Association of a nurse-led structured insulin management program with glycemic control and medication safety in patients with type 2 diabetes

Background: Insulin therapy is important for many patients with type 2 diabetes mellitus (T2DM), but its effectiveness and safety are often limited by incorrect injection technique, poor adherence, inadequate glucose monitoring and hypoglycemia risk. Objectives: To retrospectively evaluate the association of a nurse-led, structured insulin management program based on medication therapy management (MTM) principles with glycemic control and medication safety in patients with T2DM receiving insulin therapy. Methods: Medical records and nursing follow-up data of 120 adult patients with T2DM who received insulin therapy were retrospectively reviewed. The patients were allocated to either a nurse-led structured management group or a usual care group, based on the nursing care model as recorded in routine clinical practice, in a 1:1 ratio; 60 patients were allocated to each group. The structured management program included insulin education, injection training, guidance on glucose monitoring, hypoglycemia prevention and weekly telephone or digital follow-up. Outcomes were extracted at baseline and at 3-month follow-up. Results: After the 3-month observation period, HbA1c was lower in the structured management group than in the usual care group (7.6 ± 0.9% vs. 8.5 ± 1.0%, p < 0.001). Fasting blood glucose was also lower in the structured management group (7.4 ± 1.3 mmol/L vs. 8.8 ± 1.6 mmol/L, p < 0.001). Recorded hypoglycemic episodes were less frequent in the structured management group (13.3% vs. 30.0%, p = 0.028) and recorded insulin medication errors (10.0% vs. 28.3%, p = 0.012). Adherence, self-management and satisfaction scores were higher in the structured management group (all p < 0.001). Conclusion: In this retrospective comparative study, receipt of nurse-led MTM-based structured insulin management was associated with better short-term glycemic control, fewer recorded hypoglycemic episodes and insulin-related medication errors, and higher adherence, self-management, and satisfaction scores. These results should be interpreted carefully and confirmed in prospective studies.