Overcoming clinical inertia in insulin initiation in primary care for patients with type 2 diabetes: 24-month follow-up of the Stepping Up cluster randomised controlled trial

被引：15

作者：

Manski-Nankervis, Jo-Anne ^{[1
]}

Furler, John ^{[1
]}

O'Neal, David ^{[2
]}

Ginnivan, Louise ^{[1
]}

Thuraisingam, Sharmala ^{[1
]}

Blackberry, Irene ^{[1
,3
]}

机构：

[1] Univ Melbourne, Dept Gen Practice, 200 Berkeley St, Carlton, Vic 3053, Australia

[2] St Vincents Hosp, Dept Med, 41 Victoria Parade, Fitzroy, Vic 3065, Australia

[3] La Trobe Univ, John Richards Initiat Rural Ageing Res, Wodonga, Vic 3690, Australia

来源：

PRIMARY CARE DIABETES | 2017年 / 11卷 / 05期

基金：

澳大利亚国家健康与医学研究理事会;

关键词：

Type; 2; diabetes; General practice; Insulin; Cohort study; THERAPY; PEOPLE; AGENTS;

D O I：

10.1016/j.pcd.2017.06.005

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

Aim: To examine the two-year impact of Stepping Up, a general practice based model of care intervention for insulin initiation and titration in Australia. Methods: 266 participants from 74 general practices participated in the Stepping Up cluster randomised controlled trial between 2012-2014. Control practices received training in the model of care on completion of the 12-month trial. Patients were followed for 24 months. Participant baseline characteristics, insulin and non-insulin medication use were summarised for each study group. Linear mixed-effects models with random intercepts were used to estimate differences in mean outcome (HbA1c and weight) between the study groups using restricted maximum likelihood estimation. Results: At baseline 61% of patients were male, mean (SD) age 62 (10) years, diabetes duration 9 (5, 13) years and mean (95% CI) HbA1c was 8.9 (8.8-9.1)% (74 (73-76) mmol/mol) for both groups. There was a significant between group difference at 6 months which was sustained at 24 months; Mean (95% CI) HbA1c at 24 months in the intervention group was 7.6 (7.5-7.8)% (60 (58-62) mmol/mol) and 8.0 (7.7-8.4)% (64 (61-68) mmol/mol) in the control group. At 24 months 97 (71.3%) of the intervention group and 26 (31.0%) of the control group were prescribed insulin; there was no significant difference in weight. Use of non-insulin anti-hyperglycaemic agents was similar in both groups with the exception of dipeptidyl peptidase-4 inhibitors which were prescribed more frequently in the control group (30(36%) vs 21(16%)). Conclusion: Stepping Up was associated with improved glycaemic control compared to usual care for 24 months, suggesting that the model facilitated more timely treatment intensification. Ongoing RN-CDE support maybe needed to facilitate ongoing treatment intensification. (C) 2017 Primary Care Diabetes Europe. Published by Elsevier Ltd. All rights reserved.

引用

页码：474 / 481

页数：8

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