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GP-initiated insulin has long-term HbA1c benefits

By Emma Wilkinson

Patients with type 2 diabetes who have poor glycaemic control gain long-term benefits from insulin therapy initiated in primary care, a study suggests.

Three-year follow up of an insulin initiation training programme in 55 practices showed that the improvements seen in the first six months – an average 1.4% drop in HbA1c – were maintained for at least another 30 months.

Of 516 patients analysed, 41% had managed to hit a target of 7.4% at 36 months, and that included 29% whose HbA1c was less than 7%.

Those who achieved the target tended to have a lower HbA1c at the start of the study - 9.1% compared with 9.7% - weighed less and were more likely to be on basal insulin alone.

The researchers said there was still work to do on ongoing intensification of therapy and further training for primary care staff may be needed to encourage tighter glycaemic control in the long term, especially with tougher QOF targets introduced in 2009.

Study leader Professor Jeremy Dale, a GP in Coventry and director of primary care Research at Warwick Medical School, concluded: "These tighter glycaemic control targets may well increase the need for practices to be trained in initiation of insulin and intensification of insulin therapy."

Primary Care Diabetes, online 30 April

GP-initiated insulin has long-term HbA1c benefits

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