Evaluation of glargine group-start sessions in patients with type 2 diabetes as a strategy to deliver the service

Abstract

Improving glycaemic control in patients with type 2 diabetes reduces microvascular complications. The national service framework for diabetes and the new general medical service contract have been aiming to direct more focus on improving HbA1c. These measures have resulted in increasing number of patients being initiated on insulin therapy, which increases the workload of diabetes specialist nurses (DSNs). Initiating insulin on a one-to-one basis is time consuming. As a result DSN-led insulin group-start sessions were introduced. To evaluate DSN-led glargine group-start and self-titration as a strategy of providing service. We assessed the impact of this method on the use of DSNs time, HbA1c and on patients' satisfaction. A prospective audit in a district general hospital. Groups of 5-7 patients received two 2-h sessions at weeks 0 and 2. During these sessions, patients were initiated on insulin glargine and received an educational package and a self-titration protocol. DSNs did not see patients after week 2. Patients were able to phone the DSNs for advice till the end of the titration period. Patients completed Diabetes Treatment Satisfaction Questionnaire (DTSQ) at baseline, week 2 and 12 months. Weight and HbA1c were assessed at base line and 12 months later. Twenty-nine consecutive patients were included. Baseline HbA1c improved at 6 months and remained stable at 12 months (medians 10.0, 8.7 and 8.9 respectively, p < 0.001). DTSQ score improved between week 0 and 2 and this was maintained at 12 months (medians 26, 35 and 34 respectively, p < 0.001). After week 2, the DSNs spent a median of 21 min advising patients by phone during the titration period. Weight did not increase significantly. In our centre, DSN-led insulin group-start sessions and self-titration improved glycaemic control. Patients were satisfied with this method of starting insulin. This was achieved with minimal DSNs time and input and proved to be effective, yet less time consuming.

Long-Acting Insulin Analogs: A Review of &#x201C;Real-World&#x201D; Effectiveness in Patients with Type 2 Diabetes

“…Although the end-of-study use of concomitant OADs did not change substantially from baseline (43% taking sulfonylureas and 43% metformin), the dose of insulin glargine was comparatively low at 16.0 IU per day. By contrast, in a UK-based study of basal insulin glargine treatment initiated within routine secondary care, HbA1c decreased by 1.1% after 12 months, but this was associated with a mean weight gain of 4.0 kg and hypoglycemia in 24% of patients [30]. The most notable difference in the UK study compared to Schreiber et al and Lechtleiner et al was the median endof-study daily insulin dose of 40 IU (0.49 IU/kg).…”

“…Filled diamonds indicate prestudy HbA1c, filled squares indicate mean post-study HbA1c for insulin glargine. Studies 1-3 correspond to basal insulin plus OAD regimens in clinical practice [26,28,30], study 4 corresponds to the Rosenstock meta-analysis of randomized trials of insulin glargine [17]. Standard deviation (SD) bars correspond to end-of-study HbA1c, and the shaded area corresponds to SD surrounding the change in HbA1c concluded from the meta-analysis.…”

“…In the present review, a total of seven routine practice publications of insulin glargine were identified that reported all key parameters ( Table 1), including two publications representing different follow-up periods of the same study [24][25][26][27][28][29][30]. Seventeen additional studies of routine practice treatment with insulin glargine are listed in Table 1.…”

Patient-Reported Outcomes in Adults with Type 2 Diabetes Using Mealtime Inhaled Technosphere Insulin and Basal Insulin Versus Premixed Insulin

“…Improving quality of life is the ultimate outcome for any therapy, and treatment satisfaction is associated with regimen adherence 8 and with consequent clinical outcomes. [8][9][10][11] Use of inhaled Technosphere insulin has been shown to improve perceptions of insulin therapy in insulin naïve patients. 12 But to date there are no reports comparing the effects of a regimen including inhaled Technosphere insulin and a comparator insulin regimen on patient-reported outcomes (PRO) such as HRQoL and treatment satisfaction.…”

Effect of Technosphere Inhaled Insulin on Quality of Life and Treatment Satisfaction

“…Improving quality of life is the ultimate outcome for any therapy, and treatment satisfaction deserves attention because it is associated with regimen adherence 10 and with consequent clinical outcomes. [10][11][12] A comprehensive assessment of patient-reported outcomes (PRO) should include consideration of (1) general health-related quality of life (HRQOL), (2) diabetes-related worries, (3) perceptions of insulin therapy, and (4) perceptions of the insulin delivery system. All of these PRO were studied in a double-blind, randomized clinical trial of active inhaled Technosphere insulin versus placebo inhaled Technosphere insulin.…”