Attitudes to starting insulin in primary care

The aim of this study was to measure the attitudes of patients, practice nurses (PNs) and general practitioners (GPs) when starting insulin in people with type 2 diabetes in primary care. The study methods involved: (1) examining patient attitudes and collecting safety data; and (2) examining the attitudes of GPs and PNs and assessing competencies. The study was conducted in a general practice diabetic clinic, where GPs and PNs were developing new skills under supervision. Forty‐two patients who had started insulin were given questionnaires; 39 were returned. In all, 100% rated encouragement given by PNs as very good, and were satisfied with the follow‐up contact they had received; 100% acknowledged it was very important to have good glycaemic control; 88% had gained good support from friends, family and their surgery during initiation of insulin; and 92% found the information easy to understand, were confident with their injections and were happy to adjust the dose of insulin. Of 17 GPs and PNs, 14 felt empowered to manage those patients who were on maximum tolerated oral hypoglycaemic therapy and needed to go onto insulin but this fell to seven when asked whether they felt confident to discuss the full range of insulin and insulin devices. Thirty‐seven GPs and PNs who between them had started 200 patients on insulin attended a focus group ‐ this identified issues that informed the primary care trust setting up the locally enhanced diabetes service contract. People with type 2 diabetes found starting insulin in their GP's practice satisfactory, and were self‐managing and confident. Most GPs and PNs were confident about initiating insulin. Copyright © 2007 John Wiley & Sons.