To evaluate the impact of the initiation of basal insulin therapy on glycaemic control (HbA1C) and weight gain in patients with poorly controlled weight gain in patients with poorly controlled type 2 diabetes who were registered with practices that volunteered to participate in an insulin initiation training programme.
Methods
Data at baseline, three and six months post-insulin initiation were collected from log diaries and analysed, for up to 10 patients per practice for each trained healthcare professional (HCP).
Results
Out of 132 participating HCP, 94 (71.2%) provided baseline and three-month data. In 835 patients, of these, 475 (56.9%) also had six-month data. The mean HbA1C at baseline was 9.6%, at three months post insulin initiation it was 8.6%, and at six months it was 7.9%. Out of 381 patients with data on weight change, 1.9% gained weight (mean gain of 1.5 kg over six months). HCPs reported confidence in initiating insulin. They perceived that there was a high level of acceptability to patients.
Conclusion
Attending an insulin initiation training programme may prepare primary HCPs to initiate insulin therapy for patients with poorly controlled type 2 diabetes.
Baxter M., Toms G., Gadsby R.Editorial - Empowering primary care practitioners to meet the growing challenge of diabetes care in the community. Br J Diabetes Vasc Dis2006;6:245-8.
2.
Ukpds.Intensive blood glucose control with sulphonylurea or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33)Lancet1998; 352:837-53.
3.
Riddle MC, Rosenstock J., Gerich J.The treat-to-target trial: randomised addition of glargine or human NPH insulin to oral therapy of type 2 diabetic patients. Diabetes Care2003;26: 3080-6.
4.
Quality and Outcomes framework guidance. http://www.bma.org/ap.nsf/AttachmentsByTitle/PDFQualOutFrame0804/$FILE/QualOutFrame0804.pdf
5.
Davies M., Storms F., Shutler S. et al. for the AT.LANTUS study group. Improvement of glycaemic control in subjects with poorly controlled type 2 diabetes: comparison of two treatment algorithms using insulin glargine. Diabetes Care2005; 28:1282-8.
6.
Holman RR, Thorne KI, Farmer AJ et al. Addition of Biphasic, Prandial, or Basal Insulin to Oral Therapy in Type 2 Diabetes. N Engl J Med (2007); published at www.nejm.orgonSeptember21,2007(10.1056/NEJMoa075392) .
