Type 2 diabetes

Type 2 diabetes better managed in primary care


A new model of healthcare that gives practice nurses a stronger role in managing people with type 2 diabetes is associated with a higher uptake of insulin treatment and improved HbA1c.

Published in The BMJ the Australian study of 266 patients from 76 general practices found the nurse-led, protocol-driven care model called “Stepping Up” resulted in significantly higher rates of insulin initiation (70%) than usual care (22%) over 12 months.

Patients recruited into the trial were adults with type 2 diabetes who were above target HbA1c and had already been prescribed oral treatments.

More patients in the intervention arm achieved target HbA1c levels after 12 months than controls (36% v 19%).

“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 researchers concluded.

Lead author of the study Associate Professor John Furler, a GP academic at the University of Melbourne, told the limbic the scale of the problem and workforce constraints were driving examination of new models of diabetes care.

“The large numbers of people with type 2 diabetes mean this is not a clinical problem that can be managed by referring to specialist resources,” he said.

He said the findings show that more patients could be encouraged towards a timely initiation of insulin therapy with a ‘reorientation of existing resources’ in primary care.

Registered nurses with diabetes educator credentials were utilised as mentors for practice nurses rather than in direct patient care.

The study recorded no severe hypoglycaemic events.

Co-researcher Associate Professor David O’Neal, an endocrinologist at St Vincent’s Hospital, said specialist services in diabetes were oversubscribed.

He said public patients faced waiting lists and other imposts including an increased chance of loss of follow-up.

“This is a pragmatic approach to a very real problem and provides a solution where patients do significantly better than they would otherwise.”

“The advantage of practice nurses is that they have an established relationship with the primary care doctor, and the lines of communication should be uncomplicated and clear. There is also no additional cost,” he said.

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