Barriers and facilitators to starting insulin in patients with type 2 diabetes: a systematic review.
Int J Clin Pract
; 69(10): 1050-70, 2015 Oct.
Article
in En
| MEDLINE
| ID: mdl-26147376
ABSTRACT
AIM:
To identify the barriers and facilitators to start insulin in patients with type 2 diabetes.METHOD:
This was a systematic review. We conducted a systematic search using PubMed, EMBASE, CINAHL and Web of Science (up to 5 June 2014) for original English articles using the terms 'type 2 diabetes', 'insulin', and free texts 'barrier' or 'facilitate' and 'initiate'. Two pairs of reviewers independently assessed and extracted the data. Study quality was assessed with Qualsyst.RESULTS:
A total of 9740 references were identified 41 full-text articles were assessed for eligibility. Twenty-five articles (15 qualitative, 10 quantitative) were included in the review. Good inter-rater reliability was observed for the Qualsyst score (weighted kappa 0.7). Three main themes identified were as follows patient-related, healthcare professional and system factors. The main patient-related barriers were fear of pain and injection (n = 18), concerns about side effects of insulin (n = 12), perception that insulin indicated end stage of diabetes (n = 11), inconvenience (n = 10), difficulty in insulin administration (n = 7), punishment (n = 7) and stigma and discrimination (n = 7). Healthcare professionals' barriers were as follows poor knowledge and skills (n = 9), physician inertia (n = 5) and language barriers (n = 4). System barriers included lack of time (n = 5). The most common facilitators were understanding the benefits of insulin (n = 7), not being afraid of injections (n = 5), and patient education and information (n = 5).CONCLUSION:
Major barriers to insulin initiation persist despite availability of newer and safer insulin. Healthcare professionals should explore and address these barriers. Targeted interventions should be developed to overcome these barriers.
Full text:
1
Collection:
01-internacional
Database:
MEDLINE
Main subject:
Patient Compliance
/
Decision Making
/
Diabetes Mellitus, Type 2
/
Time-to-Treatment
/
Insulin
Type of study:
Prognostic_studies
/
Qualitative_research
/
Systematic_reviews
Limits:
Humans
Language:
En
Journal:
Int J Clin Pract
Journal subject:
MEDICINA
Year:
2015
Document type:
Article
Affiliation country: