Using a nurse-driven and home-based telehealth intervention to improve insulin therapy for people with type 2 diabetes in primary care: a feasibility study

Objectives: A study was undertaken to assess the feasibility and safety of the Tshwane Insulin Project (TIP) intervention, describe patients’ and healthcare professionals’ experiences with the intervention, and determine preliminary treatment effects on glycaemic control. Design: This was a single-group feasibility study. Setting: The study was carried out in the City of Tshwane, South Africa. Subjects: People with type 2 diabetes on maximum oral drugs with suboptimal glycaemic control (HbA1c: 9–12%), and healthcare professionals who were involved in the implementation of the TIP intervention were included. Outcome measures: Implementation outcome measures included satisfaction, acceptability, appropriateness and safety; and efficacy by assessing change in HbA1c levels. Results: Healthcare professionals and patients were satisfied with the intervention. Healthcare professionals agreed that the intervention was acceptable and appropriate. No symptomatic or severe hypoglycaemic events were reported. Improved glycaemic control was recorded with 2.2% lowering of HbA1c values (95% CI, 1.6–2.8%). Conclusions: The TIP intervention was feasible and can be implemented with minor amendments. Most participants recommended scaling up the intervention. Lessons learned from this study include: (1) high rates of insulin refusal should be anticipated, and insulin resistance amongst people with type 2 diabetes in primary care should be addressed; and (2) the challenges of initiating and titrating insulin in primary care can be addressed through task sharing and by involving allied healthcare workers.