Attitudes towards insulin initiation in type 2 diabetes patients among healthcare providers: A survey research
Escalada J (1), Orozco-Beltran D (2), Morillas C (3), Alvarez-Guisasola F (4), Gomez-Peralta F (5), Mata-Cases M (6), Palomares R (7), Iglesias R (8), Carratalá-Munuera C (9).
(1) Clínica Universidad de Navarra, Pamplona, Spain.
(2) University Miguel Hernandez, San Juan de Alicante, Spain.
(3) Peset University Hospital, University of Valencia, Valencia, Spain.
(4) La Calzada Primary Health Care Centre, Gijón, Spain.
(5) Segovia General Hospital, Segovia, Spain.
(6) Primary Health Care Centre La Mina - Institut Català de la Salut, Sant Adrià de Besòs, Barcelona, Spain; Institut Universitari d'Investigació en Atenció Primària Jordi Gol, Barcelona, Spain.
(7) 'Reina Sofía' University Hospital, Cordoba, Spain.
(8) Primary Care Health Centre Pedro Laín Entralgo, Alcorcon, Madrid, Spain.
(9) University Miguel Hernandez, San Juan de Alicante, Spain.
To describe the views of healthcare providers about starting insulin in patients with type 2 diabetes and to determine the specific factors that contribute to delay insulin initiation.
Two-phases observational descriptive study. In the quantitative phase we conducted a cross-sectional survey of a sample of 380 healthcare professionals (general practitioners (GPs), endocrinologists, internists and nurses). In the qualitative phase, a discussion group reviewed the results of the survey to propose solutions.
In poorly controlled patients, 46% of GPs vs. 43.2% of internists and 31.3% of endocrinologists waited 3-6months before starting insulin, and 71.4% of GPs vs. 66.7% of internists vs. 58.8% of endocrinologists need to confirm twice the HbA1c levels. The upper level of basal glucose more frequently considered as good control is 130mg/dL for GPs (35.7%), and 120mg/dL for internists (35.8%) and endocrinologists (37.5%).
In patients without comorbidities, 32.5% of endocrinologists vs. 27.2% of internists vs. 17.9% of GPs initiated insulin when HbA1c was >7% while 26.3% of endocrinologists vs. 28.4% of internists vs. 38.4% of GPs initiated insulin when HbA1c was >8%. The interference of the therapy with the patient' social life and the need for time management were the most accepted barriers to initiate insulin.
There are significant differences between GPs and endocrinologists regarding the insulin initiation and GPs and internists felt less empowered to manage patients with diabetes. Specific training for professionals and joint work with patients could improve the glycemic control.
CITA DEL ARTÍCULO Diabetes Res Clin Pract. 2016 Oct 14;122:46-53. doi: 10.1016/j.diabres.2016.10.003