Insulin initiation in patients with type 2 diabetes is often delayed, but access to a diabetes nurse may help—insights from Norwegian general practice
AbstractObjective: 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 p...
| Main Authors: | , , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Taylor & Francis Group
2024-01-01
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| Series: | Scandinavian Journal of Primary Health Care |
| Subjects: | |
| Online Access: | https://www.tandfonline.com/doi/10.1080/02813432.2023.2296118 |
| _version_ | 1797299993074204672 |
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| author | Ibrahimu Mdala Kjersti Nøkleby Tore Julsrud Berg John Cooper Sverre Sandberg Karianne Fjeld Løvaas Tor Claudi Anne Karen Jenum Esben Selmer Buhl |
| author_facet | Ibrahimu Mdala Kjersti Nøkleby Tore Julsrud Berg John Cooper Sverre Sandberg Karianne Fjeld Løvaas Tor Claudi Anne Karen Jenum Esben Selmer Buhl |
| author_sort | Ibrahimu Mdala |
| collection | DOAJ |
| description | AbstractObjective: 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. |
| first_indexed | 2024-03-07T22:59:43Z |
| format | Article |
| id | doaj.art-ff64f50a3f634fe899c48b76cad39b2a |
| institution | Directory Open Access Journal |
| issn | 0281-3432 1502-7724 |
| language | English |
| last_indexed | 2024-03-07T22:59:43Z |
| publishDate | 2024-01-01 |
| publisher | Taylor & Francis Group |
| record_format | Article |
| series | Scandinavian Journal of Primary Health Care |
| spelling | doaj.art-ff64f50a3f634fe899c48b76cad39b2a2024-02-22T15:18:19ZengTaylor & Francis GroupScandinavian Journal of Primary Health Care0281-34321502-77242024-01-0142113214310.1080/02813432.2023.2296118Insulin initiation in patients with type 2 diabetes is often delayed, but access to a diabetes nurse may help—insights from Norwegian general practiceIbrahimu Mdala0Kjersti Nøkleby1Tore Julsrud Berg2John Cooper3Sverre Sandberg4Karianne Fjeld Løvaas5Tor Claudi6Anne Karen Jenum7Esben Selmer Buhl8Department of General Practice, Institute of Health and Society, University of Oslo (UiO), NorwayDepartment of General Practice, Institute of Health and Society, University of Oslo (UiO), NorwayInstitute of Clinical Medicine, University of Oslo (UiO), NorwayNorwegian Quality Improvement of Laboratory Examinations, Haraldsplass Deaconess Hospital, Bergen (HDS), NorwayNorwegian Quality Improvement of Laboratory Examinations, Haraldsplass Deaconess Hospital, Bergen (HDS), NorwayNorwegian Quality Improvement of Laboratory Examinations, Haraldsplass Deaconess Hospital, Bergen (HDS), NorwayClinic For Medicine, Nordland Hospital, Bodø, NorwayDepartment of General Practice, Institute of Health and Society, University of Oslo (UiO), NorwayDepartment of General Practice, Institute of Health and Society, University of Oslo (UiO), NorwayAbstractObjective: 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.https://www.tandfonline.com/doi/10.1080/02813432.2023.2296118Type 2 diabetes mellitusgeneral practiceprimary caretherapeutic inertiabasal insulininsulin initiation |
| spellingShingle | Ibrahimu Mdala Kjersti Nøkleby Tore Julsrud Berg John Cooper Sverre Sandberg Karianne Fjeld Løvaas Tor Claudi Anne Karen Jenum Esben Selmer Buhl Insulin initiation in patients with type 2 diabetes is often delayed, but access to a diabetes nurse may help—insights from Norwegian general practice Scandinavian Journal of Primary Health Care Type 2 diabetes mellitus general practice primary care therapeutic inertia basal insulin insulin initiation |
| title | Insulin initiation in patients with type 2 diabetes is often delayed, but access to a diabetes nurse may help—insights from Norwegian general practice |
| title_full | Insulin initiation in patients with type 2 diabetes is often delayed, but access to a diabetes nurse may help—insights from Norwegian general practice |
| title_fullStr | Insulin initiation in patients with type 2 diabetes is often delayed, but access to a diabetes nurse may help—insights from Norwegian general practice |
| title_full_unstemmed | Insulin initiation in patients with type 2 diabetes is often delayed, but access to a diabetes nurse may help—insights from Norwegian general practice |
| title_short | Insulin initiation in patients with type 2 diabetes is often delayed, but access to a diabetes nurse may help—insights from Norwegian general practice |
| title_sort | insulin initiation in patients with type 2 diabetes is often delayed but access to a diabetes nurse may help insights from norwegian general practice |
| topic | Type 2 diabetes mellitus general practice primary care therapeutic inertia basal insulin insulin initiation |
| url | https://www.tandfonline.com/doi/10.1080/02813432.2023.2296118 |
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