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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 2diabetesMedicinesoptimisationteamsCommunitypharmacy9AcknowledgementsRight Insulin – outcomesWhat are the London outcomes when NPH insulin is used in line with NICE guidance?We have reviewed the evidence and looked at the financial benefits but it is important to review theoutcomes for our local patients. Datasets available from LPP 31 and the Quality and Outcomes Framework 37(QoF) suggest that use of NPH insulin is not associated with poorer outcomes in terms of glycaemic control.The graphs below show NPH insulin use for the year 2013/14 and the QoF indicator for proportion of peoplewith diabetes achieving an HbA 1cof less than 64mmol/mol for the year 2013/14. Many CGGs with high NPHuse are also amongst those with best performance against QoF.Key messages1 NPH has been shown to be an effective first linetreatment for the majority of people with Type 2diabetes starting insulin therapy2 Use of NPH insulin as first line treatment (wheninsulin is required) in line with NICE CG 87 cancontribute to effective use of resources in diabetes3 Use of NPH insulin first line in line with NICECG87 does not affect population control of HbA 1cThe percentage of patients with diabetes, on the register, in whom the last IFCC-HBA 1cwas≤64mmol/mol in the preceding 12 months across London in 2013-14 (excluding exceptions)Prescribing non analogue insulin (long and intermediate acting) as a percentageof all insulin (long and intermediate acting) across London in 2013-14Percentage of patients withIFCC-HBA 1c≤64mmol/mol80%75%70%65%60%55%50%BexleyBarnetRichmondCity and HackneyCamdenSouthwarkCentral London (Westminster)South London CCGsNational averageHarrowBromleyKingstonTower HamletsEnfieldWandsworthLambethCCGSuttonHaveringHillingdonMertonCroydonHaringeyOther London CCGsPan-London averageNewhamIslingtonWest LondonLewishamHammersmith and FulhamGreenwichBrentRedbridgeBarking and DagenhamHounslowEalingWaltham ForestNon analogue insulin (long andintermediate acting) as a % of all insulin(long and intermediate acting)45%40%35%30%25%20%15%10%5%0%SouthwarkLambethLewishamBexleyGreenwichBrentCentral London (Westminster)South London CCGsWaltham ForestCity and HackneyTower HamletsIslingtonBromleyWest London (K&C, QPP)CamdenSth London averageCCGHaringeyEnfieldNewhamWandsworthKingstonMertonOther London CCGsLPP target Prescribing 2012-13Pan-London averageCroydonEalingRichmondSuttonHaveringHillingdonHammersmith and FulhamHarrowRedbridgeBarking and DagenhamBarnetHounslowBack to contentsReferencesRight Insulin, Right Time, Right Dose 24