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Insulin therapy

Quality statement

Trained healthcare professionals initiate and manage therapy with insulin within a structured programme that includes dose titration by the person with diabetes.

Quality measure

Structure

a) Evidence of local arrangements for a structured programme for initiating and managing insulin therapy including training and support for the healthcare professionals and the patients.

b) Evidence of local arrangements and locally agreed criteria for healthcare professionals to demonstrate and document training and competencies in initiating and managing insulin.

Process

a) Proportion of people with diabetes starting insulin therapy that is initiated by a trained healthcare professional.

Numerator - the number of people in the denominator starting insulin therapy initiated by a trained healthcare professional.

Denominator - the number of people with diabetes requiring insulin therapy.

b) Proportion of healthcare professionals initiating insulin therapy who have documented appropriate training for starting and managing insulin.

Numerator - the number of healthcare professionals in the denominator having documented appropriate training for starting and managing insulin.

Denominator - the number of healthcare professionals initiating and managing insulin therapy.

c) Proportion of people with diabetes who receive ongoing structured support to initiate and manage insulin therapy.

Numerator - the number of people in the denominator receiving ongoing support to initiate and manage insulin therapy.

Denominator - the number of people with diabetes starting insulin therapy.

Description of what the quality statement means for each audience

Service providers ensure adequate staff training in initiating and managing insulin therapy within a structured programme.

Healthcare professionals ensure they are competent in insulin initiation and ongoing insulin management within a structured programme by accessing training and are able to support people with diabetes in managing their treatment.

Commissioners ensure they commission services that provide training and assess ongoing competency of healthcare professionals for initiating and managing insulin therapy within a structured programme.

People with diabetes who need insulin receive help and support from trained healthcare professionals, including help with starting on insulin and managing their treatment. This should include advice on adjusting the dose of insulin according to their blood sugar levels.

Source clinical guideline references

NICE clinical guideline 87 recommendation 1.7.2.3. (key priority for implementation).

NICE clinical guideline 15 recommendation section 1.9.3.

NICE technology appraisal 60.

Data sources

Structure

a) and b) Local data collection. DiabetesE collects data on insulin therapy. Contained within NICE clinical guideline 87 Audit support organisational criteria, criterion 6.

Process

a), b) and c) Local data collection.

Definitions

Therapy with insulin includes insulin pump therapy.

A structured programme employing active titration of insulin doses encompasses for the patient:

  • structured education
  • continuing telephone support
  • frequent self-monitoring
  • adjusting doses
  • understanding diet
  • managing hypoglycaemia
  • managing acute changes in plasma glucose control values
  • support from an appropriately trained and experienced healthcare professional
  • injection technique including site selection and care
  • managing sick days.

And should be:

  • evidence-based
  • quality assured
  • built around a structured curriculum
  • delivered by trained educators
  • audited.

Trained healthcare professionals must demonstrate and document appropriate training in initiating and managing insulin therapy. This may include evidence of continuing professional development, knowledge and skills framework (KSF) and evidence of supervision.

Equality and diversity

All information about treatment and care, including insulin therapy, should take into account age and social factors, language, accessibility, physical, sensory or learning difficulties, and should be ethnically and culturally appropriate. It should also be accessible to people who do not speak or read English. If needed, people with diabetes should have access to an interpreter or advocate. The needs of people who have experienced visual loss should be considered by healthcare professionals initiating and managing insulin therapy, and they may require additional ongoing support and referral to low vision services. Additional support should also be considered for people who have a physical impairment that may impede self-management of insulin.

This page was last updated: 28 March 2011

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Selected, reliable information for health and social care in one place

Accessibility | Cymraeg | Freedom of information | Vision Impaired | Contact Us | Glossary | Data protection | Copyright | Disclaimer | Terms and conditions

Copyright 2014 National Institute for Health and Care Excellence. All rights reserved.