Elizabeth Holmes-Truscott1, John Furler2, Irene Blackberry3, David N O'Neal4, Jane Speight5. 1. School of Psychology, Deakin University, 1 Gheringhap Street, Geelong 3220, VIC, Australia; The Australian Centre for Behavioural Research in Diabetes, Diabetes Victoria, 570 Elizabeth Street, Melbourne 3000, VIC, Australia. Electronic address: etruscott@acbrd.org.au. 2. Department of General Practice, The University of Melbourne, 200 Berkeley St, Carlton 3052, VIC, Australia. 3. Department of General Practice, The University of Melbourne, 200 Berkeley St, Carlton 3052, VIC, Australia; John Richards Initiative, Australian Institute of Primary Care and Ageing, La Trobe University, PO Box 821, Wodonga 3689, VIC, Australia. 4. University of Melbourne, Department of Medicine, St Vincent's Hospital Melbourne, Fitzroy 3065, Australia. 5. School of Psychology, Deakin University, 1 Gheringhap Street, Geelong 3220, VIC, Australia; The Australian Centre for Behavioural Research in Diabetes, Diabetes Victoria, 570 Elizabeth Street, Melbourne 3000, VIC, Australia; AHP Research, 16 Walden Way, Hornchurch RM11 2LB, United Kingdom.
Abstract
AIMS: We aimed to investigate predictors of insulin uptake, and change in insulin appraisals, among adults with type 2 diabetes mellitus (T2DM) who participated in the Stepping Up trial. METHODS: The Stepping Up model of care, supporting timely insulin initiation in primary care, was evaluated in a two-armed cluster-randomised controlled trial. Participants were 266 adults (mean±SD age 62±10years; 39% women) with T2DM (median (IQR) duration 8.5 (5, 13)years) from 74 primary care practices (Stepping Up intervention: 57%, control 43%). At 12months, 47% (n=126) had commenced insulin. Controlling for randomisation, logistic regression was used to explore baseline predictors of insulin uptake, including: demographic and clinical characteristics, emotional wellbeing (depressive symptoms and diabetes-related distress), insulin treatment appraisals, and, 'willingness' to initiate insulin. Two-way analysis of variance examined effects of, and interaction between, randomisation and insulin uptake on 12-month change in insulin appraisals. RESULTS: Participants using insulin at 12months were more likely (all p<0.05) than those with non-insulin-treated T2DM to report: lower socioeconomic status, higher baseline HbA1c (median difference: 0.3%; 3mmol/mol), greater willingness to commence insulin (very willing: 27% vs 12%), and less negative and more positive insulin appraisals. All contributed significantly to the final model (χ2(8)=92.1, p<0.001) except insulin appraisals. Regardless of trial allocation, those initiating insulin reported significantly greater reductions in negative insulin appraisals. CONCLUSIONS: Controlling for randomisation, 12-month insulin use was predicted by higher baseline HbA1c and 'willingness' to use insulin if recommended. Negative insulin appraisals reduced following insulin initiation.
RCT Entities:
AIMS: We aimed to investigate predictors of insulin uptake, and change in insulin appraisals, among adults with type 2 diabetes mellitus (T2DM) who participated in the Stepping Up trial. METHODS: The Stepping Up model of care, supporting timely insulin initiation in primary care, was evaluated in a two-armed cluster-randomised controlled trial. Participants were 266 adults (mean±SD age 62±10years; 39% women) with T2DM (median (IQR) duration 8.5 (5, 13)years) from 74 primary care practices (Stepping Up intervention: 57%, control 43%). At 12months, 47% (n=126) had commenced insulin. Controlling for randomisation, logistic regression was used to explore baseline predictors of insulin uptake, including: demographic and clinical characteristics, emotional wellbeing (depressive symptoms and diabetes-related distress), insulin treatment appraisals, and, 'willingness' to initiate insulin. Two-way analysis of variance examined effects of, and interaction between, randomisation and insulin uptake on 12-month change in insulin appraisals. RESULTS:Participants using insulin at 12months were more likely (all p<0.05) than those with non-insulin-treated T2DM to report: lower socioeconomic status, higher baseline HbA1c (median difference: 0.3%; 3mmol/mol), greater willingness to commence insulin (very willing: 27% vs 12%), and less negative and more positive insulin appraisals. All contributed significantly to the final model (χ2(8)=92.1, p<0.001) except insulin appraisals. Regardless of trial allocation, those initiating insulin reported significantly greater reductions in negative insulin appraisals. CONCLUSIONS: Controlling for randomisation, 12-month insulin use was predicted by higher baseline HbA1c and 'willingness' to use insulin if recommended. Negative insulin appraisals reduced following insulin initiation.
Authors: Elizabeth Holmes-Truscott; Edith E Holloway; Hanafi M Husin; John Furler; Virginia Hagger; Timothy C Skinner; Jane Speight Journal: BMJ Open Date: 2022-02-21 Impact factor: 2.692
Authors: Ka Yan Or; Benjamin Hoi-Kei Yip; Chi Hang Lau; Hing Han Chen; Yuk Wah Chan; Kam Pui Lee Journal: Diabetes Ther Date: 2017-12-07 Impact factor: 2.945