Clinical snapshots. Results from the PCDS survey series: Insulin safety in general practice

During May 2016, 174 healthcare professionals completed the survey. Demographics of respondents reflected the multidisciplinary readership of the Journal and those involved in insulin management, with 34.5% practice nurses, 18% diabetes specialist nurses, 6.5% nurse practitioners and consultant nurses, 15% GPs, nearly 10% describing themselves as diabetes leads, and the remainder district, community and hospital nurses, dietitians, podiatrists, pharmacists and consultants.

In total, 89% of those responding personally manage people on insulin within their practice, with 56% initiating insulin as part of an enhanced service. More than three quarters discuss injection technique at every insulin review and 78% inspect injection sites at least annually. However, only just over half had read best practice injection technique guidelines, suggesting this may remain an area of significant educational need (see Figure 1).

A total of 87% are somewhat or very confident adjusting insulin doses, with more than half providing written instructions to support self-titration. Several healthcare professionals provide telephone support, recommending individualised dose adjustments based on reported glucose levels.

The survey explored how knowledgeable and confident the respondents are with newer insulins. One third admitted to not being at all confident using newer insulin concentrations with half very or somewhat confident. In total, 30% were not aware of biosimilar insulins.

Just under a third of respondents stated they are not involved in choice of insulin, but not surprisingly more than 50% felt that cost always or somewhat influences insulin choice. Despite PCDS previously highlighting this as a safety concern (PCDS, 2015), 32% are aware of insulin being drawn out of insulin pen cartridges or prefilled pens, posing a significant risk to patients and professionals.

Approximately two-thirds responded that they had completed an update or training in insulin management but in more than 20% of this group, this took place more than 4 years ago.