PMID- 34712538
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20211030
IS  - 2168-8184 (Print)
IS  - 2168-8184 (Electronic)
IS  - 2168-8184 (Linking)
VI  - 13
IP  - 9
DP  - 2021 Sep
TI  - Barriers of Doctors and Patients in Starting Insulin for Type 2 Diabetes 
      Mellitus.
PG  - e18263
LID - 10.7759/cureus.18263 [doi]
LID - e18263
AB  - Background Management of patients with type 2 diabetes mellitus (T2DM) may 
      involve insulin therapy. However, this treatment may be avoided or delayed by 
      physicians or patients due to the presence of certain barriers. This study aimed 
      to evaluate the barriers to initiating insulin therapy for both physicians and 
      patients with T2DM.  Method This was a cross-sectional, questionnaire-based 
      study. Data related to the physicians' personal and professional experience were 
      collected, and 15 barriers to initiating insulin therapy were scored by each 
      physician on a four-point Likert scale. Also, the patients' general data were 
      collected, including previous insulin experience, discontinuation reason, and 
      willingness to start insulin therapy if indicated. Twenty-one other barriers were 
      examined with yes/no questions as well. Results For physicians, the 
      patient's treatment compliance, motive, dependence on others for insulin therapy, 
      hypoglycemia, socioeconomic status, occupation, and lack of follow-up were the 
      most highly ranked barriers to initiating insulin therapy. A history of insulin 
      use was reported in 42 (20.7%) patients, 31 of whom had decided to discontinue 
      insulin therapy themselves (73.8%). The three most common reasons for 
      discontinuing insulin therapy among patients were deterioration of T2DM and 
      causing complications, hypoglycemia, and needle injections. Based on the 
      findings, 99 (48.8%) patients were willing to start insulin therapy, if 
      indicated. The family history of insulin therapy was positively correlated with 
      the patient's willingness to start insulin. On the other hand, it was negatively 
      correlated with a low educational level and some barriers to insulin therapy, 
      such as fear of death, dependence on others, the difficulty of carrying insulin 
      while traveling, follow-up challenges, the difficulty of dosing accuracy, the 
      difficulty of keeping insulin, inconveniences in daily life, considering 
      insulin as the last resort, the deterioration of T2DM with insulin, and social 
      stigma. Conclusion The physicians believed that the barriers to initiating 
      insulin therapy were mainly related to the patient's attitudes and thoughts about 
      this therapy. While hypoglycemia and weight gain are well-known side effects of 
      insulin therapy, the most important patient-related barriers to insulin therapy 
      were related to its impact on the patient's social life and misperceptions about 
      the side effects of insulin.
CI  - Copyright (c) 2021, Alidrisi et al.
FAU - Alidrisi, Haider A
AU  - Alidrisi HA
AD  - Diabetes and Endocrinology, College of Medicine, University of Basrah, Basrah, 
      IRQ.
FAU - Bohan, Ali
AU  - Bohan A
AD  - Diabetes and Endocrinology, College of Medicine, University of Basrah, Basrah, 
      IRQ.
FAU - Mansour, Abbas A
AU  - Mansour AA
AD  - Diabetes and Endocrinology, College of Medicine, University of Basrah, Basrah, 
      IRQ.
LA  - eng
PT  - Journal Article
DEP - 20210925
PL  - United States
TA  - Cureus
JT  - Cureus
JID - 101596737
PMC - PMC8543092
OTO - NOTNLM
OT  - doctors' barriers
OT  - insulin
OT  - insulin injection
OT  - patients' barriers
OT  - type 2 diabetes mellitus (t2dm)
COIS- The authors have declared that no competing interests exist.
EDAT- 2021/10/30 06:00
MHDA- 2021/10/30 06:01
PMCR- 2021/09/25
CRDT- 2021/10/29 06:28
PHST- 2021/09/25 00:00 [accepted]
PHST- 2021/10/29 06:28 [entrez]
PHST- 2021/10/30 06:00 [pubmed]
PHST- 2021/10/30 06:01 [medline]
PHST- 2021/09/25 00:00 [pmc-release]
AID - 10.7759/cureus.18263 [doi]
PST - epublish
SO  - Cureus. 2021 Sep 25;13(9):e18263. doi: 10.7759/cureus.18263. eCollection 2021 
      Sep.