Which insulin regimens are used in adults newly diagnosed with

Type 1 diabetes?

Results of an electronic survey of healthcare professionals in the

UK and Ireland. Carolin Taylor1, Jackie Elliott1, Helen Hopkinson2

1. Sheffield Teaching Hospitals NHS Foundation Trust; 2. Greater Glasgow and Clyde Health Board

77

87

59

4

Doctors

Nurses

Dietitians

Number of respondents

177

41

9 NHSsecondarycare

NHS primarycare

Non-NHS

Number of respondents

41

17

15

10

9

4 3 1

Evidence

Personal Experience

Protocol

DSN Recommendation

Formulary Availability

Brand Preference

Device Availability

Cost

All staff %

Acknowledgements:

We would like to thank ABCD, DAFNE, DMEG and DEN for helping to distribute the link to the survey via their email circulation lists.

15

49

3

4 1

7

1

1 2

1 2 2

2

5 4 1

Analogue MDI with bd basal

Analogue MDI with od basal

Analogue QA with bd NPH

Analogue QA with od NPH

Soluble with analogue basal bd

Soluble with analogue basal od

Soluble with bd NPH

Soluble with od NPH

Analogue QA alone

Soluble alone

Analogue pre-mix bd

Human pre-mix bd

Analogue basal bd

NPH bd

Analogue basal od

NPH od

%

Background and Aims

In light of the new NICE Type 1 diabetes

(T1DM) guidelines1, we wished to

explore current practice in the choice of

insulin regimens for adults with newly

diagnosed T1DM amongst healthcare

professionals (HCPs) in the UK and

Ireland, to identify if there is consensus

about what should be used as well as

the factors that influence clinicians’

choice of regimen.

Methods

An on-line questionnaire using Survey

Monkey®2 and incorporating ‘skip logic’

to enable respondents to bypass

irrelevant questions was developed and

piloted within our own services before

being distributed via ABCD, DAFNE,

DMEG and Diabetes Education Network

emailing lists.

The survey was live for 1 month

(October 2015).

Data collected included:

• Profession

• Main area of practice

• Clinic post code

• Availability (plus name) of structured

education programme

• Factors influencing choice of regimen

(ranked 1-8)

• Types of insulin used (human vs

analogue)

• Choice of regimen on day 1 for a

patient newly diagnosed with T1DM

• Reasons for choosing alternative

regimen for newly diagnosed

• When regimen are changed if

necessary

• When patients are offered structured

education

Conclusion

There is variation in choice of insulin regimen, perhaps reflecting a dearth of research data

from this patient group. HCPs should be encouraged to audit and publish data on their

newly diagnosed T1DM patients.

92 (41%) ranked ‘evidence’ as the

primary influencing factor for choice of

insulin regimen; with ‘personal

experience’ and ‘protocol’ being ranked

second and third respectively.

Amongst those ranking evidence first,

the treatment of choice for newly

diagnosed is an analogue-based MDI

regimen using once-daily basal (50%

doctors; 45% DSNs; 48% dietitians).

References:

1. nice.org.uk/guidance/ng17, August 2015. ISBN: 978-1-4731-1389-3

2. https://www.surveymonkey.net

Results

227 surveys were

completed

Respondents

• 34% doctors

• 38% DSNs

• 26% dietitians

• 2% unspecified.

Area of Practice

• 78% worked in

NHS secondary

care

• 18% in NHS

primary care

• 4% non-NHS.

113 individually listed cities, towns or

regions were represented, from

Shetland in the North of Scotland to

Taunton in the South of England;

Galway in the West of Ireland to

Yarmouth in the East of England.

Incomplete postcode data prevented

linkage of data from the same clinics.

Map of Respondents Influencing Factors

Choice of Regimen for Newly

Diagnosed T1DM C

om

ple

xity

low

high

Carolin Taylor, Diabetes Specialist Nurse, email address for correspondence: carolin.taylor@sth.nhs.uk

Structured Education: Complex

Starting Regimen

96% (n=107) of those using analogue-

based multiple dose injection (MDI) with

once-daily basal insulin offered

structured education. 45% (n=50)

specified DAFNE

100% (n=34) of those routinely using

analogue-based MDI with twice-daily

basal insulin (as recommended by NICE)

offered structured education. 97% (n=33)

specified DAFNE

Simple Starting Regimen

Twice-daily NPH or once-daily analogue

basal were preferred by 21 (9%)

respondents (11 and 10 respectively).

Structured education was offered in all of

these services.

Factors Influencing Decision for an

Alternative Regimen

151

143

94

78

63

24

23

11 3

8

Patient choice / preference

Mental disability

Needlephobia

Age of patient

Physical disability

Friday evening / weekend

Interpreter needed

Hospital admission

Staffing issues

Other

Frequency of response

0

20

40

60

80

100

Insulin Type

Soluble

NPH

Human mix

Analogue rapid

Analogue basal

Analogue mixNum

ber

of

respon

dents

Insulins Used in T1DM By Those

Stating ‘Evidence’ as the Primary

Influencing Factor

Summary

227 HCPs (34% doctors) responded,

78% in NHS secondary care. Whilst over

80% use some form of MDI regimen for

newly diagnosed Type 1s and 40% state

that evidence influences their prescribing

decision, only 15% choose NICE-

recommended analogue-based MDI

using twice-daily basal. There is no

obvious relationship between the initial

insulin regimen and the availability of

structured education in the results of this

survey