Evaluating a nurse-led insulin tele-titration program on diabetes control in primary cares

Author(s): E Janice Koh Huimin, Yan Chau Chain, Karie Choo & Liau Wei Fong

Objectives: Primary care nurses have been titrating insulin doses through weekly telephone calls based on patients’ home glucose monitoring records. This study aims to evaluate the benefits of a nurse-led insulin titration program on diabetes control, specifically assessing improvements in glycaemic control over time. As a secondary aim, this study will also determine if clinical indicators, patient demographics, insulin dose and quantity of calls are predictors of HbA1c improvement in this nurse-led tele-titration program.

Methods: A purposive sampling of 193 patients were enrolled into the program from May to December 2021. Repeated-measures ANOVA test was conducted to determine if mean HbA1c differed significantly across four time points (baseline, 3, 6, 9 months). Multiple linear regressions and correlations were used to compute which predictor (gender, ethnicity, insulin type, insulin dose, Type 2 Diabetes (T2DM) duration, age and those with optimal and suboptimal clinical indicators) has the highest bivariate correlation with the dependent variable (HbA1c improvement).

Results: Repeated-measures ANOVA test found that mean HbA1c differed significantly across the four time points (p<0.001). Linear regression models revealed 14.8% to 22.2% variation of HbA1c improvement, and is useful in explaining HbA1c improvement for all time points (p<0.002) except for the 6 to 9-month time point. There was no independent variable which was able to consistently significantly predict HbA1c improvement at 9 months. This study also found significantly more HbA1c reduction for patients on lower total daily doses of insulin (p<0.01).

Conclusion: Significant improvements in HbA1c over time reaffirmed effectiveness of nurse- led telephone consultations for optimising glycaemic control for patients on insulin. Since there are no consistently significant predictors for HbA1c improvement in this program, all eligible patients can potentially benefit from enrolment. Additionally, study findings also suggest that enrolment should be considered for patients at lower total daily doses of insulin. Further studies should explore the use of a control group to more accurately isolate the benefits of the nurse-led insulin tele-titration program for evaluation.