title: Transition to insulin in Type 2 diabetes: family physicians' misconception of patients' fears contributes to existing barriers.
abstract: BACKGROUND
  Many patients with Type 2 diabetes require treatment with insulin but do not receive it.
  
  
  OBJECTIVE
  To examine the barriers that hinder the transition to insulin from the point of view of patients and family physicians.
  
  
  METHODS
  
  
  
  METHODS
  Study group (SG)-92 patients who need insulin (maximum oral medications and HbA(1c)>8.5%). Control group (CG)-101 patients who had begun insulin medication recently. PATIENTS were interviewed about attitudes and beliefs regarding their illness and insulin treatment. Physicians: 157 family physicians completed a questionnaire regarding barriers to insulin treatment and answered an open-ended question about the criteria for starting insulin.
  
  
  RESULTS
  In comparing between barriers of SG patients and perspectives of the CG patients, SG patients perceived their illness as not very serious (46.7% vs. 7%, P<.0001), had more fear of addiction to insulin (39% vs. 20.8%, P<.01) and hypoglycemia (12% vs. 4%, P=.05), and perceived the quality of their treatment worse (P<.001). Pain associated with injection and blood tests ranked low. Only 44.3% of physicians specified two criteria or more for treatment with insulin. Physicians' main barriers for commencing insulin medication were as follows: patients' compliance (92.3%), hypoglycemia (79.9%), coping with pain associated with blood tests (53.9%), and pain associated with injections (47.4%).
  
  
  CONCLUSIONS
  Physicians' knowledge was relatively low, and they assign much more importance to the physical fears of patients and are not sufficiently aware of patients' misconceptions regarding the seriousness of their condition and concerns of addiction. This gap apparently contributes to the delay or even the prevention of commencing insulin medication.
authors.affiliation: Department of Family Medicine, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
authors.forename: Sasson
authors.initials: S
authors.lastname: Nakar
authors.forename: Gila
authors.initials: G
authors.lastname: Yitzhaki
authors.forename: Reena
authors.initials: R
authors.lastname: Rosenberg
authors.forename: Shlomo
authors.initials: S
authors.lastname: Vinker
mesh_terms: D000328:Adult; D000368:Aged; D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy* / Q000523:psychology*; D005194:Family Practice; D005239:Fear / Q000523:psychology*; D005260:Female; D006801:Humans; D007328:Insulin / Q000008:administration & dosage* / Q000627:therapeutic use*; D008019:Life Style; D008297:Male; D008875:Middle Aged; D010817:Physician-Patient Relations; D014342:Truth Disclosure
chemical_list: D007328:Insulin