Over 900 young people with diabetes provided with continuous glucose monitors significantly reduce the risks of severe hypoglycaemia and ketoacidosis
Since its launch in 2023, the “Jockey Club Support for Young People with Diabetes” has provided continuous glucose monitors (CGM) and diabetes management education to over 900 young people living with the disease since its launch in 2023. Analysis of the data show that continuous use of a CGM for 12 months significantly improves overall blood glucose levels in young people with diabetes. Furthermore, the hospitalisation rate due to diabetic ketoacidosis dropped significantly, by 85%, while the risk of severe hypoglycaemia leading to hospitalisations reduced by over 60% and that of severe hyperglycaemia by over 50%. This demonstrates that CGM technology can effectively help individuals to self-manage their condition and substantially reduce the risk of severe complications.
The “Jockey Club Support for Young People with Diabetes”, organised by Youth Diabetes Action (YDA) and CU Medicine, has provided continuous glucose monitors (CGM) and diabetes management education to over 900 young people living with the disease since its launch in 2023.
(From left) Professor Juliana Lui Nga-man, Assistant Professor and a health economist at the Department of Medicine and Therapeutics at CU Medicine; Professor Ronald Ma Ching-wan, S.H. Ho Professor of Diabetes and Head (Academic Affairs) in the Division of Endocrinology and Diabetes at CU Medicine; Ms Stella Lau, Executive Director of YDA; Dr Elaine Chow Yee-kwan, Associate Professor (Clinical) in the Department of Medicine and Therapeutics at CU Medicine.
Improved self-management of Type 1 diabetes can reduce risk of severe complications
Diabetes is a common condition characterised by chronic elevation of blood glucose. If not well controlled, it can lead to acute diabetic emergencies and long-term complications such as blindness and kidney failure. Diabetes is broadly divided into Type 1 diabetes, Type 2 diabetes and gestational diabetes. While Type 1 diabetes is traditionally the most common form seen in children, increasing obesity and other factors have contributed to increasing rates of young people being affected by Type 2 diabetes. It is estimated that more than 4,000 people are living with Type 1 diabetes in Hong Kong, China, including about 800 aged below 30. It is also estimated that more than 600,000 people are living with Type 2 diabetes in the city.
Due to the destruction of pancreatic insulin-producing cells, people with Type 1 diabetes depend on multiple daily insulin injections to maintain their blood glucose levels. They are particularly vulnerable to developing severe hypoglycaemia (low blood glucose) or diabetic ketoacidosis. Severe hypoglycaemia is not uncommon in young people with diabetes. Local research indicates that annually, for every 1,000 young people or children with Type 1 diabetes, 35 of them experience severe hypoglycaemic complications, which can lead to coma if not treated promptly.
Recent developments in diabetes technology have made it possible to monitor glucose levels continuously, providing a much more comprehensive assessment of glucose control compared to multiple daily finger-prick tests. These technological advances have also made it possible to link CGMs with devices such as insulin pumps, allowing for better glucose control. The provision of CGMs and insulin pumps is rapidly becoming the standard of care for Type 1 diabetes in many regions, and has resulted in improved glucose control and reduced risk of complications.
(Left)Dr Elaine Chow Yee-kwan highlights that by using CGM, people with diabetes can access their blood glucose data and reports at any time. This enables them to adjust their diet, exercise, and medication accordingly, without having to wait until their next follow-up medical appointment to know their blood glucose levels.
Enoch recalls he once fainted on the street and was admitted to hospital due to diabetic ketoacidosis, requiring a stay in the intensive care unit before being diagnosed with type 1 diabetes. He describes diabetes as a condition that ‘‘never takes a break”—even when travelling, he needs to adjust his insulin injections based on his daily activities and diet. He finds CGM convenient to use, as it allows him to monitor his blood glucose levels in real time and better manage his condition.
Sustained CGM use shows effective blood glucose control
This leading programme is made possible thanks to the generous support from the Hong Kong Jockey Club Charities Trust. Organised by Youth Diabetes Action (YDA) and The Chinese University of Hong Kong (CUHK)’s Faculty of Medicine (CU Medicine), this major initiative is to provide CGMs to young people living with diabetes in Hong Kong. The project is also supported by the Association of Hong Kong Diabetes Nurses (AHKDN), which provides diabetes management education. Over the past two years, the project has provided continuous CGMs to more than 900 people with diabetes, including 837 with Type 1 diabetes.
Interim analysis of the project data has highlighted the significant benefits of CGM use. Among the first 644 participants in the analysis, 388 (60.4%) were not regular CGM users before joining the programme. There was a significant improvement in overall glucose control after both six and 12 months of CGM use in all participants. Average glucose control, as reflected by Glycated hemoglobin (HbA1c), decreased from 7.8% to 7.4% at six months, which was maintained at 12 months, in people with little CGM experience. Improvements in HbA1c were seen in all groups with baseline HbA1c above the optimal target of 7%. After 12 months, there was a significant reduction of 85% in the rates of hospitalisation with diabetic ketoacidosis, while severe hypoglycaemia fell by more than 60% and hyperglycaemic crises by more than 50%.
Ms Stella Lau, Executive Director YDA, remarked: “We are deeply grateful to the Hong Kong Jockey Club Charities Trust for supporting this important initiative, which has allowed people living with diabetes in Hong Kong, China to benefit from the life-changing technology provided by CGM. enabling children and young people with diabetes to be less worried about the fears of severe hypoglycaemia and to be able to live healthier lives.”
Dr Elaine Chow Yee-kwan, Associate Professor (Clinical) in the Department of Medicine and Therapeutics at CU Medicine, said: “CGMs have transformed the lives of many people living with diabetes worldwide, and we are delighted that our programme has demonstrated the important benefits of CGMs in our local population of young people with diabetes. Severe hypoglycaemia is associated with significant risks, and the marked reduction of the condition when using CGMs is highly encouraging.”
Professor Ronald Ma Ching-wan, S.H. Ho Professor of Diabetes and Head (Academic Affairs) in the Division of Endocrinology and Diabetes at CU Medicine, commented: “The interim results from this study have shown the tremendous benefit of CGM technology for young people with diabetes, with substantial reductions in hospitalisation and severe complications from hyperglycaemia and hypoglycaemia, together with overall improvements in glucose control. We are excited about the potential for this type of technology to benefit the increasing number of young children and adults being diagnosed with diabetes, especially those with Type 1 diabetes requiring insulin injections. We hope more people with diabetes can benefit from this technology in the future.”
Professor Juliana Lui Nga-man, Assistant Professor and a health economist at the Department of Medicine and Therapeutics at CU Medicine, noted: “The significant reduction in hospitalisation with severe hypoglycaemia and diabetic ketoacidosis within 12 months after starting continuous CGM use is associated with a significant reduction in medical costs. We are currently conducting a more comprehensive analysis, taking into account the additional potential benefits of improved glucose lowering in reducing multiple complications, to provide a full assessment of the cost-effectiveness of CGM provision.”
Mrs. Kwan says her four-year-old son was diagnosed with type 1 diabetes earlier this year. He needed to have his finger pricked eight to nine times a day, feeling very painful and was reluctant to cooperate. Now, with a CGM device, she can conveniently monitor his blood glucose level directly on her mobile phone.
A CGM device measures glucose levels through a sensor and wirelessly transmits the data to a smartphone, allowing people with diabetes to adjust their blood glucose levels in real time.
