title: Initiation of insulin for type 2 diabetes mellitus patients: what are the issues? A qualitative study.
abstract: BACKGROUND
  Type 2 diabetes mellitus is a progressive condition in which the pancreatic beta-cell function deteriorates with increasing duration of the disease. When good glycaemic control is not achieved despite adherence to oral hypoglycaemic drugs, healthy diet and lifestyle, insulin should be initiated. However, this is often delayed due to various reasons. We aimed to determine the issues relating to insulin initiation for diabetic patients managed in primary care polyclinics in Singapore.
  
  
  METHODS
  Qualitative data was obtained during four focus group discussions, with participation from healthcare professionals (HCPs), including physicians and nurses, and type 2 diabetes mellitus patients. The data was transcribed into text, coded and grouped into themes.
  
  
  RESULTS
  Launching the topic and doctor-patient communication on insulin therapy were key issues in insulin initiation. Patient barriers to insulin commencement included: refusal to acknowledge the need for insulin therapy; its perception as a social stigma, an inconvenient mode of treatment or punishment for failure; and fear of needles, side-effects and complications. The HCP's attitude and experience with insulin therapy were also possible barriers.
  
  
  CONCLUSIONS
  Our findings highlight that insulin initiation is affected by the complex interaction between the patients and HCPs, and other system factors. Patients may harbour misconceptions about insulin due to the late introduction of insulin therapy by HCPs or the way the therapy is being communicated to them. The key issues to address are the disparity in perceptions of diabetic control between HCPs and patients, and education regarding the need for insulin therapy.
authors.affiliation: SingHealth Polyclinics-Head Office, 167 Jalan Bukit Merah, #15-10 Connection One (Tower 5), Singapore 150167. tan.ai.meng@singhealth.com.sg
authors.forename: A M
authors.initials: AM
authors.lastname: Tan
authors.forename: L
authors.initials: L
authors.lastname: Muthusamy
authors.forename: C C
authors.initials: CC
authors.lastname: Ng
authors.forename: K Y
authors.initials: KY
authors.lastname: Phoon
authors.forename: J H
authors.initials: JH
authors.lastname: Ow
authors.forename: N C
authors.initials: NC
authors.lastname: Tan
mesh_terms: D000328:Adult; D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy*; D004032:Diet; D005260:Female; D017144:Focus Groups; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use; D007328:Insulin / Q000008:administration & dosage* / Q000627:therapeutic use; D050417:Insulin-Secreting Cells / Q000166:cytology; D008019:Life Style; D008297:Male; D008875:Middle Aged; D009339:Needles; D017060:Patient Satisfaction; D011320:Primary Health Care / Q000379:methods; D012648:Self Care / Q000379:methods; D012846:Singapore; D016896:Treatment Outcome
chemical_list: D007004:Hypoglycemic Agents; D007328:Insulin