Facilitating Initiation of Insulin in Patients with Type 2 Diabetes

In primary care, initiating insulin in type 2 diabetic patients who require additional treatment often is delayed due to patients' reluctance, physicians' lack of knowledge, systems issues, or other factors. In this randomized trial, Australian researchers evaluated whether the “Stepping Up” intervention led to higher use of insulin and improved glycemic control compared with usual primary care in 266 patients (mean age, 62) with type 2 diabetes and glycosylated hemoglobin (HbA_1c) levels ≥7.5%). The “Stepping Up” program included practice nurses who led discussions with patients about initiating and up-titrating insulin, a simple protocol for dosing, and registered nurses with diabetes-educator credentials who mentored practice nurses.

After…