Background

My name is Daljinder (Dal) Sidhu and I am currently the owner and director of Medman Consultancy Limited. 

I ran a weekly diabetes clinic in a GP practice between September 2008, when I became the first primary care pharmacist to complete the Warwick Medical School 'Intensive Management in Type 2 Diabetes Course' (also known as 'Insulin for Life'), and October 2010.

"The Intensive management in type 2 diabetes course was designed to provide advanced skills to enable effective management of people with type 2 diabetes, including insulin initiation."

An article describing my journey to competence in initiating insulin and establishing a pharmacist-led diabetes clinic was published in the Pharmaceutical Journal in April 2010, which I hope will give fellow pharmacists the impetus to establish clinics of their own.

Insulin Initiation

The ability to initiate insulin in the patient's own GP practice is, I feel, important to the patient because they are in familiar surroundings. The approach of building a good relationship with the patient and spending the time to explain why insulin is being initiated could lead to better outcomes when compared to patients being referred to clinicians outside their GP practice setting.

If the patient is referred elsewhere they may not attend their appointment or they may not feel comfortable with the clinician, especially if they have not seen them before. Seeing the patient from the point prior to the initiation of insulin and then following-up at regular intervals is very rewarding and this would not have been possible had I not embarked on the Warwick course.

Clinic Outcomes

Several outcome measures were monitored for the 115 patients seen in my clinic over the 2-year period, such as HbA1c, total cholesterol. weight and blood pressure, with the primary focus being on the first two measures.

26 patients were either initiated on insulin by myself, or had their insulin dose titrated, and a further 89 patients had their oral diabetes medication dose optimised.

Results

• Average HbA1c reduction = 0.95% (p<0.001)

• Average total cholesterol reduction = 0.31 mmol/L (p=0.02)

If you are a pharmacist who is interested in initiating insulin and require further information then please feel free to contact me via e-mail and I will be more than happy to share my experiences with you.

You can also view my profile and connect with me on LinkedIn.