Optimizing insulin initiation in primary care: the Diabetes CoStars patient support program

Abstract

PurposeThe purpose of this study was to evaluate the optimization of fasting blood glucose (FBG) levels in patients with type 2 diabetes mellitus newly initiated on insulin glargine who were enrolled in the Australian Diabetes CoStars Patient Support Program (PSP).Patients and methodsA retrospective analysis of data from 514 patients with type 2 diabetes mellitus who completed the 12-week Diabetes CoStars PSP was performed. All patients were initiated on insulin glargine in primary care and enrolled by their general practitioner, who selected a predefined titration plan and support from a local Credentialled Diabetes Educator. The data collected included initial and final insulin dose, self-reported FBG, and glycated hemoglobin (A1c) levels.ResultsThe insulin dose increased in 81% of patients. Mean FBG was reduced from 208.8 mg/dL (11.6 mmol/L) to 136.8 mg/dL (7.6 mmol/L) after 12 weeks. Initial and final A1c values were available for 99 patients; mean A1c was reduced from 9.5% (80 mmol/mol) to 8.1% (65 mmol/mol). The reductions in mean FBG and A1c were similar irrespective of titration plan. Overall, 27.2% of patients achieved FBG levels within the titration plan target range of 72–108 mg/dL (4–6 mmol/L) and an additional 43.4% of patients achieved FBG within the range recommended by current Australian guidelines (110–144 mg/dL [6.1–8.0 mmol/L]). Overall, 23.3% of patients achieved the A1c target of ≤7%.ConclusionThese data demonstrate that the majority of patients enrolled in the Diabetes CoStars PSP achieved acceptable FBG levels 12 weeks after starting insulin therapy irrespective of titration plan.

Impact of Home Care Services on Patient and Economic Outcomes: A Targeted Review

“…68 -Diabetes mellitus (n = 3; 4.7%): two (66.7%) home care initiatives consisted of PSPs aimed at diabetes mellitus patients who were starting insulin treatment. [69][70][71] One home care service was aimed at the telemonitoring and home-based nursing management of patients with diabetes and other chronic diseases (heart failure, chronic obstructive pulmonary disease, and hypertension). 72 -HIV infection (n = 2; 3.1%): These home care services 73,74 were aimed at the home delivery of antiretroviral drugs.…”