Starting Insulin Therapy in Outpatients

To the Editor.—  We read with interest the article by Wilson et al entitled "Starting Insulin Treatment as an Outpatient"1 in the Aug 15 issue of JAMA. Our institution has a diabetes education center serving approximately 1000 patients every year; insulin therapy is started routinely in 3% to 5% on an outpatient basis at the option of the referring physician if the patients meet certain standard criteria.All of our patients are assessed by a nurse-clinician and encouraged to attend a daily diabetes education class for the first five days of their insulin use. They are followed up by a nurse-clinician instructor and the medical director of the center or the patient's referring physician on a daily basis during this period. This program has proved to be safe and cost-effective and none of our patients have required hospitalization during institution of insulin therapy. We feel that your readers might be