Course-003 : How to start and manage insulin therapy in primary care - PCDE Workshop

Mehmet Sargın1, Frances Xavier Cos2 1Department of Family Medicine, Diabetes Division, Lütfi Kırdar Kartal Training and Research Hospital, Istanbul, Turkey 2CAP Sant Marti de Provençals Unit of Ensayos Clinics – University of Barcelona -Institut Investigacio Universitari Atenció Primaria Jordi Gol, Barcelona, Spain
PURPOSE: It is well know that insulin therapy is a difficult point in the treatment of Type 2 diabetes. Patients as well as health professionals (nurses and GPs) might not feel comfortable with this therapeutical option, though often necessary when T2DM people live longer and hence are in need for more advanced and complex treatment plans. In the past decade, we were seized by an “algorithm storm” of hyperglycaemia treatment schemes. The European Association for the Study of Diabetes (EASD), the American Diabetes Association (ADA), the National Institute of Clinical Excellence (NICE) and a lot of other (inter)national medical associations have published their guidelines including insulin algorithms based on the best evidence available. Despite differences, all algorithms largely agree to recommend when and how to start with an Insulin regimen. METHOD: This is a 2 hours workshop that through a case discussion would like to introduce the most common difficulties when considering Insulin as a therapy option. The idea is to answer practice based questions regarding insulin therapy following a pedagogical model focused on clinical situations. How to recognize patients who need insulin (at diagnosis of type 2 diabetes, as a stepwise approach with worsening glucose control, and during an acute process). What kind of insulin molecules do we have available on the market? What are their differences and how to use them? What is the best and easiest way possible to start insulin therapy? EXPECTED OUTCOMES: After this workshop the attendees will: know the indications for initiation of insulin therapy (who?); know how to initiate insulin therapy (how? Initial dose, titration, etc.);know how to follow up a patient on insulin (glycaemic target values, combination with other hypoglycaemic therapy options, side effects: hypoglycaemia, weight gain etc.);know red flags for referral (emergencies).
Keywords: insulin therapy, dose titration, initiation, follow-up