Involving diabetic patients in clinical process helps them make better lifestyle choices: NUHS study

National University Hospital endocrinologist Dr Yew Tong Wei in an appointment with his patient, Madam Evelyn Yeung, to discuss her diabetes condition. She had received a results letter before the consultation appointment, which gave her time to mull
National University Hospital endocrinologist Dr Yew Tong Wei in an appointment with his patient, Madam Evelyn Yeung, to discuss her diabetes condition. She had received a results letter before the consultation appointment, which gave her time to mull over the results. PHOTO: NATIONAL UNIVERSITY HEALTH SERVICES

SINGAPORE - Treating diabetes is not as simple as advising a patient to cut down on sugar intake.

Dr Yew Tong Wei, an endocrinologist at the National University Hospital (NUH), knows this all too well. One of his patients is a Malay Muslim woman who enjoys hosting parties for her friends with an array of sugary treats - not the most ideal for someone with diabetes.

"My solution for her could be just to serve salads with olive oil instead of the Malay delicacies - but that's not a real solution. It doesn't align with her customs or culture," Dr Yew said.

He is one of nine doctors in a pilot programme at NUH who are trying a new approach – involving patients in the clinical process. 

Patients receive various test results before their doctors' appointments in a format that is easy to understand. These help them identify areas where they are at higher or lower risk, such as kidney function or cholesterol levels, and enable them to make changes to their lifestyle or eating habits. 

A year into the pilot programme, patients' conditions were found to have generally improved. For example, the proportion of patients who achieved an ideal target for their glucose control increased by 2½ times, compared to before the programme.

Sharing the findings at a media briefing on Thursday (Nov 14), Dr Yew said the pilot programme has enabled patients to take control of their lifestyle habits and choices, as they can study their test results for themselves before they meet their doctors.

The results were also shared at a symposium for general practitioners (GP) as part of an event organised by Diabetes Singapore and the National University Health System (NUHS) on Sunday (Nov 17). It was attended by Senior Minister of State for Law and Health Edwin Tong.

In the case of Dr Yew's Malay Muslim patient, she was able to come up with a solution herself - going on a religious fast on the day of her parties, which is something he said he would never have thought of himself.

 
 

"We doctors are the medical experts, but the patients are the experts in their own lives," he said.

Professor Tai E Shyong, a senior consultant at NUH's endocrinology division, also noted: "Living well with diabetes requires the active participation of patients."

The pilot has since been expanded to two National University Polyclinics. It will be reviewed before a possible further expansion to all six polyclinics.

NUHS Primary Care Network

Separately, NUHS has introduced its Primary Care Network - a system that allows GP clinics, which usually operate in silos, to keep track of their patients' progress and compare the data with other clinics.

This data sharing is not just for people with diabetes. It also includes patients with other chronic conditions such as hypertension.

A one-year pilot was conducted with four private GPs in Choa Chu Kang.

Among other results, the pilot uncovered problems GPs face, such as patients refusing to start medication because they are concerned about side effects. To address this, patients can be counselled by nurses.

NKF's new haemodiafiltration programme

Meanwhile, the National Kidney Foundation (NKF) announced a new haemodiafiltration programme on Sunday at the opening of its new Foo Hai-NKF Dialysis Centre at Ubi Avenue 1.

 
 

Haemodiafiltration is similar to the more common haemodialysis process, but is said to be more effective, as it can remove smaller and bigger-sized toxins from blood.

Studies have shown that haemodiafiltration can reduce heart disease, allows for stability of blood pressure during dialysis and reduces some long-term dialysis related complications like joint pain and nerve compression at the wrist.

However, as haemodiafiltration involves an infusion of a large volume of fluid, there is a potential risk of infection if the fluid is not ultrapure. Nevertheless, studies show this is not a big concern if the process is carried out according to recommended guidelines.

The NKF piloted this programme at two dialysis centres in Bedok and Serangoon since March this year with 20 patients.

NKF executive committee and board member Johnny Heng said: "To deliver good and sustainable care, we should not be rigidly holding on to a one-size-fits-all approach. A more tailored approach to care... is necessary to meet the increasingly complex and evolving needs of our patients."