Good glycaemic control in people with type-2 diabetes reduces the risk of microvascular complications and may also result in fewer macrovascular events.1,2 Insulin is the most effective treatment in reducing hyper-glycaemia.3
The progressive nature of type-2 diabetes is characterised by a decline in beta cell function and worsening of insulin resistance. This means that a large proportion of people with type-2 diabetes go on to require insulin therapy. Within six years of starting treatment about half of patients treated with sulphonylureas will require additional insulin therapy.1
This article outlines how to achieve good glycaemic control by starting patients on insulin therapy in a timely and efficacious manner.
Initiating insulin in primary care
NICE recommends the addition of insulin for people with poorly controlled type-2 diabetes who are already on maximum tolerated doses of metformin and sulphonylureas.4 NICE recognises that this is the preferred management plan for those people who have marked hyperglycaemia.
Rising patient numbers and challenges in healthcare policy have shifted insulin initiation in type-2 diabetes from secondary to primary care.5 Training programmes have enabled healthcare professionals working in primary care to initiate insulin confidently and competently.