Stepping up: a nurse-led model of care for insulin initiation for people with type 2 diabetes

Background. Most people with type 2 diabetes (T2D) have glycaemic levels outside of target. Insulin is effective in improving glycaemia and most people with T2D eventually need this. Despite this, transition to insulin therapy is often delayed in primary care. Objective. To develop a model of care (Stepping Up) for insulin initiation in routine diabetes care in Australian general practice. To evaluate the model for feasibility of integration within routine general practice care. Methods. Drawing on qualitative work and normalisation process theory, we developed a model of care that included clarification of roles, in-practice systems and simple clinical tools. The model was introduced in an educational and practice system change intervention for gen-eral practitioners (GPs) and practice nurses (PNs). Five practices (seven GPs and five PNs) and 18 patients formed the feasibility study. Evaluation at 3 and 12 months explored experiences of GPs, PNs and patients. Results. Fourteen patients commenced insulin, with average HbA1c falling from 8.4 % (68.3 mmol/ mol) to 7.5 % (58.5 mmol/mol) at 3 months. Qualitative evaluation highlighted how the model o