The effect of an education programme for patients with Type 2 diabetes who were converted to insulin
Authors: Malcolm J. , Moir K. 
Published: May 2009

Background:  Weight gain after commencing insulin is a major issue for many patients with Type 2 diabetes (Carver, 2006; Ryan et al., 2006). An education program was developed to advise Type 2 diabetic patients who were converted to insulin on how to minimise their weight gain and achieve optimal glycaemic control. The aim of this study was to evaluate the effect of the education programme on body weight and glycaemic control in this group of patients.

Methods:  Patients with HbA1c >7.5% on maximum oral therapy were assessed and invited to attend an education group facilitated by a diabetes specialist nurse and a dietitian. Patients attended weekly for 4 weeks and 3, 6, 9 and 12 months later. Glycosylated haemoglobin (HbA1c), height and weight were measured prior to starting insulin and 3 and 12 months later. A control group (n = 16) was selected retrospectively from patients who were converted to insulin during the previous year but had not attended an education programme. This group received no routine support from other healthcare professionals. Analysis of variance, using SPSS (SPSS Inc., Chicago, IL, USA), was used to compare the effect of the intervention on the variables.

Results:  Fifty patients were assessed and invited to attend the education programme over a 7‐month period; 26 people attended the programme. Twenty‐one of the 26 people attended seven or more of the eight group sessions that were offered and these results are presented here. Five people attended initial sessions but failed to attend quarterly sessions. Means (SD) for weight gain and HbA1c are shown in Table 1. The mean weight gain was lower at 3 and 12 months for patients attending the education programme, although this was not statistically significant. There was greater reduction in HbA1c in the study group 3 and 12 months after conversion to insulin

 Effect of an education programme on weight and HbA1c after insulin conversion

Control group (n = 16)
Effect of insulin conversion
Education programme group (n = 21)
Effect of insulin conversion

Weight (kg)
Prior to insulin
93.3 (13.7)

85.5 (14.8)

3 months
96.2 (15.0)
+2.9 (3.5)
86.9 (14.7)
+1.4 (4.2)

1 year
99.3 (15.1)
+6.0 (2.9)
88.9 (15.8)
+3.4 (5.9)

HbA1C (%)
Prior to insulin
9.6 (1.4)

10.9 (1.4)

3 months
8.2 (1.1)
−1.4 (1.5)
8.6 (1.1)
−2.3 (1.6)

1 year
8.6 (1.5)
−1.0 (2.0)
8.3 (1.2)
−2.5 (1.8)

Discussion:  The education programme minimised weight gain and improved glycaemic control in Type 2 diabetic patients who were converted to insulin 3 months after conversion. These changes were maintained 1 year after conversion. These results are consistent with other studies showing that regular follow up improves outcomes (UKPDS, 1998). However, as a result of the variable responses and small group numbers, the results were not statistically significant.

Conclusions:  Education programmes facilitated by a dietitian and a diabetes specialist nurse may be effective in minimising weight gain and improving glycaemic control in this group of patients.

References Carver, C. (2006) Insulin treatment and the problem of weight gain in type 2 diabetes. Diabetes Educ. 32, 910–917.

Ryan, M., Livingston, M.B.E. & Ritz, P. (2006) Insulin treatment and weight gain in type 2 diabetes: Is our knowledge complete? Curr. Nutr. Food Sci.2, 51–58, Bentham Science Publishers.

United Kingdom Prospective Diabetes Study Group (1998) Intensive blood glucose control with sulphonylureas or insulin compared with conventional treatment and the risk of complications in patients with type 2 diabetes. Lancet352, 837–853.