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1 2 3 4 5 6 7 8Why a toolkit?The right time The right insulin Mythsand barriersInsulin management:key factsCommissioning forpeople with Type 2diabetesMedicinesoptimisationteamsCommunitypharmacy9Acknowledgements‘Treating to fail’The Diabetes Modernisation Initiative (DMI)was a Guy’s and St Thomas’ Charity fundedproject across Lambeth and Southwarkworking to bring about system-wide changefor people living with diabetes throughtransforming and improving services 23 .The DMI undertook a local audit in 2012/13which showed that of 23,945 on GP diabetesregisters, 32% had an HbA 1chigher than64mmol/mol. Of these 4% were on nodiabetes medication, 13% were on metforminonly, 3% were on a sulfonylurea only, 23%were taking metformin and a sulfonylurea,16% were taking pioglitazone, gliptins or GLP-1analogue and 41% were prescribed insulin.This data highlights there is huge scopefor improvement at each stage of theprescribing guidance and not just at 3rd and4th line therapy. More intensive therapy withmetformin and sulfonylurea in this samplewould result in an improvement in control ofup to 41% and an absolute increase of up to9% in HbA 1cof less than 64mmol/mol.HbA 1c> 64mmol/mol medication4%13%3%23%16%41%No diabetesmedicationMetformin onlySulfonylureaonlyMetformin andSulfonylureaPioglitazone,gliptins or GLP1inhibitorInsulin!• Lack of knowledge about insulin therapyaccompanied by erroneous beliefs andmisconceptions.• Negative self-perceptions and attitudinal barriers.• Perception of increased burden and stress dueto required lifestyle adaption and restrictions.• Perception of social stigma.It is important to try to avoid negative associationswith insulin therapy. Have we honestly neverthreatened and said something like:“Both people with diabetes and healthcareprofessionals can suffer from a ‘psychologicalinsulin resistance’ 24 . This is characterised by:If you don’t change your lifestyle andtake your tablets on time we will haveto consider insulin!”Alternatively we can collude:Diabetes Modernisation Initiative,2014 Diabetes UK conference poster“Well let’s just add this extra tablet andsee if you can eat less and we’ll see you insix months – I’m sure we can put off insulinfor a bit longer.”Back to contentsReferencesRight Insulin, Right Time, Right Dose 17