Multi-Centre Evaluation Program to Assess the Effectiveness of Diabetes Nurse Clinic for Patients...
Transcript of Multi-Centre Evaluation Program to Assess the Effectiveness of Diabetes Nurse Clinic for Patients...
Multi-Centre Evaluation Program to Assess the Effectiveness of Diabetes Nurse Clinic for Patients with Newly Diagnosed Type 2 Diabetes Mellitus
Cheng MW Winnie QEH Kwan YM JoJo OLMH Hung SC Veronica TMH
Diabetes
• Prevalence of diabetes in HK: 700,000 • Type 2 Diabetes: 679,000 (97%) • A chronic disease relies on patients’ day-to-day
self-care
American Diabetes Association 2016 Standards of Care for Diabetes
“All people with diabetes should participate in Diabetes Self Management Education (DSME) to acquire the knowledge, skills, and ability necessary for diabetes self-care.”
Background
• 17 HA accredited Diabetes Nurse Clinics (NC) provide DSME • Newly diagnosed type 2 diabetes patient are referred to
Diabetes Nurse Clinics for DSME • Continuous evaluation of DSME is important • No standard evaluation tools and format
Nov 2014 to June 2015
Diabetes Centre of QEH, QMH, TMH, POH, OLMH
Obj: Evaluate the effectiveness of Diabetes Nurse Clinic in empowering newly diagnosed type 2 diabetes patients’ self-care efficacy
Methodology • Recruitment criteria: DM <2 years, ≥ 18 years old,
Cantonese speaking , not on insulin therapy • Arranged to attend DSME program
– Individual session (30 - 45 min @) OR small group (2.5–3 hr. @) – 2-3 sessions / patient in both programs
DSME Program Adopt Patient Empowerment Philosophy -
Interactive with lots of discussion, sharing, skill practice…
DSME Content 1. Realize “what is diabetes” and “why is it important to them”
2. Discuss ways to control blood glucose level such as:
• Understand how diet, exercise and DM medications help • Modify undesirable daily habit especially diet and exercise • Start home blood glucose monitoring and self-review the results • Manage hypoglycemia properly if any
Outcomes Measures Any improvement in: • Glycaemic control (HbA1c) • Lipid profile • Body mass index (BMI) • DM knowledge by “Diabetes Knowledge Test in Chinese
(CKDN)” • DM self-care activities by “Summary of Diabetes Self-Care
Activities (SDSCA)”
糖尿病知識測試問卷 CKDN 1. 下列那一句是正確的?
a. 如果冇話搞到昏迷, 糖尿病控制得唔係太好都冇問題
b. 尿裡面有一些糖係最好, 因為咁就唔會血糖低
c. 糖尿病如果控制得差, 久而久之,糖尿既併發症亦會有較大機會發生
d. 我不知道 2. 血糖的正常度數是:
a. 4-8 度 b. 7-15 度 c. 2-10 度 d. 我不知道
3. 日用的食油主要是:
a. 蛋白質 b. 澱粉質 c. 脂肪 d. 礦物質及維他命 e. 我不知道
4. 米飯主要是: a. 蛋白質 b. 澱粉質 c. 脂肪 d. 礦物質及維他命 e. 我不知道
5. 下列那一種併發症通常和糖尿病沒有關係? a. 睇野差咗 b. 腎功能差咗 c. 肺功能差咗 d. 我不知道
6. 如果你覺得自已有低血糖的症狀
(例如手震、出冷汗、頭暈),你應該: a. 即刻注射糖尿針或者服用糖尿藥 b. 即刻瞓低和休息 c. 即刻服食或飲用一些含高糖份的食物或飲品 d. 我不知道
7. 下列那一種食物可以隨意食幾多都得? a. 蘋果 b. 芹菜 c. 肉類 d. 蜜糖 e. 我不知道
8. 低血糖的原因是因為:
a. 胰島素太多 b. 胰島素唔夠 c. 運動唔夠 d. 我不知道
以下二條問題有多於一個的正確答案,請圈上你認為是正確的答案 9. 以下食物,那些是屬於蛋白質類?
a. 雞蛋 b. 魚類 c. 肉類 d. 白飯 e. 咸餅乾
10. 以下食物,那些是屬於高纖維類? a. 紅米/糙米 b. 菜 c. 麥皮 d. 白麵包
下列問題是有關過去七天你自我照顧糖尿病的習慣。如果你在過去七天你因病不能照顧自己,請回想至患病以前七天的情況。 SDSCA
0 1 2 3 4 5 6 7
1. 在過去七日,你有多少天跟隨健康的飲食計劃? □ □ □ □ □ □ □ □ 2. 在過去一個月,平均每星期你有多少天跟隨健康的飲食計劃? □ □ □ □ □ □ □ □ 3. 在過去七日,你有多少天進食五份或以上的生果及蔬菜? □ □ □ □ □ □ □ □ 4. 在過去七日,你有多少天進食高脂肪食物如紅肉或全脂製成品? □ □ □ □ □ □ □ □ 5. 在過去七日,你有多少天參與最少三十分鐘的體能活動?﹝持續的活動,包括步
行,並以分鐘計算﹞ □ □ □ □ □ □ □ □ 6. 在過去七日,你有多少天刻意做一些運動﹝如:游泳、步行、騎單車﹞而不是在你
家或工作之內的呢? □ □ □ □ □ □ □ □ 7. 在過去七日,你有多少天曾測試自己的血糖? □ □ □ □ □ □ □ □ 8. 在過去七日,你有多少天曾按醫護人員建議的次數測試自己的血糖?
□ □ □ □ □ □ □ □ 9. 在過去七日,你有多少天曾檢查自己的雙腳? □ □ □ □ □ □ □ □ 10. 在過去七日,你有多少天清洗自己的雙腳? □ □ □ □ □ □ □ □ 11. 在過去七日,你有多少天檢查你鞋子的內部? □ □ □ □ □ □ □ □ 12. 在過去七日,你有多少天服食建議的糖尿藥丸?
□ □ □ □ □ □ □ □ 13. 在過去七日,你有多少天注射建議的胰島素?(單純飲食治療或口服抗糖尿藥者無須
回答) □ □ □ □ □ □ □ □ 14. 在過去七日,你有多少天接受建議而外出時帶備糖果旁身? □ □ □ □ □ □ □ □ 15. 在過去七日期間,你曾否抽煙-即使一口? □ 沒有
□ 有,平均每天____________支
Subjects Number of Subject: 113
Sex Male: 70(62%) Female: 43(38%)
Age 21 – 83 (mean 54.9 ± 11.8)
Family Hx of DM Yes: 64(57%)
Employment Working: 70(62%) Retired: 26(23%)
Education Tertiary: 22(20%) Secondary: 66(58%) Primary: 22(19%)
Smoking Smoker: 14(12%)
DM Treatment Oral tablet : 76(67%) Diet only: 37(33%)
(27 Defaulted cases have been excluded)
Result: Diabetes Self-care Knowledge (CKDN)
Full mark: 10 N=113
Results: BMI
27.56
27.9
BMI
Before After
N=113
Results: Lab Tests
0
1
2
3
4
5
6
7
8
9
HbA1c LDL-C TC HDL TG
Before
After
N=113
Result: Summary of Diabetes Self-Care Activities (SDSCA)
N=113
Conclusion For newly diagnosed type 2 diabetes patients, the Diabetes Nurse Clinic DSME program is effective in: 1. Improving BMI, glycaemic & lipid control, patients’ diabetic self-care
knowledge 2. Helping patients to adopt 5 diabetes self-care activities in daily life –
a) healthy diet b) Exercise c) Home blood glucose monitoring (HBGM) d) Foot care e) Bring sugar (Hypoglycaemia)
IMPLICATIONS
Implications (1)
• Update and re-validate the DM knowledge test (CKDN)
• Develop an electronic record system in HA Clinical Management System (CMS)
Implications (2)
• Use same evaluation tools and outcomes parameters among all Diabetes Centre
• Multi-centre project with longer duration should be considered to assess its long-term effects in maintaining healthy lifestyles and reduce both metabolic and cardiovascular risks
Acknowledgement:
Diabetes Service Development Subcommittee (DSD), Specialty Advisory Group (Endocrinology), Hospital Authority.
Thank you!