Perceptions of insulin use in type 2 diabetes in primary care: a thematic synthesis

Abstract

BackgroundIncreasing numbers of patients with type 2 diabetes mellitus are progressing to insulin therapy, and despite its potency many such individuals still have suboptimal glycaemic control. Insulin initiation and intensification is now often conducted by Practice Nurses and General Practitioners in many parts of the UK. Therefore, gaining insight into perspectives of patients and primary care clinicians is important in determining self-management and engagement with insulin. A thematic synthesis of studies was conducted exploring the views and experiences of people with type 2 diabetes and of healthcare professionals on insulin use and management in the context of primary care.MethodsProtocol based systematic searches of electronic databases (CINAHL, Cochrane Library, EMBASE, MEDLINE, PsycINFO, and Web of Science) were performed on 1 October 2014 and updated on 31 March 2015, to identify studies that identified the views and experiences of adults with type 2 diabetes or primary care clinicians on the use of insulin in the management of type 2 diabetes. Studies meeting the review inclusion criteria were critically appraised using the CASP qualitative research checklist or Barley’s checklist for survey designs. A thematic synthesis was then conducted of the collected studies.ResultsThirty-four studies were selected. Of these, 12 used qualitative interviews (nine with patients and three with healthcare professionals) and 22 were survey based (14 with patients, three with healthcare professionals, and five with both). Twelve key themes were identified and formed three domains, patient perceptions, healthcare professional perceptions, and health professional-patient relationships. The patient-centred themes were: insulin-related beliefs, social influences, psychological factors, hypoglycaemia, and therapy barriers. The clinician-related themes were: insulin skills of general practitioners, healthcare integration, healthcare professional-perceived barriers, hypoglycaemia, and explanations for adherence. Healthcare professional-patient relationship themes were drawn from the perspectives of patients and from clinicians.ConclusionsThis review reveals multiple barriers to optimal insulin use in primary care at both the patient and healthcare professional levels. These barriers indicate the need for multimodal interventions to: improve the knowledge and competencies of primary care professionals in insulin use; provide more effective patient education and self-management support; and introduce integrated insulin support systems.Electronic supplementary materialThe online version of this article (10.1186/s12875-018-0753-2) contains supplementary material, which is available to authorized users.

Evaluations of knowledge, skills and practices of insulin storage and injection handling techniques of diabetic patients in Ethiopian primary hospitals

“…Furthermore, the negative attitudes of diabetic patients towards insulin administration may further compromise their interest to look for the appropriate instructions of storage and handling techniques. Thus, educating and changing their perceptions, beliefs and attitudes towards storage and administering techniques needs to be part of an intervention [11]. In addition to implementing guideline recommendations, healthcare professionals (HCP) could play an important role in pre-brie ng patients about the best injection techniques prior to the start of injection therapy [12][13][14].…”

Experiences of Attending Group Education to Support Insulin Initiation in Type 2 Diabetes: A Qualitative Study

“…People with type 2 diabetes have reported many negative beliefs around insulin therapy [14,18,19], termed psychological insulin resistance [20][21][22], which include sense of personal failure [23]; social stigma [24]; and fears of injections [25], lifestyle change [26], side effects, complications [25], and weight gain [27]. People with type 2 diabetes are likely to discontinue insulin if concerns are not addressed [28].…”

Evaluations of knowledge, skills and practices of insulin storage and injection handling techniques of diabetic patients in Ethiopian primary hospitals

“…practices. Thus, educating and changing DM patients wrong perceptions, beliefs and attitudes towards storage and administering techniques should be an additional goal of professionals [11].…”