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Gold, incentives and meh

Group initiation of insulin is a cost-effective strategy



Group starting of insulin is becoming much more popular, especially as diabetes nurses are becoming increasingly stretched by heavy workloads.

INITIATE was a randomised, multicentre, two arm, parallel-design study that compared starting insulin (bedtime insulin glargine) as a member of a group of four to eight patients with individual tuition and support. The study recruited 121 insulin-naive patients with type 2 diabetes who were poorly controlled on oral hypoglycaemic agents.

Patients self adjusted the glargine dose to achieve a fasting plasma glucose of 4.0–5.5mmol. Patients were assessed before and at initiation of insulin treatment, and at six, 12 and 24 weeks follow-up. The primary endpoint was difference in HbA1c between the education programmes at 24 weeks.

The mean HbA1c fell from 8.7% to 6.9% in those treated individually and from 8.8% to 6.8% in the group start patients over the course of the study. There was no significant difference in the decrease in HbA1c between the groups.

There was no significant difference in the percentage of patients experiencing hypoglycaemia or the average number of symptomatic incidents experienced during the study. There was also no significant difference in the mean insulin dose at 24 weeks.

However, starting insulin in groups took half the time that initiating insulin individually took.

The findings of this study strongly support group starting of insulin as a cost-effective strategy.

Yki-Jarvinen H, Jvurinen L, Alvarsson M et al. Initiate Insulin by aggressive titration and education (INITIATE). Diabetes Care 2007;30:1364-1369

Dr Matthew LockyerDr Matthew Lockyer Reviewer

Dr Matthew Lockyer
GP, Suffolk and hospital practitioner in diabetic medicine

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