Authors (including presenting author) :
Wong KM(1), Lam FY (1),Yip SM(1), Wong KY(1), Chan LZ(1), Li CY(1), Lee K(1), Chim CK(1), Angela Kwok ML(1), Jessica Chan T(2), Becky Ho MY(2)
Affiliation :
(1)Community Outreach Services Team(COST), New Territories East Cluster(NTEC)
(2)Central Nursing Devision, NTEC
Introduction :
Silent hypoglycaemia occurs commonly in eldery patients particularly who are on insulin and Sulfonylurea. It increases the morbidity and mortality of the patients, also results in emergenecy hospital admissions. In order to intensify the support to the elderly patients, a quality of care piloted project with use of “Real Time Continuous Glucose Monitoring(rtCGM) “ is piloted in NTECCOST.
Objectives :
• To detect unawareness hypoglycaemic attack
• To prevent hospital admission
• To empower patient’s self-management skill through individualized diabetic care.
Methodology :
• Elderly patients referred to CNS who has frequent hypoglycaemic attack or fluctuated blood glucose profile were recruited.
• CNS nurse with diabetic specialty training supported the patients according to the workflow with informed consent from patient/carer, application of smart device sensor to patient at home for monitoring of blood glucose. The nurse reviewed the data by (rtCGM) reader, interpreted the findings and informed patient/carer the result. Medical consultation was sought if necsssary followed by subsequent individualized diabetic care management visit.
• Evaluate project outcomes and patients/carers satisfactory survey.
Result & Outcome :
From 1 December 2019 to 30 November 2020, 14 elderly were recruited. The medain age was 79(64-87) . Duration of wearing time was ranged from 8-14 days. HbA1C was range from 6.4% to13.6%.
14 patients were found hypoglycemia. 68 hypoglycemic episodes were recorded in reader which showed hypoglycemia occured during midnight 54%(n=37), fasting21%(n=14), pre-lunch15%(n=10), pre-dinner7%(n=5), beforebed3%(n=2) with reading ranged from LOW to 3.9mmol/L. 12 patients(86%) were referred to doctor/DM Centre for early medication adjustment. 14 patients(100%) were successfully be convinced to change their lifestyle with specific health education provided including added bedtime/in between meal snacks, switch back to regular meal time and adjustment of drug administration time in order to prevent severe hypoglycaemic attack. No patient were admitted to hospital after evalulated. All patients/carers satistified to use the smart device for blood gloucose monitoring and reflected that the device is painless and easy to use.
This pilot study showed the benefit of using smart device for early detection of silent hypoglycaemia among the high risk group. It is feasible and applicable for proactive DM management in community setting.
