Glargine insulin prescribing practices for Type 2 diabetes: is there room for improvement?

Elliott-Kemp, Yvonne Mary (2012). Glargine insulin prescribing practices for Type 2 diabetes: is there room for improvement? MPhil Thesis, School of Nursing and Midwifery, The University of Queensland.

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Author Elliott-Kemp, Yvonne Mary
Thesis Title Glargine insulin prescribing practices for Type 2 diabetes: is there room for improvement?
School, Centre or Institute School of Nursing and Midwifery
Institution The University of Queensland
Publication date 2012
Thesis type MPhil Thesis
Supervisor J. Hepworth
R. Ostini
Total pages 118
Language eng
Subjects 110306 Endocrinology
111716 Preventive Medicine
111717 Primary Health Care
Formatted abstract

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.
Keyword Chronic illness
Insulin regimens
Patient outcomes
Type 2 diabetes

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Created: Wed, 06 Feb 2013, 15:38:11 EST by Ms Yvonne Elliott-kemp on behalf of Scholarly Communication and Digitisation Service