PMID- 28864058
OWN - NLM
STAT- MEDLINE
DCOM- 20180912
LR  - 20221207
IS  - 1878-0334 (Electronic)
IS  - 1871-4021 (Linking)
VI  - 12
IP  - 1
DP  - 2018 Jan-Mar
TI  - Barriers to insulin initiation in elderly patients with type 2 diabetes mellitus 
      in Brazil.
PG  - 39-44
LID - S1871-4021(17)30281-3 [pii]
LID - 10.1016/j.dsx.2017.08.011 [doi]
AB  - AIMS: We aimed to explore insulin initiation barriers in the Brazilian Type 2 
      Diabetes Mellitus (T2DM) elderly population, according to the physician's 
      perspective, and suggest strategies to overcome them. METHODS: A 45-questions 
      survey addressing issues as clinical characteristics, barriers to insulinization, 
      and treatment strategies in elderly patients with T2DM, was sent to six 
      endocrinologists from different Brazilian locations. Thereafter, all the 
      respondents participated in a panel discussion to validate their responses and 
      collect additional relevant data. RESULTS: Endocrinologists had at least 15 years 
      of experience, with a mean of 63 elderly patients per month. Nearly 25% of the 
      elderly patients were treated in the Brazilian public healthcare system (SUS, 
      Unified Health System); only a quarter presented proper glycemic control. In 
      contrast, 55% of the patients from private healthcare system presented adequate 
      glycemic control. The main barriers for insulin initiation for patients, 
      according to physicians' perspective, are side effects and negative perception 
      over treatment (100%). For endocrinologists, main barriers were lack of time to 
      guide patients and concern over side effects (83%). Therefore, specialists 
      considered education for both healthcare professionals and patients as one of the 
      most important strategies to circumvent the current scenario related insulin 
      therapy among elderly patients in the country. CONCLUSION: Insulin therapy 
      remains underused due to several barriers, such as concern over side effects and 
      negative perception. Educational measures for patients and HCPs could improve the 
      current scenario.
CI  - Copyright (c) 2017 Diabetes India. Published by Elsevier Ltd. All rights reserved.
FAU - Eliaschewitz, Freddy G
AU  - Eliaschewitz FG
AD  - Centro de Pesquisas Clinicas, Rua Goias, 193, Sao Paulo, Sao Paulo, 01244-030, 
      Brazil. Electronic address: freddy.g@uol.com.br.
FAU - de Paula, Mauricio A
AU  - de Paula MA
AD  - Medical Manager at Sanofi, Avenida Major Sylvio de Magalhaes Padilha, 5200, Sao 
      Paulo, Sao Paulo, 05693-000, Brazil. Electronic address: 
      Mauricio.Aguiar@sanofi.com.
FAU - Pedrosa, Hermelinda C
AU  - Pedrosa HC
AD  - Unidade de Endocrinologia-Polo de Pesquisa, Hospital Regional de Taguatinga, 
      Secretaria de Estado de Saude do Distrito Federal, St. C Norte Area Especial 24, 
      Taguatinga Norte, Brasilia, Distrito Federal, 72120-970, Brazil. Electronic 
      address: pedrosa.hc@globo.com.
FAU - Pires, Antonio Carlos
AU  - Pires AC
AD  - Faculdade de Medicina de Sao Jose do Rio Preto, Avenida Brigadeiro Faria Lima, 
      5416, Sao Jose do Rio Preto, Sao Paulo, 15090-000, Brazil. Electronic address: 
      fpires@terra.com.br.
FAU - Salles, Joao Eduardo N
AU  - Salles JEN
AD  - Faculdade de Ciencias Medicas da Santa Casa de Sao Paulo, Rua Doutor Cesario 
      Motta Junior, 61, Sao Paulo, Sao Paulo, 01221-020, Brazil. Electronic address: 
      jensalles@yahoo.com.br.
FAU - Tambascia, Marcos Antonio
AU  - Tambascia MA
AD  - Universidade Estadual de Campinas, Faculdade de Ciencias Medicas, Rua Tessalia 
      Vieira de Camargo, 126, Campinas, Sao Paulo, 13083-887, Brazil. Electronic 
      address: tambascia@terra.com.br.
FAU - A Turatti, Luiz Alberto
AU  - A Turatti LA
AD  - Sociedade Brasileira de Diabetes, Rua Afonso Braz, 579, Sao Paulo, Sao Paulo, 
      04511-011, Brazil. Electronic address: turatti@uol.com.br.
LA  - eng
PT  - Journal Article
DEP - 20170825
PL  - Netherlands
TA  - Diabetes Metab Syndr
JT  - Diabetes & metabolic syndrome
JID - 101462250
RN  - 0 (Biomarkers)
RN  - 0 (Blood Glucose)
RN  - 0 (Glycated Hemoglobin A)
RN  - 0 (Hypoglycemic Agents)
RN  - 0 (Insulin)
RN  - 0 (hemoglobin A1c protein, human)
SB  - IM
MH  - *Attitude of Health Personnel
MH  - Biomarkers/analysis
MH  - Blood Glucose/analysis
MH  - Diabetes Mellitus, Type 2/*drug therapy/psychology
MH  - Follow-Up Studies
MH  - Glycated Hemoglobin/analysis
MH  - *Health Knowledge, Attitudes, Practice
MH  - Health Personnel/psychology
MH  - Humans
MH  - Hypoglycemic Agents/*therapeutic use
MH  - Insulin/*therapeutic use
MH  - Middle Aged
MH  - Patient Acceptance of Health Care
MH  - Practice Patterns, Physicians'/standards
MH  - Prognosis
OTO - NOTNLM
OT  - Elderly
OT  - Insulin
OT  - Insulin barriers
OT  - Type 2 diabetes mellitus
EDAT- 2017/09/03 06:00
MHDA- 2018/09/13 06:00
CRDT- 2017/09/03 06:00
PHST- 2017/08/03 00:00 [received]
PHST- 2017/08/20 00:00 [accepted]
PHST- 2017/09/03 06:00 [pubmed]
PHST- 2018/09/13 06:00 [medline]
PHST- 2017/09/03 06:00 [entrez]
AID - S1871-4021(17)30281-3 [pii]
AID - 10.1016/j.dsx.2017.08.011 [doi]
PST - ppublish
SO  - Diabetes Metab Syndr. 2018 Jan-Mar;12(1):39-44. doi: 10.1016/j.dsx.2017.08.011. 
      Epub 2017 Aug 25.