What primary care physicians think about insulin initiation in type 2 diabetes: a field-based study

Background/aim: A significant number of patients with type 2 diabetes mellitus require insulin and little is known about the possible physician-related factors that could cause a delay in the initiation of insulin treatment in patients with type 2 diabetes. This study aimed to evaluate those factors. Materials and methods: A total of 87 family physicians working at 36 family health centers in urban Malatya participated in our study on a voluntary basis. A self-administered survey form was structured to gather the views of the primary care physicians. The survey was developed based on a review of the literature. The survey consisted of Likert scale item questions regarding knowledge about the disease of diabetes mellitus and the views of the primary care physicians regarding insulin initiation for type 2 diabetic patients. Results: Almost half of the participants (42.5%, n = 37) felt incompetent in the starting dosage adjustment and 40.2% (n = 35) of the participants felt incompetent in maintaining the appropriate dosage adjustment. In terms of sex, female family physicians were found to be more uncertain about the timing of initiating insulin treatment for diabetic patients. Conclusion: This study shows the necessity of continuous education activities and interventions to promote motivation in family physicians to improve care of diabetic patients in primary care.

What primary care physicians think about insulin initiation in type 2 diabetes: a field-based study

Background/aim: A significant number of patients with type 2 diabetes mellitus require insulin and little is known about the possible physician-related factors that could cause a delay in the initiation of insulin treatment in patients with type 2 diabetes. This study aimed to evaluate those factors. Materials and methods: A total of 87 family physicians working at 36 family health centers in urban Malatya participated in our study on a voluntary basis. A self-administered survey form was structured to gather the views of the primary care physicians. The survey was developed based on a review of the literature. The survey consisted of Likert scale item questions regarding knowledge about the disease of diabetes mellitus and the views of the primary care physicians regarding insulin initiation for type 2 diabetic patients. Results: Almost half of the participants (42.5%, n = 37) felt incompetent in the starting dosage adjustment and 40.2% (n = 35) of the participants felt incompetent in maintaining the appropriate dosage adjustment. In terms of sex, female family physicians were found to be more uncertain about the timing of initiating insulin treatment for diabetic patients. Conclusion: This study shows the necessity of continuous education activities and interventions to promote motivation in family physicians to improve care of diabetic patients in primary care.

___

  • Furdell, EL. Fatal Thirst: Diabetes in Britain until Insulin. Boston, MA, USA: Brill Academic Publishers; 2009.
  • Korytkowski M. When oral agents fail: practical barriers to starting insulin. Int J Obes Relat Metab Disord 2002; 26: 18–24.
  • Ross A, Tildesley H, Ashkenas J. Barriers to effective insulin treatment: the persistence of poor glycemic control in type 2 diabetes. Cur Med Res Opin 2011; 27: 13–20.
  • Brod M, Kongso J, Lessard S, Christensen T. Psychological insulin resistance: patient beliefs and implications for diabetes management. Qual Life Res 2009; 18: 23–32.
  • Spann SJ, Nutting PA, Galliher JM, Peterson KA, Pavlik VN, Dickinson LM, Volk RJ. Management of type 2 diabetes in the primary care setting: a practice-based research network study. Ann Fam Med 2006; 4: 23–31.
  • Wild S, Roglic G, Green A, Sicree R, King H. Global prevalence of diabetes estimates for the year 2000 and projections for 2030. Diabetes Care 2004; 27: 1047–1053.
  • Stellefson M, Dipnarine K, Stopka C. The chronic care model and diabetes management in US primary care settings: a systematic review. Prev Chronic Dis 2013; 10: 120180.
  • Hayes RP, Fitzgerald JT, Jacober SJ. Primary care physician beliefs about insulin initiation in patients with type 2 diabetes. Int J Clin Pract 2008; 62: 860–868.
  • Nam S, Chesla C, Stotts N, Kroon L, Janson L. Factors associated with psychological insulin resistance in individuals with type 2 diabetes. Diabetes care 2010; 33: 1747–1749.
  • Cabana D, Rand C, Powe R, Wu W, Wilson H, Abboud C. Why don’t physicians follow clinical practice guidelines? A framework for improvement. JAMA 1999; 282: 1458–1468.
  • Larkin ME, Capasso VA, Chen CL, Mahoney EK, Hazard B, Cagliero E, Nathan DM. Measuring psychological insulin resistance barriers to insulin use. Diabetes Educ 2008; 34: 511–
  • Makuc J, Predikaka K. Insulin allergy. Zdrav Vestn 2008; 77: 757–759 (in Slovenian with an abstract in English).
  • Peyrot M, Barnett A, Meneghini L, Schumm-Draeger P. Insulin adherence behaviours and barriers in the multinational global attitudes of patients and physicians in insulin therapy study. Diabet Med 2012; 29: 682–689.
  • Munshi MN, Segal AR, Suhl E, Staum E, Desrochers L, Sternthal A, Giusti J, McCartney R, Lee Y, Bonsignore P et al. Frequent hypoglycemia among elderly patients with poor glycemic control. Arch Intern Med 2011; 171: 362 –364.
  • Russell-Jones D, Khan R. Insulin-associated weight gain in diabetes – causes, effects and coping strategies. Diabetes Obes Metab 2007; 9: 799–812.
  • Ab E, Denig P, van Vliet T, Dekker JH. Reasons of general practitioners for not prescribing lipid-lowering medication to patients with diabetes: a qualitative study. BMC Family Practice 2009; 10: 24.
  • Cabana M, Ebel B, Cooper-Patrick L, Powe N, Rubin H, Rand C. Barriers pediatricians face when using asthma practice guidelines. Arch Pediatr Adolesc Med 2000; 154: 685–693.
  • Aktürk Z, Acemoğlu H. Comprehensive care and its evaluation in family medicine. Eurasian Journal of Family Medicine 2012; 1: 23–28 (in Turkish with an abstract in English).
  • Rackel R. Improving patient acceptance and adherence in diabetes management: A focus on insulin therapy. Adv Ther 2009; 26: 838–846.
  • Jackson L, Yuan L. Family physicians managing tuberculosis. Qualitative study of overcoming barriers. Can Fam Physician 1997; 43: 649–655.
  • Set T, Aktürk Z, Büyüklü M, Cansever Z, Avşar ÜG, Avşar Ü, Işık M, Acemoğlu H. Improving electrocardiogram interpreting skills among primary care physicians in Turkey. Turk J Med Sci 2012; 42: 1028–32.
Turkish Journal of Medical Sciences-Cover
  • ISSN: 1300-0144
  • Yayın Aralığı: Yılda 6 Sayı
  • Yayıncı: TÜBİTAK
Sayıdaki Diğer Makaleler

Surgical management of pulmonary aspergilloma: clinical experience with 77 cases

Koray AYDOĞDU, Funda İNCEKARA, Mehmet Furkan ŞAHİN, Selim Şakir Erkmen GÜLHAN, Göktürk FINDIK, Abdullah İrfan TAŞTEPE, Sadi KAYA

Efect of keratinocyte growth factor on growth and transdiferentiation of primary alveolar epithelial type II cells

Yumei WU, Xiuxiang LIU, Zhichun FENG, Chunmei TIAN, Xiangyong KONG, Changjun LV

Urodynamic disorders and renal scarring in pediatric patients with nonmonosymptomatic nocturnal enuresis

ORKUN TOLUNAY, NECLA BUYAN, MUSTAFA ÖZGÜR TAN, HÜSNÜ OĞUZ SÖYLEMEZOĞLU, HATİCE KİBRİYA FİDAN, SEVCAN AZİME BAKKALOĞLU EZGÜ

Protective effect of \beta-glucan on acute lung injury induced by lipopolysaccharide in rats

MERYEM IRAZ, MUSTAFA IRAZ, MUKADDES EŞREFOĞLU, MEHMET ŞERİF AYDIN

Malondialdehyde and nitric oxide levels and catalase, superoxide dismutase, and glutathione peroxidase levels in maternal blood during diferent trimesters of pregnancy and in the cord blood of newborns

Sevda YÜKSEL, Ayşe Arzu YİĞİT

Quantitative study of epigenetic signature in head >and neck squamous cell carcinoma

Ayesha UMAIR, Bassel TARAKJI, Alzoghaibi IBRAHIM, Azzeghaibi NASSER, Alenzi FQ, Ayesha SHREEN

What primary care physicians think about insulin initiation in type 2 diabetes: a field-based study

Muharrem AK, Mustafa Haki SUCAKLI, Metin CANBAL, Yaşar KOŞAR

CYP 2D6*4 polymorphism and interindividual response variation to metoprolol in stage 1 hypertensive patients: no association in a rural Indian population?

RAJAGOPAL AYYAPPADHAS, UNNIKRISHNAN DHANALEKSHMI, CHELLIAH JESTIN

Te frst PTPN11 mutations in hotspot exons reported in Moroccan children with Noonan syndrome and comparison of mutation rate to previous studies

Ihssane EL BOUCHIKHI, Imane SAMRI, Mohammed HOUSSAINI IRAQUI, Saaid TRHANINT, Laila BOUGUENOUCH, Hanane SAYEL, Moustapha HIDA, Samir ATMANI, Karim OULDIM

Pandemic H1N1 IgG levels in healthcare workers

Viroj WIWANITKIT