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

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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.
Authors: Mdala, Ibrahimu (AUTHOR), Nøkleby, Kjersti (AUTHOR), Berg, Tore Julsrud (AUTHOR), Cooper, John (AUTHOR), Sandberg, Sverre (AUTHOR), Løvaas, Karianne Fjeld (AUTHOR), Claudi, Tor (AUTHOR), Jenum, Anne Karen (AUTHOR), Buhl, Esben Selmer (AUTHOR)
Source: Scandinavian Journal of Primary Health Care. Mar2024, Vol. 42 Issue 1, p132-143. 12p.
Subjects: Insulin therapy, Health services accessibility, Scientific observation, Confidence intervals, Time, Multiple regression analysis, Retrospective studies, Acquisition of data, Family nurses, Type 2 diabetes, Insulin, Treatment delay (Medicine), Medical records, Descriptive statistics, Professional competence, Research funding, Odds ratio
Geographic Terms: Norway
Abstract: 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. [ABSTRACT FROM AUTHOR]
Copyright of Scandinavian Journal of Primary Health Care is the property of Taylor & Francis Ltd and its content may not be copied or emailed to multiple sites without the copyright holder's express written permission. Additionally, content may not be used with any artificial intelligence tools or machine learning technologies. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)
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  Data: Insulin initiation in patients with type 2 diabetes is often delayed, but access to a diabetes nurse may help—insights from Norwegian general practice.
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– Name: Abstract
  Label: Abstract
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  Data: 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 &#39;timely basal insulin-initiation&#39; (primary) and &#39;attainment of HbA1c&lt;7%&#39; after insulin start-up (secondary). Associations were analyzed using multiple linear regression, and directed acyclic graphs guided statistical adjustments. Subjects: Insulin na&#239;ve patients with &#39;timely&#39; (N = 294), &#39;postponed&#39; (N = 219) or &#39;no need of&#39; (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 &lt;7%. Adjusted risk of &#39;timely basal insulin-initiation&#39; 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. [ABSTRACT FROM AUTHOR]
– Name: AbstractSuppliedCopyright
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  Data: &lt;i&gt;Copyright of Scandinavian Journal of Primary Health Care is the property of Taylor &amp; Francis Ltd and its content may not be copied or emailed to multiple sites without the copyright holder&#39;s express written permission. Additionally, content may not be used with any artificial intelligence tools or machine learning technologies. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract.&lt;/i&gt; (Copyright applies to all Abstracts.)
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RecordInfo BibRecord:
  BibEntity:
    Identifiers:
      – Type: doi
        Value: 10.1080/02813432.2023.2296118
    Languages:
      – Code: eng
        Text: English
    PhysicalDescription:
      Pagination:
        PageCount: 12
        StartPage: 132
    Subjects:
      – SubjectFull: Insulin therapy
        Type: general
      – SubjectFull: Health services accessibility
        Type: general
      – SubjectFull: Scientific observation
        Type: general
      – SubjectFull: Confidence intervals
        Type: general
      – SubjectFull: Time
        Type: general
      – SubjectFull: Multiple regression analysis
        Type: general
      – SubjectFull: Retrospective studies
        Type: general
      – SubjectFull: Acquisition of data
        Type: general
      – SubjectFull: Family nurses
        Type: general
      – SubjectFull: Type 2 diabetes
        Type: general
      – SubjectFull: Insulin
        Type: general
      – SubjectFull: Treatment delay (Medicine)
        Type: general
      – SubjectFull: Medical records
        Type: general
      – SubjectFull: Descriptive statistics
        Type: general
      – SubjectFull: Professional competence
        Type: general
      – SubjectFull: Research funding
        Type: general
      – SubjectFull: Odds ratio
        Type: general
      – SubjectFull: Norway
        Type: general
    Titles:
      – TitleFull: Insulin initiation in patients with type 2 diabetes is often delayed, but access to a diabetes nurse may help—insights from Norwegian general practice.
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            – D: 01
              M: 03
              Text: Mar2024
              Type: published
              Y: 2024
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