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Nurse-led diabetes management leads to better outcomes, finds study

Giving patients with type 2 diabetes more time with practice nurses leads to earlier insulin uptake and better outcomes, a BMJ published study has shown.

A team of researchers tested the ‘stepping up’ care model which enables practice nurses to lead on insulin treatment initiation as part of routine care.

Under the model, practice nurses are trained and mentored by a registered nurse qualified as a certified diabetes educator (CDE).

The study, carried out at the University of Melbourne, examined 266 diabetic patients, comparing those given practice nurse consultations as part of the Stepping Up model with patients receiving usual care.

The new model was shown to increase insulin initiation rates in primary care from 22% to 70%.

A year later, the patients treated under the new model had significantly better HbA1c levels, associated with lower rates of kidney and eye disease, compared to the control group.

Despite evidence that early adoption of insulin treatment among type 2 diabetic patients improves long-term outcomes, the study found that ‘insulin initiation is often delayed, particularly in primary care, because of barriers in clinical practice.’

Often there was no in-practice system in place for delegating the work, which can be quite ‘intensive and systematic’.

The intervention suggested practices address these barriers by:

  • Developing simple clinical protocols
  • Clarifying that appropriately supported nurses should initiate the discussion
  • Supporting a pathway within the practice to allocate the work to the practice nurse with CDE mentoring and GP support and review.

The report said: '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.'

Readers' comments (2)

  • Ivan Benett

    This article is misleading in both its headline and detail. This trial does not lead to improved outcomes. It couldn't in such a short space of time. The actual authors are more modest in their conclusions: " The Stepping Up model of care was associated with increased insulin initiation rates in primary care, and improvements in glycated haemoglobin without worsening emotional wellbeing."
    Whilst long term glycaemic control does influence microvascular outcomes, this trial does not demonstrate long term better glycaemic control.
    I suppose the more important misleading impression of this article is that diabetes control equates to glycaemic control. It does not. BP lifestyle and statin treatment are at least as important.
    All that said, trained nurse insulin initiation and monitoring is undoubtedly the right thing for most people with type2 diabetes.

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  • Can you share the references for this please there seem to be several unqualified statements

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