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The investigation of mobile communication software “Line” intervention for diabetes nutrition and health education
S162
Poster Presentations / Diabetes Research and Clinical Practice 120S1 (2016) S65–S211
PG-08 A probe into the improvement in HbA1c among diabetic patients on multiple insulin injections along with carbohydrate substitute diet Yu Feng TENG1*. 1Division of Metabolism, Chang Gung Memorial Hospital-Kaohsiung Medical Center, Taiwan Many factors for a good control of diabetic conditions are in the hands of the patients themselves, including diet content and portion, approaches to regular monitoring of blood glucose level, patients’ physical activity levels, and the consistency in medication dose taken. Sticking to a fixed diet portion regularly and taking medication in line with doctor’s advice can substantially improve blood glucose level control and reduce the occurrence of diabetes-related complications, such as coronary artery diseases, kidney diseases and the risk of nerve injury. Accurate carbohydrate calculation and more frequent blood glucose monitoring are associated with reduction in type 1 diabetic patients’ glycated hemoglobin levels. This study is to probe the improvement in glycated hemoglobin levels among type 1 diabetic patients on multiple insulin injections along with carbohydrate substitute diet. Method: Type 1 diabetic patients receiving more than 4 insulin injections were lodged and boarded for 1 to 2 weeks in the hospital. During their stay, they followed a fixed portion of carbohydrate in each meal and a fixed amount of exercise. Their blood glucose levels were checked before the 3 meals, 2 hours after the 3 meals and before sleep, for a total of 7 times daily. Pre-prandial and postprandial targets for blood glucose level were set. Nutritionists and health educators engaged in teaching the patients how to keep their own dietary diaries and educating them about carbohydrate substitute diet, for them to find out about their own carb-to-insulin ratio based on the carbohydrate intake/activity level and the flexible titration of insulin. Eventually, 25 cases were included in this study, whose HbA1c and total insulin changes were tracked in month 0, 3, 6, 9 and 12. The average HbA1c before the session was 11.81%; in month 3 8.63%; in month 6, 8.26%; in month 9, 8.8% and in month 12, 8.3%. The average total insulin before the session was 42.89u; in month 3, 41.39u; in month 6, 42.21u; in month 9, 43.36u and in month 12, 43.5u. This study shows that accurate carbohydrate substitute and a flexible titration of insulin can significantly improve patients’ glycated hemoglobin levels. Despite an increase in total insulin by 0.61u, with a more flexible diet, patients’ glycated hemoglobin levels were still improved. Diabetic patients on multiple insulin injections should execute carbohydrate substitute in their diet for a better control of their blood glucose levels and a better quality of life. PG-09 Analysis of food order’s effect on postprandial glycated hemoglobin level among diabetic patients from a medical center in southern Taiwan Yu Hsuan CHIEN1*. 1Division of Metabolism, Kaohsiung Chang Gung Memorial Hospital, Taiwan Objective: Diabetes is a chronic disease; its patients’ diet is predominant in their blood glucose control. The article: Food Order Has a Significant Impact on Postprandial Glucose and Insulin Levels published in one of Diabetes Care journals in 2015, pointed out that adjusting patients’ food order can help control their postprandial blood glucose levels. For this, we have designed a questionnaire in an attempt to find out if Taiwanese nationals’ diet may affect their postprandial blood glucose control in a similar manner. Method: By means of questionnaire, this study took place between December 14th and 31st, 2015, in a diabetes health education room at the Metabolism Department of a medical center, where a nutritionist entrusted by a diabetes educator inquired the patients about their food order, and made a
comparison between three different food orders’ effects upon the patients’ glycated hemoglobin level control. Result: According to ANOVA, which analyzed the differences in glycated hemoglobin levels among the three groups of patients, food order’s effect on postprandial glycated hemoglobin level is not statistically significant. Neither is significant in the effects of work patterns and sex on the food order amd the glycated hemoglobin levels. Conclusion: Sub-factors that affect blood glucose level such as exercise, medication, diet portion can also trigger the variance in blood glucose level, which leaves the assumption that food order affects postprandial glycated hemoglobin level still in question PG-10 A probe into the analysis of cause of hypoglycemia among patients joining diabetes health improvement program Chia Hui LIN1*. 1Division of Metabolism, Kaohsiung Chang Gung Memorial Hospital, Taiwan Objective: To foresee the risk factors that cause severe hypoglycemia to provide references for diabetes clinical healthcare. Method: This is a questionnaire-based study, whose object must be patients that have received diabetes healthcare for over a year, and also meet one of the three criteria as follows: 1. over 70 years old; 2. receiving insulin injection for over a year; 3. GFR < 60. A total of 200 patients meet these requirements. Result: 1. Length of healthcare received: The highest occurrence rate of hypoglycemia is 55.6%, among patients receiving healthcare for more than 10 years; the lowest occurrence rate is 38.4% (P < 0.001), among patients on healthcare between 3 and 6 years. 2. Age: In groups aged 31–40 and 41–50, the occurrence rate of hypoglycemia is 100% (P < 0.43); the lowest occurrence rate of 36% (n = 100; P < 0.001) is in group aged >70. 3. HA1C: Group HA1C 8.1–9% has the highest occurrence rate of 51.5%; Group HA1C≦6% has the lowest occurrence rate of 23.1% (P < 0.001). 4. GFR: Group GFR < 15 has an occurrence rate of 60%; Group GFR≧90 has the lowest occurrence rate of 34.6% (P < 0.001). 5. Use of Insulin: patients on solely oral medication have an occurrence rate of 30.7%; patients on insulin injection have an occurrence rate of 90.9% (P < 0.001). Conclusion: According to the data analysis in this study, a more advanced CKD stage and insulin injection treatment are the main factors for a high occurrence rate of hypoglycemia. The factors such as receiving long-term healthcare, old ages, a strict control of HA1C are statistically significant and correlated with the occurrence of hypoglycemia. These factors are not the same as those hypoglycemia risk factors mentioned in previous literatures. They are likely attributable to the smaller sample size, a single-center study, etc. PG-11 The investigation of mobile communication software “Line” intervention for diabetes nutrition and health education Hsiang-Hsun CHUANG1 *, Chieh-Hsiang LU1,2,3. 1Ditmanson Medical Foundation Chia-Yi Christian Hospital, 2Department of Business Administration, College of Management, National Chung Cheng University, 3Department of Nursing, DAYEH University, Taiwan Purpose: With the ever increasing prevalence of diabetes, self-health management for diabetes patient has become an important health care topic. Also, with the progressive improvement of communication technologies, more and more people have started using the internet or mobile devices as their primary communication tool. Therefore, this study was aimed to utilize health care instant messages for aiding
Poster Presentations / Diabetes Research and Clinical Practice 120S1 (2016) S65–S211
diabetes patients in their self-management. The mobile communication tool used in this study is “Line”. It was used for the fast and efficient tool for diabetes health education communication and reminder. The quality and success of diabetes health education of Line, the mobile communication software, intervention was further investigated. Methods: This study consisted of 12 months of research and follow-up. A total of 86 diabetes patients have participated in this study. The participants’ pre and post-intervention biological markers and satisfactions were determined and analyzed. Statistical analyses were performed with SPSS 20.0, and the results presented as descriptive statistics and pairsample T-tests. Results: Therefore, the use of the mobile communication software Line) was demonstrated to produce significant improvements for A1C, total cholesterol, and LDL. The survey portion of the study indicated that the service acceptance and satisfaction correlated positively with each other. The diet compliance also increased from 34.8% to 76.2%, post intervention; and the regular clinical visit rate also increased from 76.4% to 98.6%. Discussion: The use of mobile communication software for diabetes health education intervention was demonstrated to significantly improve patient A1C, total cholesterol, and LDL. The patients’ acceptance, satisfaction, diet compliance, and regular clinic visit rates were also increased. With the improvement of communication technologies, it is with hopes that in the future, the use of mobile communication software can be used as an important tool for the medical care team in health education communication. PG-12 Symptom management education program for people with type 2 diabetes Li-Ying LIN1 *, Hing-Chung LAM2, Ruey-Hsia WANG2. 1 Department of Nursing, Kaohsiung Veterans General Hospital, Kaohsiung City, 2Center for Geriatrics and Gerontology, Kaohsiung Veterans General Hospital, Taiwan The purpose of this study is to examine the effects of the Symptom Management Model-based education program for patients living with type 2 diabetes. Purposive sampling obtained from outpatient department of a medical center in southern Taiwan. Sampling criteria included: (1) diagnose of type 2 diabetes, (2) age between 20 and 80 years olds, (3) clear mental status and able to communicate, (4) HbA1C 8% or higher. This was a pilot study. Patients were randomly assigned into experiment or control group. Subjects in control group received the routine clinical care. The subjects of the experimental group received a symptom management- based education program. The program was held 60–90 minute interview. The data were collected by Diabetes Symptom Checklist, Diabetes Self-Care Scale, Diabetes Quality of Life Scale, and blood HbA1C before the education program and 3 months after the intervention program. The results of this study indicated that patients in the experiment group significantly improved their levels of selfcare behaviors, quality of life at 3 months post-intervention; however, their HbA1C levels and symptom experience hadn’t difference significantly. In conclusion, the results of this study provide a reference for health education, practice, and research for diabetes patients. To promote the health and quality of life of patients living with type 2 diabetes, a symptom management based education program could be used. PG-13 Elucidation of lifestyles that affect the quality of life (QOL) related to the therapy for patients with type 2 diabetes Yuka MATSUMOTO1 *, Kumi TANAKA2, Motoyoshi SAKAUE1. 1 University of Hyogo, Graduate School of Human Science and Environment, 2Ino Hospital, Japan
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High adherence to diabetes therapy is a key to maintain a good glycemic control. To keep patients in high adherence, it is important to increase their diabetes therapy related (DTR)-QOL to higher state. In this study to elevate DTR-QOL by patient education, it was elucidated what kind of lifestyle affected the DTR-QOL. Study subjects were 65 outpatients with type 2 diabetes (male 31, female 34). DTR-QOL was quantified with a questionnaire. This questionnaire consisted of 29 questions relating to 4 factors; “burden on social activities and daily activities”, “anxiety and dissatisfaction with treatment”, “hypoglycemia”, and “satisfaction with treatment”. Score of DTR-QOL was shown by the 100-point scale. Lifestyle of patients was asked using a questionnaire consisting of 24 items about lifestyle. It was answered in a 4-point scale (1 = agree to, 4 = not agree to). The subjects were classified as follows; 1 and 2 were the Yes, 3 and 4 were the No. Age of subjects was 71.4 ± 8.7 year-old, BMI was 23.9 ± 4.2, and HbA1c was 6.9 ± 1.5%. Total score of DTR-QOL was compared between the Yes and the No. Significant differences were observed in two items; “Do you try to do physical activity in everyday life for health maintenance? (Yes: 76.1 ± 13.3, No: 57.4 ± 14.5)”, and “Do you feel stress or fatigue? (Yes: 68.5 ± 13.5, No: 79.7 ± 14.0)”. We next analyzed the score of each DTR-QOL factor. In addition to 2 items described above, 3 items were found to be affected the score of DTR-QOL. Score of “burden on social activities and daily activities” was significantly lower in the Yes as to “Do you have the situation you are hard to sleep? (Yes: 71.0 ± 17.9, N: 82.9 ± 17.6)” and “Do you skip a meal (Yes: 63.6 ± 24.0, No: 80.7 ± 17.0)”. In the Yes as to “Do you eat until fullness?”, the score of “satisfaction with treatment” was also significantly lower, compared with the No (Yes: 48.1 ± 16.7, No: 63.5 ± 20.8). It was demonstrated that five kinds of lifestyle were associated with DTR-QOL. “To do physical activity in everyday”, “not to skip a meal”, and “not to eat until fullness” were lifestyles that could be improved through education for patients. Higher DTR-QOL would be achieved if patients were educated, focusing on improvement of these lifestyles. PG-14 Pilot implementation of a novel post-graduate medical education program: Steno REACH certificate course in clinical diabetes care – Malaysia Feisul MUSTAPHA1 *, Michael CALOPIETRO2. 1Steno Diabetes Center, Malaysia; 2Steno Diabetes Center, Denmark The Steno REACH Certificate Course in Clinical Diabetes Care (SRCC) is a comprehensive, competency-based educational program that blends eLearning and classroom-based group work with the aim to improve the capacity of primary care doctors and nurses to deliver high-quality diabetes care. Using the pedagogical model of the flipped classroom, 100 hours of foundational material is delivered in a self-paced, online platform while another 50 hours of classroom time is devoted to reinforcing core concepts through interactive learning activities, mini-lectures, and case discussions. Classroom learnings are facilitated by a team of Malaysian Endocrinologists, Family Medicine Specialists, Diabetes Nurses, and dieticians who completed a train-the-trainer program hosted by Steno Diabetes Center. Completing the learning circle are clinic-based learning activities. Unlike most long-format, post-graduate medical training programs, participants are able to work full-time – thereby overcoming a common barrier to participation in extensive continuing medical education. Through an agreement between the Ministry of Health Malaysia and Steno Diabetes Center Malaysia, 12 doctors and 24 nurses working in ten public health clinics in two states in Malaysia were enrolled in the pilot class of SRCC on 10 October 2015. This pioneering batch of participants will complete the training on 10 April 2016. The aim of the pilot
Poster Presentations / Diabetes Research and Clinical Practice 120S1 (2016) S65–S211
PG-08 A probe into the improvement in HbA1c among diabetic patients on multiple insulin injections along with carbohydrate substitute diet Yu Feng TENG1*. 1Division of Metabolism, Chang Gung Memorial Hospital-Kaohsiung Medical Center, Taiwan Many factors for a good control of diabetic conditions are in the hands of the patients themselves, including diet content and portion, approaches to regular monitoring of blood glucose level, patients’ physical activity levels, and the consistency in medication dose taken. Sticking to a fixed diet portion regularly and taking medication in line with doctor’s advice can substantially improve blood glucose level control and reduce the occurrence of diabetes-related complications, such as coronary artery diseases, kidney diseases and the risk of nerve injury. Accurate carbohydrate calculation and more frequent blood glucose monitoring are associated with reduction in type 1 diabetic patients’ glycated hemoglobin levels. This study is to probe the improvement in glycated hemoglobin levels among type 1 diabetic patients on multiple insulin injections along with carbohydrate substitute diet. Method: Type 1 diabetic patients receiving more than 4 insulin injections were lodged and boarded for 1 to 2 weeks in the hospital. During their stay, they followed a fixed portion of carbohydrate in each meal and a fixed amount of exercise. Their blood glucose levels were checked before the 3 meals, 2 hours after the 3 meals and before sleep, for a total of 7 times daily. Pre-prandial and postprandial targets for blood glucose level were set. Nutritionists and health educators engaged in teaching the patients how to keep their own dietary diaries and educating them about carbohydrate substitute diet, for them to find out about their own carb-to-insulin ratio based on the carbohydrate intake/activity level and the flexible titration of insulin. Eventually, 25 cases were included in this study, whose HbA1c and total insulin changes were tracked in month 0, 3, 6, 9 and 12. The average HbA1c before the session was 11.81%; in month 3 8.63%; in month 6, 8.26%; in month 9, 8.8% and in month 12, 8.3%. The average total insulin before the session was 42.89u; in month 3, 41.39u; in month 6, 42.21u; in month 9, 43.36u and in month 12, 43.5u. This study shows that accurate carbohydrate substitute and a flexible titration of insulin can significantly improve patients’ glycated hemoglobin levels. Despite an increase in total insulin by 0.61u, with a more flexible diet, patients’ glycated hemoglobin levels were still improved. Diabetic patients on multiple insulin injections should execute carbohydrate substitute in their diet for a better control of their blood glucose levels and a better quality of life. PG-09 Analysis of food order’s effect on postprandial glycated hemoglobin level among diabetic patients from a medical center in southern Taiwan Yu Hsuan CHIEN1*. 1Division of Metabolism, Kaohsiung Chang Gung Memorial Hospital, Taiwan Objective: Diabetes is a chronic disease; its patients’ diet is predominant in their blood glucose control. The article: Food Order Has a Significant Impact on Postprandial Glucose and Insulin Levels published in one of Diabetes Care journals in 2015, pointed out that adjusting patients’ food order can help control their postprandial blood glucose levels. For this, we have designed a questionnaire in an attempt to find out if Taiwanese nationals’ diet may affect their postprandial blood glucose control in a similar manner. Method: By means of questionnaire, this study took place between December 14th and 31st, 2015, in a diabetes health education room at the Metabolism Department of a medical center, where a nutritionist entrusted by a diabetes educator inquired the patients about their food order, and made a
comparison between three different food orders’ effects upon the patients’ glycated hemoglobin level control. Result: According to ANOVA, which analyzed the differences in glycated hemoglobin levels among the three groups of patients, food order’s effect on postprandial glycated hemoglobin level is not statistically significant. Neither is significant in the effects of work patterns and sex on the food order amd the glycated hemoglobin levels. Conclusion: Sub-factors that affect blood glucose level such as exercise, medication, diet portion can also trigger the variance in blood glucose level, which leaves the assumption that food order affects postprandial glycated hemoglobin level still in question PG-10 A probe into the analysis of cause of hypoglycemia among patients joining diabetes health improvement program Chia Hui LIN1*. 1Division of Metabolism, Kaohsiung Chang Gung Memorial Hospital, Taiwan Objective: To foresee the risk factors that cause severe hypoglycemia to provide references for diabetes clinical healthcare. Method: This is a questionnaire-based study, whose object must be patients that have received diabetes healthcare for over a year, and also meet one of the three criteria as follows: 1. over 70 years old; 2. receiving insulin injection for over a year; 3. GFR < 60. A total of 200 patients meet these requirements. Result: 1. Length of healthcare received: The highest occurrence rate of hypoglycemia is 55.6%, among patients receiving healthcare for more than 10 years; the lowest occurrence rate is 38.4% (P < 0.001), among patients on healthcare between 3 and 6 years. 2. Age: In groups aged 31–40 and 41–50, the occurrence rate of hypoglycemia is 100% (P < 0.43); the lowest occurrence rate of 36% (n = 100; P < 0.001) is in group aged >70. 3. HA1C: Group HA1C 8.1–9% has the highest occurrence rate of 51.5%; Group HA1C≦6% has the lowest occurrence rate of 23.1% (P < 0.001). 4. GFR: Group GFR < 15 has an occurrence rate of 60%; Group GFR≧90 has the lowest occurrence rate of 34.6% (P < 0.001). 5. Use of Insulin: patients on solely oral medication have an occurrence rate of 30.7%; patients on insulin injection have an occurrence rate of 90.9% (P < 0.001). Conclusion: According to the data analysis in this study, a more advanced CKD stage and insulin injection treatment are the main factors for a high occurrence rate of hypoglycemia. The factors such as receiving long-term healthcare, old ages, a strict control of HA1C are statistically significant and correlated with the occurrence of hypoglycemia. These factors are not the same as those hypoglycemia risk factors mentioned in previous literatures. They are likely attributable to the smaller sample size, a single-center study, etc. PG-11 The investigation of mobile communication software “Line” intervention for diabetes nutrition and health education Hsiang-Hsun CHUANG1 *, Chieh-Hsiang LU1,2,3. 1Ditmanson Medical Foundation Chia-Yi Christian Hospital, 2Department of Business Administration, College of Management, National Chung Cheng University, 3Department of Nursing, DAYEH University, Taiwan Purpose: With the ever increasing prevalence of diabetes, self-health management for diabetes patient has become an important health care topic. Also, with the progressive improvement of communication technologies, more and more people have started using the internet or mobile devices as their primary communication tool. Therefore, this study was aimed to utilize health care instant messages for aiding
Poster Presentations / Diabetes Research and Clinical Practice 120S1 (2016) S65–S211
diabetes patients in their self-management. The mobile communication tool used in this study is “Line”. It was used for the fast and efficient tool for diabetes health education communication and reminder. The quality and success of diabetes health education of Line, the mobile communication software, intervention was further investigated. Methods: This study consisted of 12 months of research and follow-up. A total of 86 diabetes patients have participated in this study. The participants’ pre and post-intervention biological markers and satisfactions were determined and analyzed. Statistical analyses were performed with SPSS 20.0, and the results presented as descriptive statistics and pairsample T-tests. Results: Therefore, the use of the mobile communication software Line) was demonstrated to produce significant improvements for A1C, total cholesterol, and LDL. The survey portion of the study indicated that the service acceptance and satisfaction correlated positively with each other. The diet compliance also increased from 34.8% to 76.2%, post intervention; and the regular clinical visit rate also increased from 76.4% to 98.6%. Discussion: The use of mobile communication software for diabetes health education intervention was demonstrated to significantly improve patient A1C, total cholesterol, and LDL. The patients’ acceptance, satisfaction, diet compliance, and regular clinic visit rates were also increased. With the improvement of communication technologies, it is with hopes that in the future, the use of mobile communication software can be used as an important tool for the medical care team in health education communication. PG-12 Symptom management education program for people with type 2 diabetes Li-Ying LIN1 *, Hing-Chung LAM2, Ruey-Hsia WANG2. 1 Department of Nursing, Kaohsiung Veterans General Hospital, Kaohsiung City, 2Center for Geriatrics and Gerontology, Kaohsiung Veterans General Hospital, Taiwan The purpose of this study is to examine the effects of the Symptom Management Model-based education program for patients living with type 2 diabetes. Purposive sampling obtained from outpatient department of a medical center in southern Taiwan. Sampling criteria included: (1) diagnose of type 2 diabetes, (2) age between 20 and 80 years olds, (3) clear mental status and able to communicate, (4) HbA1C 8% or higher. This was a pilot study. Patients were randomly assigned into experiment or control group. Subjects in control group received the routine clinical care. The subjects of the experimental group received a symptom management- based education program. The program was held 60–90 minute interview. The data were collected by Diabetes Symptom Checklist, Diabetes Self-Care Scale, Diabetes Quality of Life Scale, and blood HbA1C before the education program and 3 months after the intervention program. The results of this study indicated that patients in the experiment group significantly improved their levels of selfcare behaviors, quality of life at 3 months post-intervention; however, their HbA1C levels and symptom experience hadn’t difference significantly. In conclusion, the results of this study provide a reference for health education, practice, and research for diabetes patients. To promote the health and quality of life of patients living with type 2 diabetes, a symptom management based education program could be used. PG-13 Elucidation of lifestyles that affect the quality of life (QOL) related to the therapy for patients with type 2 diabetes Yuka MATSUMOTO1 *, Kumi TANAKA2, Motoyoshi SAKAUE1. 1 University of Hyogo, Graduate School of Human Science and Environment, 2Ino Hospital, Japan
S163
High adherence to diabetes therapy is a key to maintain a good glycemic control. To keep patients in high adherence, it is important to increase their diabetes therapy related (DTR)-QOL to higher state. In this study to elevate DTR-QOL by patient education, it was elucidated what kind of lifestyle affected the DTR-QOL. Study subjects were 65 outpatients with type 2 diabetes (male 31, female 34). DTR-QOL was quantified with a questionnaire. This questionnaire consisted of 29 questions relating to 4 factors; “burden on social activities and daily activities”, “anxiety and dissatisfaction with treatment”, “hypoglycemia”, and “satisfaction with treatment”. Score of DTR-QOL was shown by the 100-point scale. Lifestyle of patients was asked using a questionnaire consisting of 24 items about lifestyle. It was answered in a 4-point scale (1 = agree to, 4 = not agree to). The subjects were classified as follows; 1 and 2 were the Yes, 3 and 4 were the No. Age of subjects was 71.4 ± 8.7 year-old, BMI was 23.9 ± 4.2, and HbA1c was 6.9 ± 1.5%. Total score of DTR-QOL was compared between the Yes and the No. Significant differences were observed in two items; “Do you try to do physical activity in everyday life for health maintenance? (Yes: 76.1 ± 13.3, No: 57.4 ± 14.5)”, and “Do you feel stress or fatigue? (Yes: 68.5 ± 13.5, No: 79.7 ± 14.0)”. We next analyzed the score of each DTR-QOL factor. In addition to 2 items described above, 3 items were found to be affected the score of DTR-QOL. Score of “burden on social activities and daily activities” was significantly lower in the Yes as to “Do you have the situation you are hard to sleep? (Yes: 71.0 ± 17.9, N: 82.9 ± 17.6)” and “Do you skip a meal (Yes: 63.6 ± 24.0, No: 80.7 ± 17.0)”. In the Yes as to “Do you eat until fullness?”, the score of “satisfaction with treatment” was also significantly lower, compared with the No (Yes: 48.1 ± 16.7, No: 63.5 ± 20.8). It was demonstrated that five kinds of lifestyle were associated with DTR-QOL. “To do physical activity in everyday”, “not to skip a meal”, and “not to eat until fullness” were lifestyles that could be improved through education for patients. Higher DTR-QOL would be achieved if patients were educated, focusing on improvement of these lifestyles. PG-14 Pilot implementation of a novel post-graduate medical education program: Steno REACH certificate course in clinical diabetes care – Malaysia Feisul MUSTAPHA1 *, Michael CALOPIETRO2. 1Steno Diabetes Center, Malaysia; 2Steno Diabetes Center, Denmark The Steno REACH Certificate Course in Clinical Diabetes Care (SRCC) is a comprehensive, competency-based educational program that blends eLearning and classroom-based group work with the aim to improve the capacity of primary care doctors and nurses to deliver high-quality diabetes care. Using the pedagogical model of the flipped classroom, 100 hours of foundational material is delivered in a self-paced, online platform while another 50 hours of classroom time is devoted to reinforcing core concepts through interactive learning activities, mini-lectures, and case discussions. Classroom learnings are facilitated by a team of Malaysian Endocrinologists, Family Medicine Specialists, Diabetes Nurses, and dieticians who completed a train-the-trainer program hosted by Steno Diabetes Center. Completing the learning circle are clinic-based learning activities. Unlike most long-format, post-graduate medical training programs, participants are able to work full-time – thereby overcoming a common barrier to participation in extensive continuing medical education. Through an agreement between the Ministry of Health Malaysia and Steno Diabetes Center Malaysia, 12 doctors and 24 nurses working in ten public health clinics in two states in Malaysia were enrolled in the pilot class of SRCC on 10 October 2015. This pioneering batch of participants will complete the training on 10 April 2016. The aim of the pilot