An exploration of barriers to insulin initiation for physicians in Japan: findings from the Diabetes Attitudes, Wishes And Needs (DAWN) JAPAN study.
OBJECTIVE
Insulin is recommended as an appropriate treatment in type 2 diabetes patients with suboptimal glycemic control; however, its initiation is often delayed. We therefore conducted the DAWN (Diabetes Attitudes, Wishes and Needs) JAPAN study in an attempt to identify specific patient- and physician-related factors which contribute to delay of insulin initiation among Japanese patients with diabetes. In this report, we explored barriers for physicians which prevent timely insulin initiation.


METHODS
The DAWN JAPAN study is a multicenter, questionnaire-based survey, conducted between 2004 and 2005. Participating physicians were categorized as follows based on their expertise: Japan Diabetes Society (JDS) certified specialists (n = 77), JDS-affiliated physicians (n = 30), and non-JDS-affiliated physicians (n = 27). To assess physician barriers to insulin initiation, we have used a newly developed 27- item questionnaire.


RESULTS
The mean age of patients (n = 11,656) treated by participating physicians was 64.1 years. The mean duration of diabetes was 121.6 months, and their mean HbA1c was 7.5%. Insulin was used in 27.4% of total patients. With regard to physician barriers to insulin initiation, the biggest differences in concerns expressed by JDS-certified specialists and non-JDS-affiliated physicians were observed in the following items with statistical significance: "I do not have staff (nurse, pharmacists) who can assist with explanations" (1.3% vs 55.5%, respectively), "I have concerns about the use of insulin therapy in elderly patients" (38.1% vs 81.5%), and "It is difficult to provide guidance and education on insulin injection to patients" (16.9% vs 55.5%). The mean HbA1c at which physicians responded they would recommend insulin to their patients was 8.7%; however, they would reduce this level to 8.2% if they themselves required insulin.


CONCLUSIONS
Our results demonstrated that physicians have concerns about insulin use, and suggested that their concerns can lead to delay of insulin initiation.
Department of Endocrinology, Tenri Hospital, Tenri, Nara, Japan. hit@tenriyorozu.jp
Hitoshi
H
Ishii
Yasuhiko
Y
Iwamoto
Naoko
N
Tajima
D000328:Adult; D001291:Attitude of Health Personnel; D001294:Attitude to Health; D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy*; D005260:Female; D006442:Glycated Hemoglobin / Q000032:analysis; D006301:Health Services Needs and Demand; D006801:Humans; D007328:Insulin / Q000008:administration & dosage* / Q000627:therapeutic use; D007564:Japan; D008297:Male; D008875:Middle Aged; D010820:Physicians / Q000523:psychology*; D011795:Surveys and Questionnaires
D006442:Glycated Hemoglobin; D007328:Insulin