The Stepping Up trial and cohort study: Supporting insulin initiation in General Practice
Rationale and objectives for research
The Stepping Up trial is a trial of a new model of care in primary care to support timely initiation of insulin for people with type 2 diabetes. The trial completed 12 month follow up of participants in April 2015 and a second year of follow up is due to be completed in April 2016.
Most people with type 2 diabetes (T2D) live with out-of-target HbA1c levels. This can cause downstream cardiovascular and microvascular complications. Insulin is effective in improving glycaemic levels, yet insulin initiation in General Practice is uncommon in Australia, and is often delayed. Facilitating insulin initiation for patients with T2D as a routine element of generalist primary care practice will support holistic care, reduce care fragmentation and lessen referrals to more costly secondary care. The study aims to test a sustainable model of care for insulin initiation in primary care based on an enhanced role for the Practice Nurse to manage timely initiation of insulin within routine care.
The Stepping Up Cohort Study will prospectively observe longer-term diabetes trajectories, health outcomes, diabetes management, burden of disease, health services utilisation and healthcare costs of patients from the original trial.
The Stepping Up study is a cluster randomised controlled trial. The Stepping Up cohort study captures an additional year of follow up data on the trial participants
The study is set in General Practices in Victoria, Australia
74 practices and 266 patients joined the Stepping Up Study
When final results will be reported/timeline/are preliminary results available?
The Stepping Up RCT was completed in April 2015 and the Cohort Study will be complete in April 2016. The outcomes of the trial have been presented internationally and the final outcomes paper is currently under review for publication.
Associate Professor John Furler, Leader of the Research Group
Irene Blackberry (La Trobe), Director, John Richards Initiative | Australian Institute for Primary Care & Ageing, College of Science, Health and Engineering, La Trobe University,
Irene Blackberry (Melbourne), Honorary Senior Research Fellow, Department of General Practice, Stepping Up Study coordinator 2012-2013 (University of Melbourne)
Dr Jo-Anne Manski-Nankervis, lecturer
Louise Ginnivan, Credentialled Diabetes Educator
Katie De La Rue, Research Officer and Study Co-ordinator
Chief Investigators Stepping Up trial
Associate Professor John Furler
Associate Professor David O'Neal, Department of Medicine, St Vincent's Hospital
Professor Doris Young, Professor
Professor James Best, Dean Lee Kong Chian Medical School, Nanyang Technological University, Singapore
Professor Elizabeth Patterson
Irene Blackberry, Stepping Up Study coordinator 2012-2013
Stepping Up Study: $768,346 (NHMRC) and $90,000 (Roche Diagnostics)
Stepping Up Cohort Study: $59, 998 RACGP Research Foundation