Telemedicine for diabetes using the HA Go mobile app developed by the Hong Kong Hospital Authority (HA) is shown to be effective, as reported Ms Maisy Mok, Nurse Consultant (Diabetes) of the HA Kowloon East Cluster, at the 26^th Diabetes and Cardiovascular Risk Factors ? East Meets West Symposium.

HA Go is a one-stop, secure mobile platform tailor-made to include HA teleconsultation functions, aiming to connect with patients beyond hospital care and empower them to manage their own health. Telemedicine practice on HA Go commenced in July 2021. [https://www2.ha.org.hk/hago/en/about-ha-go/ha-go/what-is-ha-go]

“Home monitoring of selected patients with type 1 or type 2 diabetes mellitus [DM] can be done through the ‘self-monitoring’ feature in HA Go, where data from patients’ self-monitoring blood glucose [SMBG] meters can be conveniently transferred via Bluetooth to their devices with HA Go installed and subsequently uploaded to the HA Clinical Management System. Continuous glucose monitoring [CGM] reports can similarly be shared through HA Go. These data would then be discussed on-screen during video teleconsultation with patients and their caregivers/relatives who may join the interactive session from a different location,” said Mok. “Additionally, the DM Care mini app within HA Go provides educational materials on diabetes care and self-management.”

Outcomes were positive with Teleconsultation in Diabetes Nurse Clinic pilot programmes conducted from 2021 to 2023 in the New Territories West Cluster (NTWC), New Territories East Cluster (NTEC) and Kowloon West Cluster (KWC), each having different objectives/aims, with the telehealth mode of care well accepted by both patients and healthcare professionals.

“For NTWC, which focused on patient empowerment and drug compliance reinforcement in stable patients [n=84], evaluation after 6 months of intervention found similar clinical outcomes for the telehealth care group [n=42] and the conventional DM nurse clinic care group [n=42]. Results also showed excellent patient satisfaction and attendance rate for the telehealth group,” reported Mok. “No significant between-group differences were found in levels of HbA_1c [7.18 vs 7.43 percent; p=0.320], total cholesterol [3.95 vs 3.98 mmol/L; p=0.854], LDL-cholesterol [2.08 vs 2.04 mmol/L; p=0.835], HDL-cholesterol [1.22 vs 1.12 mmol/L; p=0.875] and triglyceride [1.40 vs 1.62 mmol/L; p=0.253].”

NTEC aimed to explore a new service model and replace part of on-site in-person consultation with teleconsultation for patients requiring insulin therapy and titration (n=27). High patient satisfaction with the structure and process of the service model was similarly achieved, and the patients had improved glycaemic control (HbA_1c, 9.86 vs 8.22 percent for pre- vs post-teleconsultation; p=0.003). “We can also capture extra information on the patients’ home environment during teleconsultation,” added Mok.

“KWC’s focus was on the use of CGM, hypoglycaemia prevention, lifestyle modification and medication adjustment. All 28 patients were initially required to attend an in-person visit for CGM installation. Having teleconsultation in the subsequent 26 weeks led to improved glycaemic control, with patients’ median time in target glycaemic range of 3.9?10 mmol/L increasing from 57 percent at baseline to 77 percent at 6 months. Hypoglycaemia management, exercise and medication adherence also improved, and regimen-related distress reduced.”

“Overall, we found comparable quality of care between in-person consultation and teleconsultation. Despite the small sample sizes, the positive experience and outcomes point to integrating telemonitoring, DM care applications, telephone hotline and teleconsultation to empower DM self-management as the way forward,” Mok concluded.