Supporting insulin initiation in type 2 diabetes in primary care: Results of the Stepping Up pragmatic cluster randomised controlled clinical trial

Abstract

To compare the effectiveness of a novel model of care ('Stepping Up') with usual primary care in normalising insulin initiation for type 2 diabetes, leading to improved glycated haemoglobin (HbA1c) levels. Design Cluster randomised controlled trial. Setting Primary care practices in Victoria, Australia, with a practice nurse and at least one consenting eligible patient (HbA1c ≥7.5% with maximal oral treatment). Participants 266 patients with type 2 diabetes and 74 practices (mean cluster size 4 (range 1-8) patients), followed up for 12 months. Intervention The Stepping Up model of care intervention involved theory based change in practice systems and reorientation of the roles of health prof..