Evaluation of a model of care of credentialed diabetes educator – registered nurses (cde-rn/s) supporting primary health care professionals to initiate insulin in people with type 2 diabetes (t2d): the initiation study — ASN Events
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Evaluation of a model of care of credentialed diabetes educator – registered nurses (cde-rn/s) supporting primary health care professionals to initiate insulin in people with type 2 diabetes (t2d): the initiation study (#34)

Louise Ginnivan 1 , Hanan Derraz 1 2 , J Furler 1 , I Blackberry 1 , N Cohen 2 , J D Best 3 , D Young 1 , A J Jenkins 3 , D Liew 3 , G Ward 4 , D O'Neal 3
  1. General Practice and Primary Health Care Academic Centre, University of Melbourne, Carlton, Vic, Australia
  2. Baker IDI Heart & Diabetes Institute, Melbourne, Vic, Australia
  3. University of Melbourne, Department of Medicine, St Vincent's Hospital, Melbourne, VIC, Australia
  4. Department of Endocrinology and Diabetes, St Vincent's Hospital, Melbourne, Vic, Australia

Introduction: Glycaemia in T2D patients in Australia remains suboptimal, and improved utilisation of scarce CDE-RN resources is required. The INITIATION Study evaluates the efficacy of General Practitioner (GP) and Practice Nurse (PN) teams, with CDE-RN and endocrinologist support, to initiate basal/prandial insulin regimens in T2D patients. The study also evaluates the effect of retrospective Continuous Glucose Monitoring (CGM).
Aim: To describe CDE-RNs’ experience in training, mentoring and supporting GPs and PNs to initiate insulin and use CGM technology in primary care.
Method:  22 general practices were recruited in Melbourne. T2D patients on maximum oral hypoglycaemic agents, HbA1c >7.5% requiring insulin were identified. GPs & PNs attended a group training session by CDE-RN and endocrinologist. The CDE-RN provided ongoing support and mentorship to GPs and PNs to confirm eligibility and initiate basal (glargine; Sanofi) and prandial insulin (glulisine; Sanofi) using a structured protocol. Patients were randomised to routine Self-Monitoring of Blood Glucose (SMBG: Freestyle Optium™; Abbott) or with adjunct retrospective-CGM (iPro™ 2/Enlite™; Medtronic). The nature of ongoing CDE-RN support was determined by the CDE-RN’s assessment and the perceived needs of the GPs and PNs.
Outcomes:  Of 98 T2D patients screened 89 commenced insulin. Results to date show significant reduction in mean HbA1c, with no major hypoglycaemia. The GCM arm gave GPs and PNs more confidence of titration safety, which translated to the routine monitoring study arm. The CDE-RN role evolved from very hands-on to increasing independence with time and subsequent insulin initiations. Characteristics of general practices that lead to successful implementation of this model of care will be presented and discussed.
Conclusion: The INITIATION study is testing a new model of care that may be more effective and efficient in utilisation of CDE-RN’s skills, as well as facilitating timely initiation of insulin among people with T2D, in primary care settings.