Barriers of Doctors and Patients in Starting Insulin for Type 2 Diabetes Mellitus

Abstract

BackgroundManagement of patients with type 2 diabetes mellitus (T2DM) may involve insulin therapy. However, this treatment may be avoided or delayed by physicians or patients due to the presence of certain barriers. This study aimed to evaluate the barriers to initiating insulin therapy for both physicians and patients with T2DM. MethodThis was a cross-sectional, questionnaire-based study. Data related to the physicians' personal and professional experience were collected, and 15 barriers to initiating insulin therapy were scored by each physician on a four-point Likert scale. Also, the patients' general data were collected, including previous insulin experience, discontinuation reason, and willingness to start insulin therapy if indicated. Twenty-one other barriers were examined with yes/no questions as well. ResultsFor physicians, the patient's treatment compliance, motive, dependence on others for insulin therapy, hypoglycemia, socioeconomic status, occupation, and lack of follow-up were the most highly ranked barriers to initiating insulin therapy. A history of insulin use was reported in 42 (20.7%) patients, 31 of whom had decided to discontinue insulin therapy themselves (73.8%). The three most common reasons for discontinuing insulin therapy among patients were deterioration of T2DM and causing complications, hypoglycemia, and needle injections. Based on the findings, 99 (48.8%) patients were willing to start insulin therapy, if indicated. The family history of insulin therapy was positively correlated with the patient's willingness to start insulin. On the other hand, it was negatively correlated with a low educational level and some barriers to insulin therapy, such as fear of death, dependence on others, the difficulty of carrying insulin while traveling, follow-up challenges, the difficulty of dosing accuracy, the difficulty of keeping insulin, inconveniences in daily life, considering insulin as the last resort, the deterioration of T2DM with insulin, and social stigma. ConclusionThe physicians believed that the barriers to initiating insulin therapy were mainly related to the patient's attitudes and thoughts about this therapy. While hypoglycemia and weight gain are well-known side effects of insulin therapy, the most important patient-related barriers to insulin therapy were related to its impact on the patient's social life and misperceptions about the side effects of insulin.

Patterns of initial and first‐intensifying antidiabetic drug utilization among patients with type 2 diabetes mellitus in Scotland, 2010–2020: A retrospective population‐based cohort study

“…8,9 However, because of the barriers associated with using insulin, patients and prescribers may prefer to use combination oral drugs over insulin. 23,24 Consistent with this study finding, Wang et al 25 reported that 92% of participants in their study were started on single ADDs. The result was also in keeping with the studies by Lee et al 26 (2021) and Chu et al, 17 who showed a significant increase in combinationtherapy prescribing for T2DM management in Korea (between 2000 and 2019) and Taiwan (between 2005 and 2012), respectively; however, it was not stated in these studies at which treatment stage the prescribing pattern was observed.…”

A Hybrid Model of In-Person and Telemedicine Diabetes Education and Care for Management of Patients with Uncontrolled Type 2 Diabetes Mellitus: Findings and Implications from a Multicenter Prospective Study

“…This is caused by several factors, including loss to follow-up, insufficient clinical consultation time, limited number of follow-up appointments, inadequate education provided to patients to allow starting or intensifying insulin therapy, anxiety about injections, fear of self-monitoring, perceived lack of self-efficacy, and inadequate training to perform self-care management. 55–58 This further worsened during the COVID-19 pandemic, especially during its early phases. 39 , 59–62 Consequently, one of the solutions to address these challenges is to implement innovative and flexible initiatives to educate and support patients, especially those receiving insulin and injectable therapy, and to coach patients during the initiation, intensification, and titration of insulin.…”

A Practical Approach to the Initiation, Titration and Intensification of Insulin Therapy in Adults with Diabetes in the Indian Context: Recommendations by Association of Clinical Endocrinologists Consensus Group

“…Physician-related barriers may include their lack of knowledge of updated guidelines, experience of insulin therapy, beliefs and attitudes towards insulin and diabetes management, side effects of insulin therapy (e.g., hypoglycemia and weight gain), and perceptions of patients' attitudes towards insulin therapy (patient's adherence, and wish to prolong non-insulin therapy) [29].…”

“…Patient-related barriers include fear of needle and injection phobia, hypoglycemia and weight gain, negative effects of therapy on occupation and social life, the difficulty of administering injections, perceptions of personal failure in self-management, and the effectiveness of therapy [29].…”