Attitudes towards insulin initiation in type 2 diabetes patients among healthcare providers: A survey research.
OBJECTIVE
To describe the views of healthcare providers about starting insulin in patients with type 2 diabetes and to determine the specific factors that contribute to delay insulin initiation.


METHODS
Two-phases observational descriptive study. In the quantitative phase we conducted a cross-sectional survey of a sample of 380 healthcare professionals (general practitioners (GPs), endocrinologists, internists and nurses). In the qualitative phase, a discussion group reviewed the results of the survey to propose solutions.


RESULTS
In poorly controlled patients, 46% of GPs vs. 43.2% of internists and 31.3% of endocrinologists waited 3-6months before starting insulin, and 71.4% of GPs vs. 66.7% of internists vs. 58.8% of endocrinologists need to confirm twice the HbA1c levels. The upper level of basal glucose more frequently considered as good control is 130mg/dL for GPs (35.7%), and 120mg/dL for internists (35.8%) and endocrinologists (37.5%). In patients without comorbidities, 32.5% of endocrinologists vs. 27.2% of internists vs. 17.9% of GPs initiated insulin when HbA1c was >7% while 26.3% of endocrinologists vs. 28.4% of internists vs. 38.4% of GPs initiated insulin when HbA1c was >8%. The interference of the therapy with the patient' social life and the need for time management were the most accepted barriers to initiate insulin.


CONCLUSIONS
There are significant differences between GPs and endocrinologists regarding the insulin initiation and GPs and internists felt less empowered to manage patients with diabetes. Specific training for professionals and joint work with patients could improve the glycemic control.
Clínica Universidad de Navarra, Pamplona, Spain. Electronic address: fescalada@unav.es.
Javier
J
Escalada
University Miguel Hernandez, San Juan de Alicante, Spain. Electronic address: dorozcobeltran@gmail.com.
Domingo
D
Orozco-Beltran
Peset University Hospital, University of Valencia, Valencia, Spain. Electronic address: cmorillas@telefonica.net.
Carlos
C
Morillas
La Calzada Primary Health Care Centre, Gijón, Spain. Electronic address: f.a.guisasola@gmail.com.
Fernando
F
Alvarez-Guisasola
Segovia General Hospital, Segovia, Spain. Electronic address: fgomezperalta@gmail.com.
Fernando
F
Gomez-Peralta
Primary Health Care Centre La Mina - Institut Català de la Salut, Sant Adrià de Besòs, Barcelona, Spain; Institut Universitari d'Investigació en Atenció Primària Jordi Gol, Barcelona, Spain. Electronic address: manelmatacases@gmail.com.
Manel
M
Mata-Cases
'Reina Sofía' University Hospital, Cordoba, Spain. Electronic address: rafapalomares@clinicasierrabella.es.
Rafael
R
Palomares
Primary Care Health Centre Pedro Laín Entralgo, Alcorcon, Madrid, Spain. Electronic address: chiglesiasgonzalez@gmail.com.
Rosario
R
Iglesias
University Miguel Hernandez, San Juan de Alicante, Spain. Electronic address: ccarratalm@gmail.com.
Concepción
C
Carratalá-Munuera
D000328:Adult; D001291:Attitude of Health Personnel; D001786:Blood Glucose / Q000187:drug effects; D003430:Cross-Sectional Studies; D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy*; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006282:Health Personnel; D006801:Humans; D007328:Insulin / Q000008:administration & dosage*; D008297:Male; D008875:Middle Aged; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D013030:Spain; D011795:Surveys and Questionnaires; D013997:Time Factors
D001786:Blood Glucose; D007328:Insulin
Diabetes mellitus; Disease management; General practice; Insulin; Time-to-treatments; Type 2