Reducing diabetes care costs and district nurse visits through novel insulin regimens

Background An increasingly frail and ageing population has resulted in an unsustainable demand on district nurse teams in terms of insulin administration. Aims This quality improvement initiative aimed to reduce district nursing team visits by adjusting the insulin regimens of people with type 2 diabetes from twice to once daily, where possible. Methods The integrated community care team audited all people receiving district nursing visits for insulin administration. Community diabetes specialist nurses provided personalised insulin adjustment guides. HbA1c levels before and after the intervention were assessed over a 3-year follow-up period. Findings Twice daily visits were reduced by 77%. Mean HbA1c significantly decreased by 16.3 mmol/mol (1.5%) (from 94.9 [10.8%] to 78.6 [9.3%]) at 12 months. The mortality rate was 30%, and median follow up was 18 months. Conclusions This innovative way of working and change of insulin regimens lessened the burden of insulin administration on district nursing teams, while improving glycaemia and yielding estimated savings of approximately £839 500 annually.