Home Initiation of Injectable Therapy in Type 2 Diabetes (HIIT-D) Pilot outline

• About RDNS

• Community Nurses

• Nurse consultants

• Good processes

• Long close relationship with general practice

• Research Institute

RDNS

Diabetes

• Large number of people with diabetes are delayed going onto injectable therapy

• Average HbA1c at commencement is 9.3%

• Many reasons for this

HIIT-D

• RDNS trialling increased resources into the community to support general practice

• Improve uptake of injectable therapy

• Pilot for 12 months

• If successful – rolled out

What's involved?

• Identifying patients not at target that need injectable therapy

• Decide on what injectable therapy you want to initiate (can ask A/Prof Ralph Audehm if unsure)

• Can include RDNS in care plan

• Refer patient to project

Referral Process

• Fill in form

– Template (MD and BP) • Also on USB stick & rdns.com.au/hiitd

– Manual

– Fax to RDNS

• Referral through usual process at RDNS

• Allocated to a nurse and research officer (Jessica Occleston)

• If meets criteria – visits organised

Criteria

• Be adults aged 18 years and over with T2DM, living in Northern Metropolitan Melbourne

• People with T2DM who – Are not currently using injectable therapy – Are on oral hypoglycaemic agents and who meet the

criteria for starting an injectable therapy: • GLP1 therapy – HbA1c ≥7 % for more than 3 months (Inzucchi et al.,

2012). • Insulin – person has not achieved their individualised target HbA1c

for over 3 months.

• Are able to speak English or one of the 3 culturally and linguistically diverse language target groups – Arabic, Assyrian and Turkish.

Exclusions • Type 1 diabetes

• Aged less than 18 years

• Gestational diabetes

• Have impaired renal function, with an eGFR <30.

• Unplanned hospital admission in the last one month.

• Ischaemic event in the preceding three months.

• Active heart failure – still symptomatic, having active medication dose adjustments being made.

• Active foot ulcer – unless referred by a diabetes foot service or expert diabetes foot practitioner.

– If not part of Diabetes Foot Service (DFS) – to refer to a local DFS.

• Individuals with gross physical and/or intellectual disabilities, unstable psychiatric disorders

• or significan’t cognitive impairment who do not have a suitable carer.

• Individuals that live in an unsafe environment or have no telephone services available.

• Pregnancy, or planned pregnancy.

• Nurse clinical judgment that patient is medically unstable or unable to learn self-care.

– Client or carer unable to perform injections.

– Client or carer unable to monitor blood glucose

What happens?

• Visit by research officer (questionnaires)

• Visit by RDNS nurse

– Initial and second within 1-2 days

– Injectable initiated on 2nd visit if appropriate

• Regular follow up supporting self-management and titration

Feedback

• As per referral letter – tick how often you would like information about doses and readings

• Patient discharged when confident with injecting and adjusting (insulin) or on Byetta 10mcg and stable

• If unable to be discharged – referred to RDNS general service at 3 months for ongoing support

Duration

• Project is for 12 months only; aim to recruit 100 participants

• If successful – will remain in place

• After 12 months:

–People >65 can be referred

– Issues with people <65 due to new rules around HACC funding

Research - RDNS

• Rajna Ogrin

• Jessica Occleston

• Tracey Aylen

• More information included in your bag, on the enclosed USB and at www.rdns.com.au/hiitd

• Focus groups/discussions with GPs and PNs at end (hopefully back here )

• Measuring impact, efficiency and sustainability