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Independents' Day

Five-year wait to be put on insulin

By Joanna Clarke-Jones

Patients with uncontrolled diabetes are waiting years to be transferred to insulin therapy, even after suffering complications from the disease, a new study warns.

Half of all patients who were not controlled on oral antidiabetic drugs suffered delays of five years or more before being started on insulin.

The researchers called for the removal of barriers to initiating insulin, while GPs said it strengthened the case for allowing inhaled insulin for those particularly reluctant to begin on injections.

Study leader Dr Annalisa Rubino, director of research epidemiology at independent foundation the RTI international institute in Manchester, said: 'Half of patients with type 2 diabetes delay insulin initiation for at least four to six years despite lack of glycaemic control with multiple oral antidiabetics.

'This delay occurs even for patients who have been diagnosed with complications.'

The researchers analysed how long it took to initiate insulin in 2,501 patients with type 2 diabetes who were taking oral antidiabetics but had an HbA1C of 8 per cent or more.

Their study, presented at this week's American Diabetes Association conference, found 25 per cent of patients had initiated insulin within 1.8 years and 50 per cent within 4.9 years.

Dr Peter Tasker, a GP in Kings Lynn and diabetes lead at Norfolk West PCT, said GPs often did not appreciate that type 2 diabetes was progressive and needed close monitoring. 'GPs think once patients have been put on to oral agents that's it. People still worry about insulin therapy and many GPs think insulin is a secondary care thing, which is a very antiquated idea.'

Professor Mike Kirby, a GP in Letchworth and visiting professor at the University of Hertfordshire, said GPs often 'colluded' with patients who tried to put off starting on insulin by saying they would do more exercise or change their diets.

GPs also warned that patients could be averse to needles or feel anxious about being dependent on a drug.

When to initiate insulin

· First ensure all avenues are explored and drug dosages optimised

· If a specific intervention is not working within three to six months, go to the next step

· Consult with PCT diabetes lead, GPSI or diabetes lead nurse about insulin initiation

· Allay patient's fears of injections by carrying out a demonstration in the surgery with them

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