The incidence of Type 2 diabetes in the Australian population trebled between 1995 and 2005. Contemporary management practice of Type 2 diabetes recommends a ‘treat to target’ approach with the aim of maintaining near normal blood glucose levels; often this will result in the patient being prescribed insulin. Glargine is the most frequently prescribed basal insulin in Australia. However, in order to achieve optimal therapeutic results in a safe fashion, Glargine insulin must be titrated in response to the patient’s fasting blood glucose results. The manufacturer of Glargine insulin (SanofiAventis) recommends a particular titration program.
To investigate and describe the prescription of Glargine insulin for people with Type 2 diabetes who attended a specialist clinic at a tertiary hospital. Specific questions of interest include the demographic characteristics of people with Type 2 diabetes; the percentage who have Glargine insulin optimally titrated; the percentage who have a reduction in HbA1c; and the percentage with complications associated with Type 2 diabetes.
The study is a descriptive retrospective study that used template content analysis to categorise and record data obtained from the medical records of people with Type 2 diabetes who were prescribed Glargine insulin at a specialist diabetes clinic and referred to their general practitioner for ongoing management. Parametric and nonparametric statistical analyses were used to assess relationships and group differences on key variables.
Records from a sample of 103 people with Type 2 diabetes were eligible for inclusion in the study. Fifty-six were male and 47 female, with a group median age of 59 years had records included. Ninety medical records were complete (had pre- and post- HbA1c results recorded). Of these records only 9 (10%) people with Type 2 diabetes had optimal adjustment of their Glargine dose. Despite this, data extracted from the patient’s medical record indicated that 47 (52.2%) people with Type 2 diabetes recorded a reduction in their HbA1c result by at least 1%, with a further 22 (24.2%) recording a reduction of less than 1%.
Relevance to clinical practice
This study indicates that Glargine insulin does not appear to be consistently, optimally prescribed and used. Patient or clinician factors could explain why such a small percentage of people with Type 2 diabetes had their Glargine prescription optimally adjusted. Study findings indicate there is a need to explore the development of innovative titration programs that better meet patients’ needs, including the delivery of programs using new mobile communication technology.