primary care diabetes 4 ( 2 0 1 0 ) 85–89 Contents lists available at ScienceDirect Primary Care Diabetes journal homepage: http://www.elsevier.com/locate/pcd Original research Insulin initiation in primary care for patients with type 2 diabetes: 3-Year follow-up study Jeremy Dale * , Steven Martin, Roger Gadsby Warwick Medical School, University of Warwick, Coventry, United Kingdom article info Article history: Received 2 July 2009 Received in revised form 1 March 2010 Accepted 9 March 2010 Available online 13 April 2010 Keywords: Insulin initiation Primary care Type 2 diabetes abstract Purpose of study: To evaluate the 3-year impact of initiating basal insulin on glycaemic control (HbA1c) and weight gain in patients with poorly controlled type 2 diabetes registered with UK general practices that volunteered to participate in an insulin initiation training programme. Methods: Audit utilising data collected from practice record systems, which included data at baseline, 3, 6 months and subsequent six-monthly intervals post-insulin initiation for up to 10 patients per participating practice. Results: Of 115 eligible practices, 55 (47.8%) contributed data on a total of 516 patients. The mean improvement in HbA1c levels in the first 6 months was 1.4% (range -3.8% to 8.2%, median = 1.40%). Thereafter, there was no overall change in HbA1c levels, although the change for individual patients ranged from -4.90% to +7.50%. At 36 months, 141 (41%) patients for whom data were provided had achieved the pre-2006/2007 UK Quality and Out- comes Framework (QOF) target of 7.4% or less, including 98 (29%) who had achieved an HbA1c of 7% or less. Patients who achieved target had a lower HbA1c at baseline (mean 9.1% compared to 9.7%; p < 0.001); had a lower weight at 36 months (mean 88.0 kg compared to 93.5 kg; p = 0.05); were more likely to be on basal insulin alone (88, 47.1% compared to 46, 34.6%; p < 0.05); and were slightly older (mean 64.5 years compared to 61.7 years; p < 0.05). Conclusion: Attending an insulin initiation training programme may successfully prepare primary healthcare professionals to initiate insulin therapy as part of everyday practice for patients with poorly controlled type 2 diabetes. The impact on glycaemic control is maintained over a 3-year period. Although intensification of treatment occurred during this period, the findings suggest scope for further intensification of insulin therapy in order to improve on the glycaemic control achieved during the first 6 months post-insulin initiation. © 2010 Primary Care Diabetes Europe. Published by Elsevier Ltd. All rights reserved. 1. Introduction Tight glycaemic control is central to reducing the risk of long- term macrovascular and microvascular complications of type ∗ Corresponding author at: Health Sciences Research Institute, Warwick Medical School, Gibbet Hill Rd, University of Warwick, Coventry, CV4 7AL, United Kingdom. Tel.: +44 024 765 22891. E-mail address: jeremy.dale@warwick.ac.uk (J. Dale). 2 diabetes and the associated morbidity and mortality [1]. The American Diabetes Association (ADA) and the European Asso- ciation for the Study of Diabetes (EASD) [2], as well as the recent British National Institute of Clinical Excellence (NICE) guidelines on type 2 diabetes [3] recommend the addition of 1751-9918/$ – see front matter © 2010 Primary Care Diabetes Europe. Published by Elsevier Ltd. All rights reserved. doi:10.1016/j.pcd.2010.03.001