title: Insulin therapy in type 2 diabetes is no longer a secondary care activity in the Netherlands.
abstract: OBJECTIVE
  Because Dutch health care organisations did want to establish well-defined diabetes shared care groups, we investigated the organisation of insulin therapy in general practice in the Netherlands and assessed factors that were associated with providing insulin therapy in type 2 diabetes (DM2) patients.
  
  
  METHODS
  Questionnaire to half of the Dutch general practitioners (GPs) (n=3848). We compared GPs who both start insulin treatment and monitor the dosages with those who always refer patients requiring insulin therapy or only monitor insulin dosages.
  
  
  RESULTS
  Total response was 42% (n=1621). 67% of the GPs start insulin therapy in patients with DM2, especially male GPs and those above the age of 40, as well as GPs working in a health centre and those working together with a practice nurse. GPs working in urban regions less often start insulin. The most often mentioned barriers for starting and/or monitoring insulin therapy are lack of knowledge of insulin therapy, lack of time and insufficient financial incentives.
  
  
  CONCLUSIONS
  This nation-wide overview shows that insulin therapy is no longer a secondary care based activity. However, there is still need to enlarge the practice staff and to overcome the perceived skills deficit.
authors.affiliation: Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, The Netherlands. m.j.p.vanavendonk@umcutrecht.nl
authors.forename: Mariëlle J P
authors.initials: MJ
authors.lastname: van Avendonk
authors.forename: Kees J
authors.initials: KJ
authors.lastname: Gorter
authors.forename: Maureen
authors.initials: M
authors.lastname: van den Donk
authors.forename: Guy E H M
authors.initials: GE
authors.lastname: Rutten
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001291:Attitude of Health Personnel; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000188:drug therapy* / Q000191:economics; D016903:Drug Monitoring; D005194:Family Practice / Q000191:economics / Q000458:organization & administration*; D005260:Female; D006442:Glycated Hemoglobin / Q000378:metabolism; D019538:Health Care Surveys; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007004:Hypoglycemic Agents / Q000008:administration & dosage* / Q000191:economics; D007328:Insulin / Q000008:administration & dosage* / Q000191:economics; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D010818:Practice Patterns, Physicians'; D011320:Primary Health Care / Q000191:economics / Q000458:organization & administration*; D012017:Referral and Consultation; D012052:Reimbursement, Incentive; D011795:Surveys and Questionnaires; D013997:Time Factors
chemical_list: D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents; D007328:Insulin; C517652:hemoglobin A1c protein, human