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Nurse-led care model improves uptake of type 2 diabetes treatment

A care model led by practice nurses improves the uptake of insulin treatment among patients with type 2 diabetes, say researchers in Australia. 

A care model led by practice nurses improves the uptake of insulin treatment among patients with type 2 diabetes, say researchers in Australia. 


The researchers said that insulin initiation could become part of routine
diabetes management. Picture: iStock

The Stepping Up model involves an enhanced role for practice nurses, who are trained and mentored by registered nurses with a qualification in diabetes education to enable them to lead on insulin treatment initiation within the practice as part of routine care.

To test the effectiveness of the model, the researchers studied 266 patients from 74 general practices across Australia; 151 had consultations with the practice nurse as part of the model, and 115 received usual care. 

The researchers found significantly higher rates of insulin initiation among patients in the Stepping Up group, with 70% starting insulin compared to just 22% of those who received usual care. 

Routine management 

After 12 months, patients in the intervention group also had better HbA1c levels than those in the control group, and the model uses existing resources so does not increase costs. 

'Our results indicate that, with appropriate support and redesign of the practice system, insulin initiation can become part of routine diabetes management in primary care, obviating the need to refer to specialist services with geographical, cost, and accessibility barriers,' the study authors said. 

'Our pragmatic, translational study has important implications for policymakers, funders, and practitioners seeking innovative ways to provide the best care for people with type 2 diabetes in primary care.' 


Furler J et al (2017) Supporting insulin initiation in type 2 diabetes in primary care: results of the Stepping Up pragmatic cluster randomised controlled clinical trial. BMJ. http://dx.doi.org/10.1136/bmj.j783 

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