Insulin initiation in patients with type 2 diabetes is often delayed, but access to a diabetes nurse may help-insights from Norwegian general practice

被引:0
作者
Mdala, Ibrahimu [1 ]
Nokleby, Kjersti [1 ]
Berg, Tore Julsrud [2 ,3 ]
Cooper, John [4 ,5 ]
Sandberg, Sverre [4 ,6 ]
Lovaas, Karianne Fjeld [4 ]
Claudi, Tor [7 ]
Jenum, Anne Karen [1 ]
Buhl, Esben Selmer [1 ]
机构
[1] Univ Oslo UiO, Inst Hlth & Soc, Dept Gen Practice, Oslo, Norway
[2] Univ Oslo UiO, Inst Clin Med, Oslo, Norway
[3] Oslo Univ Hosp OUS, Dept Endocrinol, Oslo, Norway
[4] Haraldsplass Deaconess Hosp Bergen HDS, Norwegian Qual Improvement Lab Examinat, Bergen, Norway
[5] Stavanger Univ Hosp SUS, Div Med, Stavanger, Norway
[6] Univ Bergen UiB, Dept Global Publ Hlth & Primary Care, Bergen, Norway
[7] Nordland Hosp, Clin Med, Bodo, Norway
关键词
Type 2 diabetes mellitus; general practice; primary care; therapeutic inertia; basal insulin; insulin initiation; diabetes nurse; THERAPEUTIC INERTIA; CLINICAL INERTIA; BASAL INSULIN; ATTITUDES; INTENSIFICATION; PROVIDERS; BARRIERS;
D O I
10.1080/02813432.2023.2296118
中图分类号
R19 [保健组织与事业(卫生事业管理)];
学科分类号
摘要
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 HbA(1c)<7%' after insulin start-up (secondary). Associations were analyzed using multiple linear regression, and directed acyclic graphs guided statistical adjustments.Subjects: Insulin na & iuml;ve patients with 'timely' (N = 294), 'postponed' (N = 219) or 'no need of' (N = 3,781) basal insulin-initiation, respectively.Results: HbA(1c) [median (IQR)] increased to 8.8% (IQR, 8.0, 10.2) prior to basal insulin-initiation, which reduced HbA(1c) to 7.3 (6.8-8.1) % by which only 35% of the subjects reached HbA(1c) <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.
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收藏
页码:132 / 143
页数:12
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