It’s a cost-effective approach.
Initiation of insulin therapy requires considerable time and effort for patients and healthcare providers. One potentially cost-effective approach is to initiate insulin in group sessions, rather than individually.
This European study included 121 patients with type 2 diabetes who were beginning once-daily glargine insulin because of inadequate control on oral agents (mean hemoglobin A1c, 8.7%). Patients were randomized to either five individual or five group sessions (group size, 4–8 patients) during a 26-week period. The individual and group sessions involved the same study personnel and instructional approach (which included self-titration of insulin). Patients in both study arms received considerable telephone support between visits.
After 6 months, mean HbA1c levels, insulin doses, numbers of hypoglycemic episodes, and overall patient satisfaction were similar in the two study arms. However, the total time expended by healthcare providers (including visits and phone calls) was 50% less for the group-session arm than for the individual-session arm.
Comment: In many practice settings, general diabetes education is already provided in groups. This study suggests that it is also reasonable and cost-effective to initiate insulin therapy in groups rather than individually. The success of this approach likely depends on the provider’s skill and the characteristics of each patient population.
Published in Journal Watch General Medicine July 10, 2007
Yki-Järvinen H et al. Initiate insulin by aggressive titration and education (INITIATE): A randomized study to compare initiation of insulin combination therapy in type 2 diabetic patients individually and in groups. Diabetes Care 2007 Jun; 30:1364-9.