Insulin initiation and management in people with Type 2 diabetes in an ethnically diverse population: the healthcare provider perspective

Patel, Naina; Stone, Margaret; Chauhan, Aneesha; Davies, Melanie J.; Khunti, Kamlesh

doi:10.1111/j.1464-5491.2012.03669.x

Cited by 28 publications

(51 citation statements)

References 19 publications

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“…People from Asian cultures also may see the initiation of insulin as indicative of a failure of the patient to care for him- or herself rather than as a result of the natural progression of diabetes. Members of these populations also may believe insulin causes more complications in the long term (12,14,15,22). Similarly, the underutilization of insulin in African Americans is linked to a perception that insulin causes organ damage (9,23).…”

Section: Barriers To the Use Of Insulinmentioning

confidence: 99%

“…For example, certain Asian cultures view insulin as a form of handicap that may indicate severe illness and feel it may prevent a person with diabetes from finding a marriage partner (22). Some Asians also are more likely to be influenced by other people’s views about taking injections; this can prompt requests to their HCP to change their therapy even if the change is not as effective at controlling glucose (12). …”

Section: Barriers To the Use Of Insulinmentioning

confidence: 99%

“…When discussing health information, it is important to consider the type of language and terminology used, as well as to be compassionate and respectful when delivering information at a level that is understandable and acceptable to patients (12,33). …”

Section: Conquering Barriers To the Use Of Insulinmentioning

confidence: 99%

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Cultural Differences and Considerations When Initiating Insulin

Rebolledo

Arellano

2016

Diabetes Spectrum

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Section: Barriers To the Use Of Insulinmentioning

confidence: 99%

Section: Barriers To the Use Of Insulinmentioning

confidence: 99%

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Cultural Differences and Considerations When Initiating Insulin

Rebolledo

Arellano

2016

Diabetes Spectrum

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“…Furthermore, there is evidence [6,7] of comparatively lower prescribing of insulin for people with Type 2 diabetes who are from South Asian populations than for the white British population. Whilst not much is known from a South Asian perspective about the reasons for lower levels of prescribing insulin, our previous study of healthcare professionals' views and experiences found that patient-related barriers to insulin prescribing are perceived to be accentuated in some South Asian patients [8]. The reasons cited included lower levels of understanding and knowledge about diabetes and insulin; language barriers; and the influence of 'other people' in decisions about commencing insulin therapy [8].…”

mentioning

confidence: 99%

“…Whilst not much is known from a South Asian perspective about the reasons for lower levels of prescribing insulin, our previous study of healthcare professionals' views and experiences found that patient-related barriers to insulin prescribing are perceived to be accentuated in some South Asian patients [8]. The reasons cited included lower levels of understanding and knowledge about diabetes and insulin; language barriers; and the influence of 'other people' in decisions about commencing insulin therapy [8].A useful concept to emerge from research into the reasons for delays and refusal to commence insulin therapy is 'psychological insulin resistance', which can apply to both healthcare professionals and patients [9,10]. The concept encompasses issues such as fear of needles and feelings of personal failure in patients, and lack of confidence to initiate insulin [11] and concerns about hypoglycaemia in healthcare professionals [12].…”

mentioning

confidence: 99%

Concerns and perceptions about necessity in relation to insulin therapy in an ethnically diverse UK population with Type 2 diabetes: a qualitative study focusing mainly on people of South Asian origin

et al. 2014

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Aim:To explore attitudes towards insulin acceptance in an ethnically diverse population of people with Type 2 diabetes. Methods: We conducted semi-structured interviews using a topic guide based on a literature review and findings from our previous study which explored the perspectives of healthcare professionals about insulin initiation and management. Analysis of data involved undertaking an abductive approach in response to emerging themes. Results: Participants discussed not only their concerns about insulin therapy, but also their views and beliefs about the necessity of insulin. Their attitudes to accepting insulin could be mapped into four main typologies. These fitted with an attitudinal scale based on the Necessity-Concerns Framework, described in the medication adherence literature, comprising four attitudes: accepting, sceptical, ambivalent and indifferent. Decisions about accepting insulin involved balancing concerns (such as needle-size) against perceived necessity of insulin (generally, inadequacy of oral medication). South Asian and White British participants had similar concerns, but these were sometimes enhanced in South Asians, due to the influence of negative views and experiences of other insulin users. Conclusions: When discussing insulin with people with Type 2 diabetes, healthcare providers need to ensure that they explore and contribute to patients' understanding and interpretation of the necessity of insulin as well as discussing their concerns. Furthermore, they should be aware of how an individual's social context can influence their perceptions about the necessity of insulin as well as concerns, and that this influence may be more enhanced in some South Asian populations. Word count: 244 Correspondence to: Naina Patel. E-mail: np89@le.ac.uk What's new?• This is the first time the Necessity and Concerns Framework drawn from the medical adherence literature has been used to explore decisions to commence insulin therapy in an ethnically diverse sample of people with Type 2 diabetes.• This study offers a practical insight on why it is important to elicit beliefs about the necessity of insulin therapy as well as people's concerns to help address the reluctance of some people with Type 2 diabetes to commence insulin therapy in a timely way.2 IntroductionApproximately 50% of people with Type 2 diabetes will at some point need to commence insulin therapy [1] in order to achieve or maintain good levels of blood glucose control. Good glycaemic control can help to reduce or prevent the development of diabetes associated complications as shown by the 10 year post-trial follow up data from the United Kingdom Prospective Diabetes Study [2]. This showed that good glycaemic control continued to confer benefits; in the sulfonylurea-insulin group, for example, there were relative reductions of 13% and 24% in the risk of diabetes-related death and microvascular complications respectively. Additionally, research modelling has shown that if insulin is commenced according to management guidelines there ...

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Diabetes, ethnic minority groups and COVID‐19: an inevitable storm

Khunti

2022

Practical Diabetes

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The risk of type 2 diabetes (T2DM) is two‐ to four‐fold higher in ethnic minority populations compared to White populations in the UK and is also associated with an increased risk of certain macrovascular and microvascular complications. Additionally, T2DM has an earlier onset in ethnic minority groups of around 10–12 years than in White populations. The exact reasons for the higher prevalence are unclear but include the complex interplay of biological, lifestyle, environmental and socioeconomic factors. This is further compounded by disparities in care received by ethnic minority populations. The UK was the first country to report on the disproportionate impact of COVID‐19 on ethnic minority groups. Diabetes is also a major risk factor for severe COVID‐19 and, combined with pre‐existing ethnic disparities in diabetes care, has been a significant contributor to inequalities in COVID‐19 outcomes for ethnic minority populations with diabetes including disproportionate hospitalisation and mortality. Major ethnic disparities in diabetes care in the US and UK, especially intermediate outcomes and diabetes complications, were evident prior to the COVID‐19 pandemic. However, the COVID‐19 pandemic has exposed these pre‐pandemic health disparities for ethnic minority populations with diabetes. Similar to the higher risk of T2DM in ethnic minority populations, the exact reasons for higher risk of COVID‐19 in minority ethnic groups are complex and include comorbidities, risk factor control, deprivation and access to care including wider structural issues. As we now plan for recovery, it is imperative that those delivering diabetes care urgently address the disproportionate impact the pandemic has had on ethnic minority populations. Reducing these inequalities will require a greater understanding of the causes. Copyright © 2022 John Wiley & Sons.

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Insulin initiation and management in people with Type 2 diabetes in an ethnically diverse population: the healthcare provider perspective

Cited by 28 publications

References 19 publications

Cultural Differences and Considerations When Initiating Insulin

Cultural Differences and Considerations When Initiating Insulin

Concerns and perceptions about necessity in relation to insulin therapy in an ethnically diverse UK population with Type 2 diabetes: a qualitative study focusing mainly on people of South Asian origin

Diabetes, ethnic minority groups and COVID‐19: an inevitable storm

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