Journal article

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

John Furler, David O'Neal, Jane Speight, Jo-Anne Manski-Nankervis, Alexandra Gorelik, Elizabeth Holmes-Truscott, Louise Ginnivan, Doris Young, James Best, Elizabeth Patterson, Danny Liew, Leonie Segal, Carl May, Irene Blackberry

BMJ-BRITISH MEDICAL JOURNAL | BMJ PUBLISHING GROUP | Published : 2017

Abstract

Objective 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 healt..

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