How to start insulin in primary care settings for type 2 diabetic patients?

David VK Chao 周偉強

HK Pract 2024;46:51-52

In this issue of the Hong Kong Practitioner, we have included three articles which are related to different but important aspects of family medicine practice.

With the ageing population, the number of patients suffering from chronic diseases are on the rise. Diabetes Mellitus (DM) is one of these more prevalent chronic conditions that family doctors are seeing in the community, especially Type II DM. Due to the progressive nature of DM, more patients may need to consider having insulin in due course to gain optimal glycaemic control. In the article entitled, “Insulin therapy for Type 2 diabetes mellitus in primary care – common case scenarios and practical tips”, the authors commented that with the availability of newer insulin analogues and structured risk assessment and management programmes, insulin initiation and intensification can be simple and safe in primary care settings. Three clinical cases of Type II DM patients with 7 different scenarios commonly encountered by family doctors in the community were described and explained to provide illustrations on how to manage this group of patients effectively and when refer to endocrinologists for secondary care.

One of the most performed office procedures when patients visit the clinics is to have blood pressure measurement. However, some people may feel anxious and uncomfortable when they are in clinical settings and when healthcare staff take their blood pressure, and hence driving up their blood pressure readings, the so called white coat effect on blood pressure measurements. In the original article “Automated office waiting-area blood pressure as a practical method to eliminate white coat effect in conventional office blood pressure measurement in Chinese older people in a clinic setting in Hong Kong”, the author investigated whether automated office blood pressure measurement in the waiting area (waAOBP) can effectively eliminate the white coat effect (WCE) in blood pressure (BP) measurement and to evaluate the comparability of wa-AOBP and home blood pressure monitoring (HBPM) measurements. The author concluded that wa-AOBP is effective in the elimination of the WCE of conventional office blood pressure measurement for older people in a clinic setting, the effect of which is comparable with HBPM.

Also in this issue of the Journal, we have included the 34^th Dr Sun Yat Sen Oration delivered by our Orator and Honorary Fellow of HKCFP 2024, Dr. Chris Hughes. In the Oration entitled “Universal Health Insurance: Born with the best of intentions but now facing a mid-life crisis”, Dr. Hughes shared with us the original ideas of Universal Health Insurance that all citizens should have access to healthcare services regardless of their financial means, tracing back to the 19^th Century in Europe. Since then, the journey of Universal Health Insurance has been up and down in various countries over the years. Factors affecting the implementation of Universal Health Insurance and a quick glimpse on the future directions of general practice have been discussed in the oration.

All in all, the three articles illustrated the various important facets of family medicine practice. Enjoy!