Once-daily insulin regimens cut district nurse visits 77%, improved HbA1c 1.5% in T2DM.

Type 2 diabetes in an increasingly frail and aging population places unsustainable demand on district nursing teams for insulin administration. Current regimens often require frequent visits, straining resources and potentially increasing patient burden. Simplified insulin protocols are crucial to alleviate this pressure while maintaining or improving glycemic control and patient outcomes. This initiative addresses the gap by optimizing insulin delivery frequency.

This quality improvement initiative targeted type 2 diabetes patients receiving district nurse visits for insulin administration. The integrated community care team audited eligible individuals, and community diabetes specialist nurses provided personalized guides to adjust insulin regimens from twice to once daily. The primary endpoints were reduction in nurse visits and changes in HbA1c levels, assessed over a 3-year follow-up period.

Adjusting insulin regimens from twice to once daily led to a 77% reduction in twice-daily district nurse visits.

Mean HbA1c significantly decreased by 16.3 mmol/mol (1.5%) at 12 months, moving from a baseline of 94.9 mmol/mol (10.8%) to 78.6 mmol/mol (9.3%). The median follow-up for patients was 18 months, during which a mortality rate of 30% was observed. This indicates improved glycemic control alongside reduced healthcare burden.