Poster Presentation The Annual Scientific Meeting of the Australian Diabetes Society and the Australian Diabetes Educators Association 2013

Peer-to-peer, multidisciplinary, process-focussed education increases GP confidence in using insulin therapy in type 2 diabetes (T2D)  (#309)

Gary Deed 1 , Gary Kilov 2 , Patrick Phillips , Anita Sharma 3 , Stephen Leow , Ian Arthur , John Barlow 4 , Mark Kennedy 5
  1. Mediwell, Coorparoo, QLD, Australia
  2. Seaport Medical Practice, Launceston, Tasmania, Australia
  3. Platinum Medical Centre, Chermside, Qld, Australia
  4. Bankstown Medical Practice, Bankstown, NSW, Australia
  5. Corlo Medical Clinic, Corlo, Victoria, Australia

Glycaemic targets are not being achieved due to ‘clinical inertia’, with GPs reluctant to use insulin to intensify treatment despite guidelines highlighting the need to do so. The common barriers of lack of time, perceived complexity of insulin therapy, and patient reluctance were addressed in 2-day, peer-to-peer, multidisciplinary meetings aimed at increasing GPs’ confidence and attitudes towards insulin therapy.

This program was developed by GPs with diabetes expertise, credentialed diabetes educators (CDEs), an endocrinologist and an education provider. An endocrinologist presented the evidence behind the need for timely insulin therapy and the simple insulin initiation/up-titration process; this was then reinforced in 3 small group, interactive workshops facilitated by GPs and CDEs. Meeting success was measured by comparing GPs’ assessment of their individual confidence and attitudes at the beginning and end of the meeting; and via an evaluation form.

Aggregated results from the 1368 GP attendees showed that GPs’ confidence in initiating insulin improved – 80%  felt ‘very confident’ after the meeting versus 13% before it. Also, fewer GPs would refer patients to an endocrinologist to initiate insulin post- versus pre-meeting (0.4% vs 28%), but more would enlist the help of a diabetes nurse educator (68% vs 34%). More GPs reported feeling ‘very confident’ about up-titrating insulin following the meeting (88% vs 24% before) and in doing this quickly (75% vs 14%). Evaluation form data showed that the program helped GPs overcome their barriers to prescribing insulin (92% of GPs) and 86% considering it ‘very likely’ that they would change their practice as a result of attending. 

Through reinforcement of evidence-based guidelines and peer-to-peer training in using a simple step-by-step process for initiating and up-titrating insulin, not only were GPs barriers to insulin therapy quickly removed, but participants realised they had an important role in managing T2D patients on insulin.