Changes in health services usage associated with insulin initiation in primary care

Area of Science:

• Endocrinology
• Health Services Research
• Primary Care Medicine

Background:

• Insulin initiation in type 2 diabetes management is often delayed due to concerns about increased clinical workload.
• Type 2 diabetes requires careful management of glycaemic levels to prevent complications.

Purpose of the Study:

• To quantify health services usage (HSU) changes following insulin initiation in patients with type 2 diabetes.
• To assess the impact of insulin initiation on general practitioner (GP) consultations, hospitalizations, and specialist visits.

Main Methods:

• Secondary analysis of data from the Stepping Up randomised controlled trial.
• Comparison of HSU in the 6 months before versus 12 months after insulin initiation in 142 participants.
• Statistical analysis to determine changes in HSU events and specific consultation types.

Main Results:

• HSU events increased significantly in the 6 months post-insulin initiation (median 18 to 23, P=0.05).
• This increase was primarily driven by higher GP consultations (median 6 to 8, P=0.01).
• HSU and GP consultations returned to baseline levels by 12 months post-initiation, with no significant changes in hospitalizations or specialist visits.

Conclusions:

• Insulin initiation is associated with a short-term, manageable increase in GP consultations.
• The overall health services burden related to insulin initiation does not persist beyond 12 months.
• Findings can inform health policy and resource allocation to facilitate insulin initiation in primary care settings.