Eighty five percent of practice nurses are underestimating the prevalence of insulin resistance in type 2 diabetes patients

November 05, 2001

While practice nurses' understanding of the definition of insulin resistance is excellent (80% know it is the inability of the body to respond to its own insulin1), the number of patients that it affects is being greatly underestimated. Eighty-five percent of practice nurses1 (and 60% of GPs2) are unaware that at least 92% of people with type 2 diabetes are insulin resistant3.

An independent survey carried out by Taylor Nelson Sofres* has revealed that 79% of practice nurses understand that insulin resistance is related to the development of cardiovascular complications.1. However, it may be extremely difficult to optimise treatment without widespread appreciation of the prevalence of insulin resistance, a fundamental cause of type 2 diabetes.

Gwen Hall, (practice nurse/trainer, Haslemere) is also keen that practice nurses realise their potential in the management of type 2 diabetes, 'Practice nurses are often responsible for regular patient reviews. These are an ideal opportunity to involve diabetes patients in their own care and educate them about insulin resistance, which is not only implicated in the causal factors of type 2 diabetes but the onset or progression of complications. With improved patient understanding and full use of available treatment options, including therapies which resensitise the body to its own insulin, glycaemic goals may be reached.'

'Cardiovascular disease is the principal cause of death amongst these patients4. Treatment of insulin resistance improves glycaemic control. The UKPDS study has shown that maintenance of glycaemic control may reduce the risks of CV complications associated with type 2 diabetes5,6,' comments Dr Peter Tasker of Primary Care Diabetes UK. 'New treatments that increase the body's sensitivity to insulin address this problem and may therefore impact on cardiovascular risk factors, but without the knowledge that insulin resistance is a problem for nearly all type 2 diabetes patients, opportunities for gaining control of type 2 diabetes may be lost and patient education may prove difficult.'

This view is supported by further survey data. Research has shown that increasing the body's sensitivity to its own insulin by using drugs such as AVANDIA (rosiglitazone) - a member of the thiazolidinedione (TZD) class of oral antidiabetic agents - can result in improved glycaemic control7,8. Studies have also shown that AVANDIA has positive effects on a range of cardiovascular risk factors9-13. However, the survey shows only 13% of practice nurses feel familiar with the place of TZDs within the treatment algorithm1, which may reflect the lack of awareness of the prevalence of insulin resistance in type 2 diabetes patients. These survey results highlight the need for greater understanding of the prevalence of insulin resistance to enable practice nurses to make informed management decisions and to pass their knowledge on to their patients. In support of this goal, GlaxoSmithKline is launching the TIME2COMBINE initiative to maximise awareness of insulin resistance as a fundamental cause of type 2 diabetes, and of treatment combinations that will help patients reach their glycaemic goals. TIME2COMBINE educational meetings are currently being held across the UK for all levels of healthcare professional. Practical tools and services to enable healthcare providers and patients to manage the disease effectively, will shortly become available. ###

Shire Hall Communications

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