Physician related barriers towards insulin therapy at primary care centres in Trinidad: a cross-sectional study

Motilal, Shastri

doi:10.1186/s12875-020-01271-1

Cited by 4 publications

(3 citation statements)

References 30 publications

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“…A structured questionnaire was developed after a comprehensive review of the literature investigating physicians’ attitude and barriers to insulin initiation and intensification worldwide with some adaptation to ensure compatibility with the Saudi primary healthcare sector [ 19 , 20 , 21 , 22 ]. The questionnaire consisted of two parts and was reviewed for content validity by an expert group of family physicians and diabetologists.…”

Section: Methodsmentioning

confidence: 99%

“…Three questions with multiple items focused on the barriers towards initiation and intensification of insulin therapy. Items were developed depending on an extensive review of similar studies [ 19 , 20 , 21 , 22 ]. The first question included twelve items related to the commonly reported barriers to insulin acceptance among T2D patients.…”

Section: Methodsmentioning

confidence: 99%

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Barriers and Attitudes of Primary Healthcare Physicians to Insulin Initiation and Intensification in Saudi Arabia

Alhagawy

Yafei

Hummadi

et al. 2022

IJERPH

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Saudi Arabia is a country with high prevalence of diabetes, uncontrolled diabetes, and diabetes-related complications. Poor glycemic control is multifactorial and could be explained in part by physician and patient reluctance toward insulin or insulin inertia. This study aimed to address physician barriers toward insulin therapy in primary care settings. It included 288 physicians from 168 primary healthcare centers (PHC) in the Jazan region of Saudi Arabia. Participants responded to questionnaire investigating physicians’ attitude and barriers to insulin initiation and intensification in PHCs. In physician opinion, the most common barriers among their patients were fear of injection, lack of patient education, fear of hypoglycemia, and difficult administration. Physicians were reluctant to initiate insulin for T2D patients mostly due to patient non-adherence to blood sugar measurement, non-adherence to appointment or treatment, elderly patients, or due to patient refusal. Physicians’ fear of hypoglycemia, lack of staff for patient education, and lack of updated knowledge were the primary clinician-related barriers. Exaggerated fears of insulin side effects, patient non-adherence, limited staff for patient’s education, patient refusal, and inadequate consultation time were the main barriers to insulin acceptance and prescription.

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Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Barriers and Attitudes of Primary Healthcare Physicians to Insulin Initiation and Intensification in Saudi Arabia

Alhagawy

Yafei

Hummadi

et al. 2022

IJERPH

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“…Зокрема, ADA допускає застосування людського НПХ-інсуліну у пацієнтів із ЦД2 виключно за умов відсутності в анамнезі гіпоглікемічних станів [1]. Додатковим критерієм застосування НПХ-інсуліну є сталий режим харчування [9]. У рекомендаціях ADA зазначається, що гларгін-100 та детемір мають менший ризик гіпоглікемій, ніж НПХ-інсулін, а при застосуванні деглюдеку або гларгіну-300 цей ризик є ще меншим [1].…”

Section: результатиunclassified

Basal insulin titration algorithms in patients with type 2 diabetes: the simplest is the best (?)

Katerenchuk

2023

Mìžnarodnij endokrinologìčnij žurnal

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Basal insulin is the first and main component of insulin therapy in patients with type 2 diabetes mellitus (T2DM). Based on the shortcomings of human NPH insulin and the advantages provided by long-acting basal insulin analogues, they are recommended for priority use in patients with T2DM. The leading factor in the success of insulin therapy is titration of its dose with the achievement of the target range of glycemia. Data from clinical trials and real clinical practice indicate that simpler dose titration algorithms ensure better achievement of glycemic goals with a lower risk of hypoglycemia. In addition, simple dose titration algorithms are better accepted by patients and increase satisfaction with treatment. The leading societies of diabetologists ADA/EASD and AACE/ACE recommend the use of simple dose titration algorithms. Recent clinical trials on the effectiveness of the insulin glargine dose titration based on the INSIGHT algorithm, which, unlike the traditional options for changing the dose 1–2 times a week, involves a daily correction of the insulin glargine dose by 1 Unit, have proven its effectiveness and safety. Most patients prefer this type of insulin dose titration. The same titration algorithm can be used for a fixed combination of glargine with lixisenatide, which was also confirmed by the results of clinical trials. In general, simplified options for correcting the basal insulin dose have demonstrated their effectiveness and allow increasing the percentage of patients who manage to achieve the glycemic goal without increasing the risk of hypoglycemia. When prescribing basal insulin, physician must determine the target range of glycemia, demonstrate the titration algorithm that is acceptable for each insulin and which a patient will use to achieve the glycemic goal.

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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

Tourkmani,

Alharbi,

Rsheed

et al. 2024

Telemedicine Reports

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Background: Patients with uncontrolled type 2 diabetes mellitus (T2DM) require close follow-up, support, and education to achieve glycemic control, especially during the initiation or intensification of insulin therapy and self-care management. This study aimed to describe and evaluate the impact of implementing a hybrid model of in-person and telemedicine care and education on glycemic control for patients with uncontrolled T2DM (hemoglobin A1c [HbA1c] ≥9%) during the coronavirus disease pandemic. Methods: This prospective multicenter-cohort pre-/post-intervention study was conducted on patients with uncontrolled T2DM. This study included three chronic illness centers affiliated with the Family and Community Medicine Department at Prince Sultan Military Medical City in Riyadh, Saudi Arabia. A hybrid model of in-person (onsite) and telemedicine care and education was developed. This involved implementing initial in-person care at the physicians' clinic and initial in-person education at the diabetes education clinic, followed by telemedicine services of tele-follow-ups, support, and education for an average 4-month follow-up period. Results: Of the enrolled 181 patients, more than half of the participants were women ( n = 103, 56.9%). The mean age of participants (standard deviation) was 58.64 ± 11.23 years and the mean duration of diabetes mellitus was 13.80 ± 8.55 years. The majority of the patients ( n = 144; 79.6%) were on insulin therapy. Overall, in all three centers, the hybrid model had significantly reduced HbA1c from 10.47 ± 1.23% to 7.87 ± 1.59% (mean difference of reduction 2.59% [95% confidence interval (CI) = 2.34–2.85%], p < 0.001). At the level of each center, HbA1c was reduced significantly with mean differences of 3.17% (95% CI = 2.81–3.53%), 2.49% (95% CI = 1.92–3.06%), and 2.16% (95% CI = 1.76–2.57%) at centers A, B, and C, respectively (all p < 0.001). Conclusion: The findings showed that the hybrid model of in-person and telemedicine care and education effectively managed uncontrolled T2DM. Consequently, the role of telemedicine in diabetes management could be further expanded as part of routine diabetes care in primary settings to achieve better glycemic control and minimize nonessential in-person visits when appropriate.

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Physician related barriers towards insulin therapy at primary care centres in Trinidad: a cross-sectional study

Cited by 4 publications

References 30 publications

Barriers and Attitudes of Primary Healthcare Physicians to Insulin Initiation and Intensification in Saudi Arabia

Barriers and Attitudes of Primary Healthcare Physicians to Insulin Initiation and Intensification in Saudi Arabia

Basal insulin titration algorithms in patients with type 2 diabetes: the simplest is the best (?)

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

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