The use of multiple daily injections versus insulin pump therapy for HgbA1c reduction in patients with insulin-dependent type 2 diabetes.

BACKGROUND: More than 35 million Americans live with type 2 diabetes (T2D), resulting in the need for newer strategies and technologies to manage the disease. Insulin pump therapy (IPT) has historically been reserved for type 1 diabetes, although emerging data demonstrates improved glucose outcomes for patients with T2D using IPT. PURPOSE: To measure the change in HgbA1c in patients with T2D after changing therapy from multiple daily injections (MDI) to continuous subcutaneous insulin infusion through IPT. METHODOLOGY: A retrospective comparison study was conducted by reviewing the electronic medical record of patients with T2D, older than 18 years, who had been on multiple daily insulin injections for at least 1 year, followed by IPT for at least 1 year. RESULTS: One hundred seventy-one patients met the inclusion criteria. There was a statistically significant reduction in mean HgbA1c from 9.6% to 7.6%. CONCLUSION: Insulin pump therapy may result in lower HgbA1c levels for T2D not at goal on MDI. IMPLICATIONS: Patients on multiple daily insulin injections who are not at goal should be considered for IPT.

An interdisciplinary telemedicine innovation to enhance pediatric diabetes care in rural communities: A proposed practice initiative.

PURPOSE: The COVID-19 pandemic highlighted disparities in healthcare access and outcomes, particularly among individuals with chronic conditions. A positive outcome of the pandemic was an increased use of telehealth and the creation of innovative models of care. In many organizations, nurses became the leaders for these new models. Before this change, pediatric medicine had far fewer telehealth models than adult medicine due to limited Medicaid reimbursement and equipment that was not designed with children in mind. This article describes a new model of care for children with diabetes. We will review how a nurse-led initiative with the incorporation of telehealth modalities can improve access and outcomes while reducing cost. Successful models of care will be reviewed, as well as programmatic planning, financial implications, and regulatory considerations. CONCLUSIONS: It is no longer necessary for families living in rural communities to drive long distances, missing school and work, to attend the frequent appointments needed for optimal management of pediatric diabetes. Telemedicine can bridge gaps in access to specialty care, and is feasible, reimbursable, and well-accepted by families and providers. PRACTICE IMPLICATIONS: Nurses in both primary care and pediatric specialty offices can initiate and support innovative telehealth models of care, such as this proposal. To win the backing of practice leadership, the availability of cost-effective videoconferencing equipment and software, improvements in telehealth reimbursement prompted by the pandemic, and enhanced patient and parent satisfaction and outcomes should be emphasized.