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Practice nurse-led insulin initiation and outcomes in T2D

In this Australian study investigators sought to determine if enhancing the role of practice nurses in insulin initiation, and providing mentoring support from a diabetes educator nurse for these nurses, would improve aspects of diabetes care. They devised the “Stepping Up” model and applied it across 74 general practices. The found that the model was associated with increased insulin initiation rates in primary care and improvements in HbA1c, without worsening emotional wellbeing.

By Colin Kenny, GP, Dromore

In this study, which was conducted in primary care in Victoria, Australia, 266 people with type 2 diabetes from 74 practices were treated and followed up for 12 months. The practices were randomised to the intervention or usual care. The intervention arm applied the Stepping Up model of care, which involved changes in practice systems that included an enhanced role for practice nurses in leading insulin initiation, as well as mentoring for these nurses by a registered nurse with diabetes educator credentials.

HbA1c was found to be improved in both arms, but with a clinically significant difference between the arms favouring the intervention. At 12 months, in intervention practices 70% of participants had started insulin, compared with 22% in control practices. The investigators concluded that the Stepping Up model was associated with increased insulin initiation rates in primary care and improvements in HbA1c, without worsening emotional wellbeing.

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