Practice nurses involved in diabetes care improve patient outcomes

By Bianca Nogrady
Involving practice nurses in the initiation of insulin in patients with type 2 diabetes can improve outcomes for patients, a new study suggests.

Researchers conducted a cluster randomised controlled trial in 266 patients attending 74 practices in Victoria, looking at a new model of primary care for type 2 diabetes in which the practice nurse, mentored by a diabetes educator, took a leading role in insulin initiation.

According to the findings, published in the BMJ, the 12-month study found the approach – the ‘Stepping Up’ model of care – was associated with significantly higher insulin initiation rates compared with the usual primary care model.

Patients at practices using the new model of care were more than twice as likely to achieve their target HbA1c and had significantly greater improvements in HbA1c without any reported incidence of severe hypoglycaemia.

The new approach did not result in an increase in adverse outcomes such as depressive symptoms, and there was even a significantly greater improvement in overall mental health among those patients in the intervention arm.

Study coauthor Associate Professor Irene Blackberry said the new model was intended to address the challenges associated with timely insulin initiation in primary care, such as the need for specialist referral and the delays associated with that, as well as the additional pressure on busy GPs.

Although practice nurses are not able to prescribe insulin, the model involves the GP opening a discussion with a patient about intensifying treatment and the need for insulin, then passing the patient to the practice nurse for a more detailed discussion.

‘The clinical guidance still sits with the GP but we’re trying to upskill practice nurses to support patients and have that mentoring from a registered nurse with diabetes educator credentials,’ said Professor Blackberry, from the Australian Institute for Primary Care & Ageing at LaTrobe University, Melbourne.

The approach was designed with sustainability in mind, Professor Blackberry told Medicine Today, pointing out that it was about operating within the current system and resources.

‘A lot of people have a fear of insulin and injections, and there is a lot of uncertainty with patients, but these are things a practice nurse can actually deal with.’
BMJ 2017; 356: j783. http://dx.doi.org/10.1136/bmj.j783. 

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