Inpatient or outpatient initiation of insulin therapy. Experience and cost effective analysis in a suboptimal...

In diabetic day-care centres insulin therapy is started on an outpatient basis. However, in areas where such centres are non-existent, diabetics are admitted to hospital for initiation of insulin therapy. As an alternative to this practice, insulin was initiated in 53 outpatients in a suboptimal clinical setting to find out if it is safe, feasible, acceptable and cost-effective. Fifty-one diabetics, admitted for initiation of insulin, served as controls. No significant difference was found in the mean blood glucose before and after treatment, insulin requirement and response to treatment in both groups. Cost analysis showed that outpatient treatment was cheaper than inpatient treatment at third class and indicated a saving of US $273.00 per patient; these costs were much higher for those admitted to expensive classes. None of the outpatients had hypoglycaemia or ketoacidosis during the study period. Thus, outpatient insulin therapy is safe, feasible, acceptable and cost effective; it could be adopted even in places with suboptimal clinical setting.