Insulin initiation in patients with type 2 diabetes is often delayed, but access to a diabetes nurse may help—insights from Norwegian general practice.
Objective: We opted to study how support staff operational capacity and diabetes competences may impact the timeliness of basal insulin-initiation in general practice patients with type 2 diabetes (T2D). Design/Setting/Outcomes: This was an observational and retrospective study on Norwegian primary...
| Publicado en: | Scandinavian Journal of Primary Health Care Vol. 42; no. 1; pp. 132 - 144 |
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| Autores principales: | , , , , , , , , |
| Formato: | algorithm research tables/charts Journal Article |
| Publicado: |
Taylor & Francis Ltd
Mar2024
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| Acceso en línea: | Ver este registro en EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=175301438&site=ehost-live header: @attributes: shortDbName: ccm uiTerm: 175301438 longDbName: CINAHL Complete uiTag: AN controlInfo: bkinfo: dissinfo: jinfo: jid: 02813432 BDB jtl: Scandinavian Journal of Primary Health Care issn: 02813432 maglogo: Y pubinfo: dt: Mar2024 vid: 42 iid: 1 pid: 377 pub: Taylor & Francis Ltd place: Philadelphia, Pennsylvania artinfo: ui: 175301438 174352669 175301438 175301438 10.1080/02813432.2023.2296118 175301438 ppf: 132 ppct: 12 formats: fmt: – @attributes: type: T – @attributes: type: P tig: atl: Insulin initiation in patients with type 2 diabetes is often delayed, but access to a diabetes nurse may help—insights from Norwegian general practice. aug: au: Mdala, Ibrahimu Nøkleby, Kjersti Berg, Tore Julsrud Cooper, John Sandberg, Sverre Løvaas, Karianne Fjeld Claudi, Tor Jenum, Anne Karen Buhl, Esben Selmer affil: Department of General Practice, Institute of Health and Society, University of Oslo (UiO), Norway sug: subj: Family Nurses Norway Diabetes Mellitus, Type 2 Drug Therapy Insulin Therapeutic Use Insulin Administration and Dosage Treatment Delay Health Services Accessibility Human Norway Nonexperimental Studies Retrospective Design Record Review Time Factors Multiple Linear Regression Descriptive Statistics Confidence Intervals Odds Ratio Professional Competence Funding Source ab: Objective: We opted to study how support staff operational capacity and diabetes competences may impact the timeliness of basal insulin-initiation in general practice patients with type 2 diabetes (T2D). Design/Setting/Outcomes: This was an observational and retrospective study on Norwegian primary care patients with T2D included from the ROSA4-dataset. Exposures were (1) support staff size, (2) staff size relative to number of GPs, (3) clinic access to a diabetes nurse and (4) share of staff with diabetes course (1 and 2 both relate to staff operational capacity, whereas 3 and 4 are both indicatory of staff diabetes competences). Outcomes were 'timely basal insulin-initiation' (primary) and 'attainment of HbA1c<7%' after insulin start-up (secondary). Associations were analyzed using multiple linear regression, and directed acyclic graphs guided statistical adjustments. Subjects: Insulin naïve patients with 'timely' (N = 294), 'postponed' (N = 219) or 'no need of' (N = 3,781) basal insulin-initiation, respectively. Results: HbA1c [median (IQR)] increased to 8.8% (IQR, 8.0, 10.2) prior to basal insulin-initiation, which reduced HbA1c to 7.3 (6.8–8.1) % by which only 35% of the subjects reached HbA1c <7%. Adjusted risk of 'timely basal insulin-initiation' was more than twofold higher if access to a diabetes nurse (OR = 2.40, [95%CI, 1.68, 3.43]), but related only vaguely to staff size (OR = 1.01, [95%CI, 1.00, 1.03]). No other staff factors related significantly to neither the primary nor the secondary outcome. Conclusion: In Norwegian general practice, insulin initiation in people with T2D may be affected by therapeutic inertia but access to a diabetes nurse may help facilitating more timely insulin start-up. In patients with type 2 diabetes (T2D) cared for by their general practice physician (GP), insulin therapy was susceptible to therapeutic inertia. In Norwegian general practice, chance of timely basal insulin-initiation was found more than two-fold higher if the GP had access to a diabetes nurse. In contrast, the timeliness of basal insulin-initiation in general practice patients with T2D seemed unaffected by share of support staff with diabetes course and by factors indicatory of support staff overall operational capacity. In Norwegian general practice, a diabetes nurse seems to offer unique clinical benefits to the care of insulin treated patients with T2D. pubtype: Academic Journal doctype: algorithm research tables/charts Journal Article ougenre: Article language: English refInfo: holdings: @attributes: islocal: N |
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