title: Insulin therapy attitudes and beliefs of physicians in Middle Eastern Arab countries.
abstract: BACKGROUND
  Studies assessing attitudes and beliefs of physicians regarding insulin therapy in Arab countries are scant despite the high prevalence of type 2 diabetes mellitus (T2DM).
  
  
  OBJECTIVE
  This study examines family physicians' attitudes and beliefs towards insulin therapy in T2DM patients in the East Mediterranean Region of the World Organization of National Colleges, Academies and Academic Associations of General Practitioners/Family Physicians.
  
  
  METHODS
  This is a cross-sectional study conducted on 348 family physicians invited via email to fill an anonymous online questionnaire about their attitudes, beliefs and perceived barriers regarding insulin initiation in T2DM patients.
  
  
  RESULTS
  One hundred and twenty-two physicians completed the questionnaire. Of the 122 physicians, 73.6% preferred to delay insulin initiation until it is absolutely essential and 59.0% initiated it themselves. The majority agreed that T2DM patients benefit from insulin prior to the development of complications (85.7%) and that patient education is important (99.1%) and uncomplicated (74.7%). Sixty-three per cent expressed reluctance to start insulin mostly because of perceived patients' reluctance. Referral to endocrinologists to initiate insulin therapy was associated with inadequate experience and concern about risks, particularly in elderly patients (backward logistic regression, P < 0.05). Physicians' reluctance to initiate insulin therapy was associated with patients' perception of insulin initiation as a personal failure and threat to the quality of life (backward logistic regression, P < 0.05).
  
  
  CONCLUSIONS
  Although family physicians in the Arab world believe in the benefits of insulin therapy, many are reluctant to initiate it themselves. Further studies are needed per country, as well as multiple measures to minimize the physicians' barriers to insulin prescription.
authors.affiliation: Department of Family Medicine, American University of Beirut Medical Center (AUBMC), Beirut, Lebanon.
authors.forename: Najla A
authors.initials: NA
authors.lastname: Lakkis
authors.forename: Grace J
authors.initials: GJ
authors.lastname: Maalouf
authors.forename: Dina M
authors.initials: DM
authors.lastname: Mahmassani
authors.forename: Ghassan N
authors.initials: GN
authors.lastname: Hamadeh
mesh_terms: D000328:Adult; D000368:Aged; D001291:Attitude of Health Personnel; D003430:Cross-Sectional Studies; D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy*; D005194:Family Practice; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007328:Insulin / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D008877:Middle East; D010342:Patient Acceptance of Health Care; D010353:Patient Education as Topic; D010818:Practice Patterns, Physicians'; D012017:Referral and Consultation; D011795:Surveys and Questionnaires
chemical_list: D007328:Insulin
keywords: Attitude; behaviour; belief; clinical inertia; diabetes mellitus; insulin barriers; perception; psychological insulin resistance.