Authors (including presenting author) :
So TTY(1), Chan STK(2), Lee KY (3), Choy WY(3), Wong RYM(3), Cheung KKT(3), Fong FCS(2)
Affiliation :
(1) Central Nursing Division, (2) Health Resource Centre, (3) Diabetes and Endocrine Centre, Prince of Wales Hospital
Introduction :
Adoption of new technology is the trend of modern health care management. For diabetes glucose monitoring, Continuous Glucose Monitoring System (CGMS) is commonly discussed in recent years. Especially the new advance of CGMS could cover the areas that self-blood glucose monitoring (SMBG) unable to serve, e.g. analysis, continuous real-time results, trend detect, etc; more clinical pictures could be identified, monitored and treated accordingly. Of which, problems like nocturnal hypoglycaemia(hypo.), asymptomatic hypo., unawareness hypo. could cause severe health problems or even death. Appropriate CGMS could play a role on monitoring and facilitate clinical decision making.
Objectives :
1. To explore and co-relate participants’ SMBG habits, pattern of hypoglycemic attacks and concepts of CGMS; 2. To understand the clinically in needed group on their preference on use of CGMS; 3. To identify patient's road-blocks on use of new monitoring technology: CGMS.
Methodology :
A cross-sectional survey was conducted in October of 2018 in a HA diabetes patient support group activity. The survey for diabetes participants enquires few aspects: (1) history, attack time and severity of hypoglycaemia in the past 3 months; (2) habits of SMBG; (3) acceptance and road-blocks of not considering CGMS.
Result & Outcome :
Total 109 survey were collected, 45 male, 64 female diabetes patients; mean age was 66 year-old (43-84); year of diabetes: 66% >10 years, 17% 5-10 years; 17% <5years; 95 % were type 2 diabetes; 78% follow up in SOPC, 22% in GOPC; 56% were insulin treated, of which more than 1/3 were on multiple insulin therapy (MDI). HbA1c were 7.91% (5.4-14.3% +/-1.57). Data shown 22.2% of participants do not have SMBG habit. Among this no SMBG group: 38% were insulin treated; 25% had recent hypoglycaemic attack(s), of which one reported to have severe hypoglycaemia in the past 3 months. Hence, glucose monitoring was in needed. However, the SMBG group also noted 19% did not have any record of BG results. Survey also noted overall 38% (41/109) of participants claimed they had recent hypoglycaemia attack(s), from 1-5 times/month, (average 2.1). The most common times of attack: 27% during sleep; 27% just wake-up; 46% when awake. Hence, use of CGMS, especially on patients have history of frequent hypo, severe hypo. or nocturnal hypo. were recommended. That could be a good clinical record of hypoglycaemic conditions and for appropriated drugs/insulin adjustment. However, 88% of participants did not consider about it,the 3 main reasons were: lack of related information; costing issue & did not perceive the clinical need. For the 6 participants who had experience of CGMS usage, they gave the overall rating 60-100 marks (mean =80 marks), good and constructive comments given. The main reason of not using it again was the costing issue. Survey also enquired participant’s preference on the use of CGMS if excluded the costing factor: 61% showed they would try it. Use of CGMS could enhance diabetes control, identify hypoglycaemic risk, pattern, time and facilitate treat-to-target. However, costing and inadequate relevant information would be the road-blocks for clients to use the new technology for diabetes care. Hence, program from the HA or the government to subsidize those high risk group of clients for CGMS would be a long-term need. Policy might reduce the overall health cost and hospital admissions, also to promote people’s health in return.
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