dc.contributor.author | Mdala, Ibrahimu | |
dc.contributor.author | Nøkleby, Kjersti | |
dc.contributor.author | Berg, Tore Julsrud | |
dc.contributor.author | Cooper, John | |
dc.contributor.author | Sandberg, Sverre | |
dc.contributor.author | Løvaas, Karianne Fjeld | |
dc.contributor.author | Claudi, Tor | |
dc.contributor.author | Jenum, Anne Karen | |
dc.contributor.author | Buhl, Esben Selmer | |
dc.date.accessioned | 2024-03-19T14:08:00Z | |
dc.date.available | 2024-03-19T14:08:00Z | |
dc.date.created | 2024-01-08T13:07:13Z | |
dc.date.issued | 2024 | |
dc.identifier.issn | 0281-3432 | |
dc.identifier.uri | https://hdl.handle.net/11250/3123184 | |
dc.description.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. | en_US |
dc.language.iso | eng | en_US |
dc.publisher | Taylor & Francis | en_US |
dc.rights | Navngivelse 4.0 Internasjonal | * |
dc.rights.uri | http://creativecommons.org/licenses/by/4.0/deed.no | * |
dc.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 | en_US |
dc.type | Journal article | en_US |
dc.type | Peer reviewed | en_US |
dc.description.version | publishedVersion | en_US |
dc.rights.holder | Copyright 2023 The Author(s) | en_US |
cristin.ispublished | true | |
cristin.fulltext | original | |
cristin.qualitycode | 1 | |
dc.identifier.doi | 10.1080/02813432.2023.2296118 | |
dc.identifier.cristin | 2222277 | |
dc.source.journal | Scandinavian Journal of Primary Health Care | en_US |
dc.source.pagenumber | 132-143 | en_US |
dc.identifier.citation | Scandinavian Journal of Primary Health Care. 2024, 42 (1), 132-143. | en_US |
dc.source.volume | 42 | en_US |
dc.source.issue | 1 | en_US |