Authors (including presenting author) :
Wong KW, Wong SN, Wong AL, Chan PF, Chao DVK
Affiliation :
Department of Family Medicine and Primary Health Care, Kowloon East Cluster, Hospital Authority, Hong Kong
Introduction :
The eight general out-patient clinics (GOPCs) of Kowloon East Cluster (KEC) have served more than 50,000 diabetes patients in 2019. With the increasing number of diabetes patients indicated for insulin therapy, we have set up diabetes clinics under Risk Assessment and Management Programme in GOPCs since 2011. With the support of diabetes nurses, family medicine specialists initiate insulin therapy for indicated patients in community. This aims to enhance their diabetic control and reduce the number of referrals to secondary care.
Objectives :
To investigate the clinical outcomes of type 2 diabetes patients who have joined the insulin initiation programme in a GOPC of KEC.
Methodology :
A before-after study design was employed. All type 2 diabetes patients who had been initiated insulin in the programme in 2017 and 2018 of a GOPC were recruited. Basic demographic information and relevant clinical information were retrieved by medical record review. Latest clinical information was compared with that before insulin initiation. The main clinical outcome was mean glycosylated haemoglobin (HbA1c).
Result & Outcome :
Sixty-seven diabetes patients joined the insulin initiation programme in the study period. The mean age was 63.8 (SD = 9.7) years, and 58.2% (39/67) were male. They had diabetes for an average of 15.0 (SD = 6.2) years. At baseline, the mean HbA1c, systolic blood pressure (SBP), diastolic blood pressure (DBP) and LDL-cholesterol (LDL) were 9.2%, 125.1 mmHg, 72.5 mmHg and 2.0 mmol/L correspondingly; 37.9% (25/66) and 38.8% (26/67) had microalbuminuria/proteinuria and estimated glomerular filtration rate (eGFR) < 60 ml/min/1.73 m2 respectively. After insulin initiation for an average of 22.2 (SD = 7.3) months, 71.6% (48/67) showed reduction in HbA1c and the mean HbA1c was lowered to 8.4% (p < 0.001). 26.9% (18/67) could achieve HbA1c < 7.5%. There were no statistically significant differences in BP and LDL before and after insulin initiation.
