 diabetes (T2DM) patients who fail to control their glycemic level with oral antidiabetic agents (ODA) in order to reduce the risk of diabetic complications. Group-based pre-insulin class is one of the commonly used methods in Hospital Authority for promoting insulin initiation amongst T2DM patients with suboptimal diabetic control. It was launched since 2015 in one general outpatient clinics (GOPCs) in HKWC. However, there is little information describing the insulin initiation rate for those referred to the pre-insulin class.
Objectives :
This study aimed (1) to estimate insulin initiation rate for T2DM patients referred to the pre-insulin class, and (2) to identify factors related to the insulin initiation for those patients referred to the pre-insulin class.
Methodology :
A retrospective cohort study was conducted. All the T2DM patients referred to the pre-insulin class of the GOPC in HKWC for preparation of insulin initiation were identified from administrative databases (CDARS, CMS & OPAS) within the study period (1 January 2015 - 31 August 2020). Patient demographics, comorbidities, medications, laboratory test results, class attendance and the rate of insulin initiation during the subsequent follow-up consultation (within three months) were collected and analyzed by two samples independent t-tests, chi-square tests and logistic regression. Primary outcome was “insulin initiation” which is dichotomous with yes/no during their subsequent follow-up consultations after classes.
Result & Outcome :
Total 323 patients had been identified from the databases. Both attended and unattended group was shown to be no significant difference in sex, age, ethnicity, occupation, and lifestyle. 78.6% of the referred patients attended the class. The insulin initiation rate of attended patients was 22.8% and those unattended (17.4%). Stepwise logistics regression showed that self-monitoring blood glucose (SMBG) and HbA1c were significantly associated with insulin initiation (OR=2.13, 95% CI=1.22, 3.7; p-value =0.007) and (OR=1.28, 95%CI=1.02, 1.61; p=0.03) but with no other factors including class attendance. This study added to the understanding for the patients who were referred to the pre-insulin class and gave an implication with approach focusing on SMBG & HbA1c for promoting insulin initiation. Further, the insulin initiation rate was low even within the attended group. Therefore, future studies should explore effective approach to increase insulin initiation rate.
