Efficiency - Insulin

The current NICE Guideline on the management of type 2 diabetes recommends that when control of blood glucose remains or becomes inadequate on oral anti-diabetic therapy, insulin should be considered as the next treatment option. Human isophane insulin, commonly known as NPH, is recommended as the first choice regimen for the majority of people.

The aim of the indicator is to reduce the prescribing of long acting insulin analogues.

 Insulin

  • There is an absence of evidence to suggest the superiority of the long-acting insulin analogues versus NPH insulin.
  • NICE recommends NPH as first choice regimen before long-acting insulin analogues for the majority of people (NG28, 2017).

 

Trend in long-acting analogue prescribing as a percentage of total long and intermediate-acting insulin prescribed in primary care

Graph 18 Insulin primary care trend    

 Trend graph key

 

How can changes be made?

  • Patients should have the opportunity to make informed decisions about their care and treatment, in partnership with their healthcare professionals. Discuss with the patient the comparative effectiveness of the specific insulin types and ascertain any preference.
  • When patients are started on an insulin therapy, a structured programme of active dose titration should be employed. In addition, this programme should also cover injection technique, continuing telephone support, self-monitoring, dietary understanding, DVLA guidance, management of hypoglycaemia, management of acute changes in plasma glucose control, and support from an appropriately trained and experienced healthcare professional.

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