2-year review of Prediabetes Program in Primary Care Setting – Kowloon West Cluster

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Authors (including presenting author) :
Ng OYC(1), Lai WY(1), Cheung KL(1), Chan C(1), Luk W(1)
Affiliation :
West Kowloon General Outpatient Clinic, Family Medicine and Primary Care Department, Kowloon West Cluster
Introduction :
Prediabetes (PreDM) is a condition defined as having blood glucose levels above normal but below the defined threshold of diabetes. It is considered to have high chance of developing type 2 diabetes mellitus (T2DM). In Kowloon West Cluster (KWC), a retrospective multicenter 5-year (2002-2007) cohort study reviewed that more than one-fifth (overall annual incidence rate 5.981/100 person-years) of impaired fasting glucose (IFG) subjects in primary care setting progressed from IFG to T2DM within 5 years. Multidisciplinary PreDM Program at the West Kowloon General Outpatient Clinic (WKGOPC) has been commenced since 2015 which targets non-pharmacological interventions to PreDM patients with modifiable risk factors for disease progression.
Objectives :
To review the effectiveness of PreDM Program in improving (1) Body Weight and (2) Physical Activity Level
Methodology :
PreDM patients were screened and referred by KWC GOPC physicians or nurses at Sham Shui Po District. Inclusion criteria was either (1) fasting blood glucose of 5.6-6.9 mmol/L; or (2) impaired glucose tolerance (IGT) with 2-hour plasma glucose of 7.8-11.0 mmol/L after ingestion of 75 g of oral glucose load. Multidisciplinary PreDM Program includes nursing education, dietary modification by dietitian, and Physiotherapy exercise program. Measuring tools for change of body weight and physical parameters were (1) Body Mass Index (BMI); (2) limbs strength (number of dumbbell lifts by biceps curl and sit-to-stand in 30 seconds respectively); (3) aerobic capacity (number of steps in 2 minutes). Patient engagement of self-exercise compliance and behavioral change of exercise lifestyle were scored by self-administered Chinese version of Self-Efficacy for Exercise Scale (SEE-C) and International Physical Activity Questionnaire (IPAQ) respectively.
Result & Outcome :
468 patients were recruited into Physiotherapy exercise program from December 2015 to September 2018. Total 172 PreDM patients with mean age 61 completed a 3-months, 3 sessions (HKD50 per session) Physiotherapy program, in which 113 were women and 59 were men. BMI was significantly dropped (mean difference = 0.26kg/m2, 95% confidence interval [CI] 0.14-0.39; P < 0.001). Significant improvements in 3 physical parameters were shown. Upper limb strength (mean difference = 5.11, CI 4.41-5.83; P < 0.001), lower limbs strength (mean difference = 2.46, 95% CI 1.81-3.11; P < 0.001) and aerobic capacity (mean difference = 13.10, 95% CI 8.61-17.59; P < 0.001). Patients were in High Level of physical activity with IPAQ mean score (±SD) = 4863±2180. Self-exercise efficacy improved in SEE(C) with mean score = 59.11±16.48 versus 56.21±18.74 as baseline. To conclude, T2DM is one of the growing demands and economic burdens in worldwide public health issue. Current multidisciplinary-program model under collaborations of Physiotherapist, Family Physician, Dietitian and Nurse in primary care setting is cost effective in improving PreDM patients' body weight, physical parameters, activity level and self-exercise compliance, as to reduce the risk for disease progression. This model also concurs with Hospital Authority plan in primary care service development.

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