title: Optimizing care and outcomes for people with type 2 diabetes - lessons from a translational research program on insulin initiation in general practice.
abstract: BACKGROUND
  Clinical inertia, failure to intensify treatment according to evidence-based guidelines, leads to prolonged, avoidable hyperglycemia in people with type 2 diabetes (T2D). This is a challenge for General Practice and Primary Care, where most people with T2D receive most of their care. Sustained, integrated translational research programs are needed to embed effective treatments in routine practice, yet many challenges exist for developing such programs.
  
  
  OBJECTIVE
  To explore challenges and facilitators to implementing a translational research program focused on insulin initiation and titration among people with T2D in general practice and to identify key factors important to support and sustain such translation research in primary care. Operationalizing a program of translational work in primary care: We describe a series of studies on insulin initiation and titration in general practice including theory and qualitative work (Phase 1), a small feasibility and acceptability pilot (Phase 2), a large scale pilot (Phase 3), and a pragmatic cluster randomized trial currently under way (Phase 4). We used mixed methods to explore practice level implementation issues, and reflective investigator discussions to explore broader research program sustainability. Challenges for translational research in primary care: Key facilitators and barriers at practice and research program levels, include: Appropriate funding structures to secure long-term capacity building and people support; Building and maintaining linkages between communities of practice, primary and secondary/tertiary care researchers, institutions, and industry partners; Strategies for engagement and support for practitioners and participants.
  
  
  CONCLUSIONS
  Building effective and sustainable translational research programs are critical for developing evidence-based policy that drives improved outcomes at a population level. Diverse sources of funding that support extensive and sustained trans-mural collaboration as well as engagement with practitioners, patients, and policymakers in the field are crucial.
authors: General Practice and Primary Health Care Academic Centre, The University of Melbourne , Carlton, VIC , Australia.
authors: John
authors: J
authors: Furler
authors: General Practice and Primary Health Care Academic Centre, The University of Melbourne , Carlton, VIC , Australia ; John Richards Initiative, School of Nursing and Midwifery, La Trobe University , Wodonga, VIC , Australia.
authors: Irene
authors: I
authors: Blackberry
authors: General Practice and Primary Health Care Academic Centre, The University of Melbourne , Carlton, VIC , Australia.
authors: Jo-Anne
authors: JA
authors: Manski-Nankervis
authors: Department of Medicine, St Vincent's Hospital, The University of Melbourne , Fitzroy, VIC , Australia.
authors: David
authors: D
authors: O'Neal
authors: Melbourne Medical School, The University of Melbourne , Parkville, VIC , Australia.
authors: James
authors: J
authors: Best
authors: General Practice and Primary Health Care Academic Centre, The University of Melbourne , Carlton, VIC , Australia.
authors: Doris
authors: D
authors: Young
keywords: diabetes mellitus; general practice; insulin; primary nursing; translational medical research; type 2