PMID- 25340869 OWN - NLM STAT- MEDLINE DCOM- 20150618 LR - 20220317 IS - 1438-8871 (Electronic) IS - 1439-4456 (Print) IS - 1438-8871 (Linking) VI - 16 IP - 10 DP - 2014 Oct 23 TI - Diabetes patients' experiences with the implementation of insulin therapy and their perceptions of computer-assisted self-management systems for insulin therapy. PG - e235 LID - 10.2196/jmir.3198 [doi] LID - e235 AB - BACKGROUND: Computer-assisted decision support is an emerging modality to assist patients with type 2 diabetes mellitus (T2DM) in insulin self-titration (ie, self-adjusting insulin dose according to daily blood glucose levels). Computer-assisted insulin self-titration systems mainly focus on helping patients overcome barriers related to the cognitive components of insulin titration. Yet other (eg, psychological or physical) barriers could still impede effective use of such systems. OBJECTIVE: Our primary aim was to identify experiences with and barriers to self-monitoring of blood glucose, insulin injection, and insulin titration among patients with T2DM. Our research team developed a computer-assisted insulin self-titration system, called PANDIT. The secondary aim of this study was to evaluate patients' perceptions of computer-assisted insulin self-titration. We included patients who used PANDIT in a 4-week pilot study as well as patients who had never used such a system. METHODS: In-depth, semi-structured interviews were conducted individually with patients on insulin therapy who were randomly recruited from a university hospital and surrounding general practices in the Netherlands. The interviews were transcribed verbatim and analyzed qualitatively. To classify the textual remarks, we created a codebook during the analysis, in a bottom-up and iterative fashion. To support examination of the final coded data, we used three theories from the field of health psychology and the integrated model of user satisfaction and technology acceptance by Wixom and Todd. RESULTS: When starting insulin therapy, some patients feared a lifelong commitment to insulin therapy and disease progression. Also, many barriers arose when implementing insulin therapy (eg, some patients were embarrassed to inject insulin in public). Furthermore, patients had difficulties increasing the insulin dose because they fear hypoglycemia, they associate higher insulin doses with disease progression, and some were ignorant of treatment targets. Patients who never used a computer-assisted insulin self-titration system felt they had enough knowledge to know when their insulin should be adjusted, but still believed that the system advice would be useful to confirm their reasoning. Furthermore, the time and effort saved with automated insulin advice was considered an advantage. Patients who had used PANDIT found the system useful if their glycemic regulation improved. Nevertheless, for some patients, the absence of personal contact with their caregiver was a drawback. While guidelines state that adjustment of basal insulin dose based on fasting plasma glucose values is sufficient, both patients who had and those who had not used PANDIT felt that such a system should take more patient data into consideration, such as lifestyle and diet factors. CONCLUSIONS: Patients encounter multiple obstacles when implementing insulin therapy. Computer-assisted insulin self-titration can increase patient awareness of treatment targets and increase their confidence in self-adjusting the insulin dose. Nevertheless, some barriers may still exist when using computer-assisted titration systems and these systems could also introduce new barriers. FAU - Simon, Airin Cr AU - Simon AC AUID- ORCID: 0000-0002-4950-3712 AD - University of Amsterdam/Academic Medical Center, Internal Medicine/Medical Informatics, Amsterdam, Netherlands. a.c.simon@amc.uva.nl. FAU - Gude, Wouter T AU - Gude WT AUID- ORCID: 0000-0001-7941-5281 FAU - Holleman, Frits AU - Holleman F AUID- ORCID: 0000-0001-5858-5089 FAU - Hoekstra, Joost Bl AU - Hoekstra JB AUID- ORCID: 0000-0002-2473-5963 FAU - Peek, Niels AU - Peek N AUID- ORCID: 0000-0002-6393-9969 LA - eng GR - MR/K006665/1/MRC_/Medical Research Council/United Kingdom PT - Journal Article PT - Research Support, Non-U.S. Gov't DEP - 20141023 PL - Canada TA - J Med Internet Res JT - Journal of medical Internet research JID - 100959882 RN - 0 (Blood Glucose) RN - 0 (Hypoglycemic Agents) RN - 0 (Insulin) SB - IM MH - Blood Glucose/*metabolism MH - Diabetes Mellitus, Type 2/blood/*drug therapy/*psychology MH - Female MH - Humans MH - Hypoglycemic Agents/*administration & dosage MH - Insulin/*administration & dosage MH - Male MH - Middle Aged MH - Pilot Projects MH - Self Care/*psychology MH - Therapy, Computer-Assisted/*methods PMC - PMC4259961 OTO - NOTNLM OT - Type 2 diabetes mellitus OT - clinical decision support systems OT - patient acceptance of health care COIS- Conflicts of Interest: None declared. EDAT- 2014/10/24 06:00 MHDA- 2015/06/19 06:00 PMCR- 2014/10/23 CRDT- 2014/10/24 06:00 PHST- 2013/12/24 00:00 [received] PHST- 2014/07/10 00:00 [accepted] PHST- 2014/06/24 00:00 [revised] PHST- 2014/10/24 06:00 [entrez] PHST- 2014/10/24 06:00 [pubmed] PHST- 2015/06/19 06:00 [medline] PHST- 2014/10/23 00:00 [pmc-release] AID - v16i10e235 [pii] AID - 10.2196/jmir.3198 [doi] PST - epublish SO - J Med Internet Res. 2014 Oct 23;16(10):e235. doi: 10.2196/jmir.3198.