Authors (including presenting author) :
HUNG YW (1), HO KM (1), TAM SP(1), LAM PL(1), SIU TS(1), WONG SF(1), LEUNG MK(1)
Affiliation :
(1)Community Nursing Service, Our Lady of Maryknoll Hospital
Introduction :
Diabetes Mellitus (DM) is a growing problem in Hong Kong. Patients with DM (HbA1c >7.0%) had 3-fold rates of hospitalization than people without diabetes, the hospitalization risk increased with increasing HbA1c level. Insulin administration has a therapeutic effect towards older people with Type 2 Diabetes for achieving optimal glycemic control, but risk of hypoglycemia cannot be neglected. It is less recognized and under reported since hypoglycemic symptoms are nonspecific and atypical. However, self-administration of insulin is perceived as a complex task to older people, it requires cognitive and psychomotor skills that constitute the learning of different procedures.Proper technique of insulin administration is crucial. Individualized coaching in community setting was proved to be effective in improving both administration technique and HbA1c. Therefore, the project was launched to prove the effectiveness for glycemic control among older people in the community of Wong Tai Sin.
Objectives :
1) To enhance the insulin administration technique and knowledge of DM self-care among older people; 2) To improve the glycemic control among older people; 3) To prevent hypoglycemic attack among older people.
Methodology :
Individualized insulin administration coaching was adopted for Type 2 DM patients who are aged over 60, living at home, and require insulin administration. Patients with AMT ≥6 or their committed carers (for patients having AMT < 6) were recruited. Throughout the home visit, intensive education sessions related to insulin administration were delivered by designated nurses, tailor-made Insulin Administration Booklet and Videos shown on IPads were the teaching aids which focus on live demonstration at home setting. The pre & post HbA1c result, insulin administration technique checklist and Empowerment score of DM care were used to measure the effectiveness of the coaching. Episode of Accident & Emergency Department (AED) readmission due to hypoglycemic attack and the number of hypoglycemic attacks during home visit period were recorded.
Result & Outcome :
16 participants were recruited for the coaching from November 2019 to February 2020, the mean age was 79 years old. Enhancement of patient’s insulin administration technique and knowledge of DM self-care were reflected by the pre & post technique checklist scores and Empowerment scores. The mean insulin administration technique checklist scores increased from 16.2 to 21.3 for penfill insulin users (p=0.00), and from 11.8 to 18.0 for conventional syringe users (p=0.02), whereas the mean Empowerment scores of DM care increased from 11.6 to 19.1 (p=0.00). Regarding the HbA1c,only 11 out of 16 patients’ Pre and Post HbA1c could be retrieved from blood profile in CMS.90.9% (10 out of 11 patients) showed reduction in HbA1c after coaching, and the mean HbA1c decreased by 2.1% at 3-month after first coaching. None of the patients attended AED due to hypoglycemia. 68.8% of patients did not encounter any hypoglycemic attacks, remaining 31.2% experienced 1-4 episodes of hypoglycemic attack.
