Guidance on the Use of Premix Insulin in the Management of Type 2 Diabetes in Primary Care

This Research Review Educational Series E-Learning Module is intended for NZ primary healthcare professionals including GPs and practice nurses involved in managing patients with type 2 diabetes.
It discusses the use of insulin in this patient group, with emphasis on the use of premix insulin and the concept of patient-centred therapy.

Before starting the module please read the Research Review Educational Series publication, accessed through the link below:

CLICK HERE
to access the quiz source material
Educational Series - Guidance on the Use of Premix Insulin in the Management of Type 2 Diabetes in Primary Care

The PDF through the link above can be viewed on screen, saved and printed.

This Educational Series E-Learning Module covers:

• Overview of insulin therapy in the management of type 2 diabetes, including the different types of insulin, dosing and titration, patient characteristics, and concurrent non-insulin glucose-lowering drugs.
• Preparing patients for insulin therapy
• Initiating insulin therapy
• Considerations at initiation
• Intensifying insulin therapy
• Guidance on dose and titration when initiating insulin therapy with premix insulin

Learning outcomes

After completing this module you should have an improved understanding of how to:

• Manage diabetes as a long-term condition and to support complex patients who require specialist diabetes services as part of a multidisciplinary team approach.
• Set glycaemic targets for patients with type 2 diabetes on insulin therapy.
• Manage patients with type 2 diabetes with regular reviews and timely intensification of treatment, including insulin initiation and intensification when appropriate.
• Adopt a patient-centred approach when initiating and intensifying insulin therapy.
• Effectively use premix insulin and basal insulin, which are both suitable for the initiation of insulin therapy in patients with type 2 diabetes.
• Counsel patients on correct self-monitoring of pre- and post-prandial blood glucose levels.

Contributing Experts

Expert commentary is provided by Dr Brandon Orr-Walker, an Endocrinologist at Middlemore hospital in Auckland.

Module questions have been developed by Dr Chris Tofield, who works in primary care skin cancer treatment, is clinical advisor at Bay of Plenty District Health Board, and consultant to Research Review.

Accreditation

“Guidance on the Use of Premix Insulin in the Management of Type 2 Diabetes in Primary Care" E-Learning Module has been endorsed by The Royal New Zealand College of General Practitioners (RNZCGP) and has been approved for up to 1 CME credit for the General Practice Educational Programme (GPEP) and Continuing Professional Development (CPD) purposes.
Further info

"Guidance on the use of Premix Insulin in the Management of Type 2 Diabetes in Primary Care" E-Learning has been endorsed by The College of Nurses and has been approved for 1 hour professional development.
Further info

References

• MOH. Living Well with Diabetes: A plan for people at high risk of or living with diabetes 2015–2020. Wellington: Ministry of Health. 2015. Available from: http://www.health.govt.nz/system/files/documents/publications/living-well-with-diabetes-oct15.pdf
• NZGG. Management of type 2 Diabetes. New Zealand Primary Care Handbook 2012. 3rd ed. Wellingon: New Zealand Guidelines Group. 2012. Available from: https://www.health.govt.nz/system/files/documents/publications/nz-primary-care_handbook_2012.pdf
• International Diabetes Federation Guideline Development Group. Global guideline for type 2 diabetes. Diabetes Res Clin Pract. 2014;104(1):1-52.
• Inzucchi SE, et al. Management of hyperglycaemia in type 2 diabetes, 2015: a patient-centred approach. Update to a position statement of the American Diabetes Association and the European Association for the Study of Diabetes. Diabetologia. 2015;58(3):429-42.
• Wu T, et al. Practical guidance on the use of premix insulin analogs in initiating, intensifying, or switching insulin regimens in type 2 diabetes. Diabetes Ther. 2015;6(3):273-87.
• Ampudia-Blasco FJ, et al. Basal plus basal-bolus approach in type 2 diabetes. Diabetes Technol Ther. 2011;13 Suppl 1:S75-83.
• Inzucchi SE, et al. Management of hyperglycaemia in type 2 diabetes: a patient-centered approach. Position statement of the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD). Diabetologia. 2012;55(6):1577-96.
• ADHBs. Auckland Regional HealthPathways. Auckland: Auckland Region District Health Boards. Last update date: Not stated. Available from: http://aucklandregion.healthpathways.org.nz/index.htm. [Date accessed: November 2016].
• RACGP. Clinical guidelines: General practice management of type 2 diabetes 2016–18. Melbourne, VIC: Royal Australian College of General Practitioners. Last update date: Not stated. Available from: http://www.racgp.org.au/your-practice/guidelines/diabetes/. [Date accessed: November 2016].
• BPAC. Managing patients with type 2 diabetes: From lifestyle to insulin. Dunedin: Best Practice Advocacy Centre New Zealand. Last update date: December 2015. [Date accessed: November 2016].