Authors (including presenting author) :
Lin LH (1), Chan WS (1), Yeung SK (2), Lai CY (3), Lo HM (2)
Affiliation :
(1) Diabetes and Endocrine Center, Prince of Wales Hospital, (2) Diabetes and Endocrine Center, North District Hospital, (3) Diabetes and Endocrine Center,Alice Ho Miu Ling Nethersole Hospital
Keyword 1: :
Diabetes Nurse
Keyword 2: :
Insulin titration
Keyword 3: :
Evidence-Based
Introduction :
Diabetes mellitus (DM) is a chronic condition that impacts millions of individuals globally, with insulin therapy being a vital component for many patients. According to the HA DM Data Report 2023,11% (n=64,251) of diabetic patients are reliant on insulin. However, effective management of insulin therapy presents challenges, including complex treatment regimens, the potential for hypoglycemia, and adherence difficulties. These situations are even worsen given with the long medical follow-up intervals in the Hospital Authority. In response to these challenges, nurse-led protocol-driven insulin titration programs have emerged as a promising solution. These programs offer interim diabetes reviews with individualized assessments, comprehensive diabetes education and management, as well as ongoing support, allowing diabetes nurses to play an essential role in optimizing glycemic control and improving patient outcomes through evidence-based practices.
Objectives :
1.To assess the change in HbA1c levels after the implementation of nurse-led insulin titration in three diabetes centres in the NTEC. 2.To determine whether the intervention reduces the frequency of Accident & Emergency Department (AED) visits or hospital admissions.
Methodology :
The study involved patients aged 18 and older with Type 1 or Type 2 diabetes and HbA1c levels over 7.5%. They received insulin therapy and were under the care of diabetes nurses from January to September 2024 at three diabetes centres in NTEC. Patients with significant cognitive impairments or psychiatric conditions affecting treatment adherence were excluded. Data were collected from electronic medical records over six months before and after implementing the nurse-led insulin titration program. This program involved diabetes nurses managing individualized insulin titration based on a protocol. Follow-up appointments or phone consultations were held weekly or bi-weekly to adjust insulin doses as needed. The primary outcome measured was the change in HbA1c levels from baseline to three to six months after the intervention. Secondary outcomes included the frequency of visits to Accident & Emergency Departments (AED) or hospital admissions related to diabetes management. Data analysis utilized descriptive statistics and paired t-tests to evaluate changes in HbA1c, with a p-value of less than 0.05 considered statistically significant. The study also examined whether the intervention reduced AED visits and hospital admissions for hypoglycemic or hyperglycemic events.
Result & Outcome :
A total of 273 patients participated, including 156 males and 117 females, with a mean age of 65.71 ± 13.08 years and an average diabetes duration of 18.22 ± 10.51 years. Among them, 196 were referred for hyperglycemia and 77 for hypoglycemia.
After the nurse-led insulin titration program, the mean HbA1c significantly decreased from 9.52 ± 1.98% to 7.97 ± 1.53% (p < 0.001). The number of AED visits and hospital admissions for hyperglycemia and hypoglycemia significantly decreased, from 49 to 6 and from 77 to 8, respectively. Insulin doses were adjusted 223 times upward and 236 times downward. These results indicate improved glycemic control and a reduction in acute care needs following the intervention.
Conclusions: Diabetes Nurse Clinics play a crucial role in bridging the gap between long medical follow intervals, ensuring patients receive continuous care and support. Provision of interim diabetes reviews, including regular blood glucose monitoring, medication adherence, and lifestyle adjustments. Additionally, nurse clinics provide protocol-driven insulin titration, which helps improve glycemic control, reduces hospital admissions, and decreases emergency department visits. These nurse-led programs highlight the importance of integrating evidence-based, patient-centered interventions into diabetes management to enhance outcomes effectively.
