Patients with poorly controlled diabetes in primary care: healthcare clinicians' beliefs and attitudes.
OBJECTIVE
To determine doctors' and nurses' attitudes and beliefs about treating patients with type 2 diabetes with less than ideal glycaemic control while receiving maximal oral treatment in primary care.


METHODS
Focus groups.


METHODS
Primary care.


METHODS
Four focus groups of 23 GPs and practice nurses.


RESULTS
General practice was thought to be the best setting for managing all patients with type 2 diabetes but there were concerns about a lack of resources and unfamiliarity with starting insulin. Issues around compliance were extensively discussed; the "failing diabetic" had dual meanings of failing glycaemic control and failing compliance and effort by both patient and doctor. Although views about insulin therapy differed, patients were understood to be resistant to starting insulin, representing for them a more serious stage of diabetes, with fears of needles and hypoglycaemia.


CONCLUSIONS
The role of diabetes specialist nurses working in primary care will be crucial in managing such patients to improve knowledge, for extra resources, for their experience of insulin use, and to change attitudes.
Jeavons
D
D
Centre for Integrated Health Care Research, University of Durham, Wolfson Research Institute, Stockton on Tees, UK.
Hungin
A P S
AP
Cornford
C S
CS