The purpose of this research is to determine if meeting in a group with other subjects with
diabetes can reduce barriers to starting insulin.
Diabetes is a common, morbid and expensive disease among veterans. Achieving and
maintaining adequate glycemic control can reduce the devastating complications of diabetes.
Unfortunately a large percentage of veterans with type 2 diabetes continue to have poorly
controlled blood sugars. Insulin is the most potent medication for reducing glycemia, but
is not used often enough due to barriers that are both patient and provider driven.
We propose to conduct a pilot study to evaluate the feasibility of establishing an insulin
education group that would serve to educate patients about insulin, to initiate insulin in a
group setting, and to provide appropriate follow-up of those who start insulin. If the
intervention is successful, we plan to develop a multicenter study to test rigorously the
effect of this approach.
To determine if psychological barriers to insulin initiation in patients with uncontrolled
type 2 diabetes are favorably affected by a group insulin education and insulin initiation
visit, as measured by the Barriers to Insulin Treatment (BIT) Questionaire before and after
To evaluate the feasibility of the intervention as measured by the percent of patients who
are referred to the class, but either cancel without rescheduling or fail to report and the
percent of patients who begin insulin.
To evaluate the safety of the intervention as measured by the proportion of patients
experiencing hypoglycemic symptoms; proportion of patients requiring sugar intake to manage
hypoglycemia; and the proportion of patients requiring assistance to manage hypoglycemia.
- Primary care patient at McGuire Veterans Affairs Medical Center in Richmond, Virginia
- Age > 18 years
- Inadequately controlled diabetes (HbA1c > 8.0%) and not on insulin (using most recent
HbA1c, within 1 month of the first visit)
- Primary Care Provider referral to insulin initiation/education group
- Patient brings home glucose readings to first visit
- Patient is reluctant to participate in a group visit for any reason
- Patient unwilling to sign consent form