High level of clinical inertia in insulin initiation in type 2 diabetes across Central and South-Eastern Europe: insights from SITIP study.

Authors:
Matthew D Campbell
Matthew D Campbell
University of New England
United States
Lea Smircic-Duvnjak
Lea Smircic-Duvnjak
University Clinic for Diabetes
Tsvetalina Tankova
Tsvetalina Tankova
Medical University
Poland
Asimina Mitrakou
Asimina Mitrakou
Democritus University of Thrace
Greece
Peter Kempler
Peter Kempler
Semmelweis University
Hungary
Andrej Janez
Andrej Janez
University Medical Centre Ljubljana
Ljubljana | Slovenia

Acta Diabetol 2019 Apr 16. Epub 2019 Apr 16.

Department of Endocrinology, Diabetes and Metabolic Diseases, University Medical Centre, Ljubljana, Slovenia.

Aims: Little is known regarding initiation of insulin therapy in type 2 diabetes (T2D) in Central and South-Eastern European countries. Therefore, we conducted a survey to characterise the prescribing practices of specialist diabetes healthcare professionals in this region and assessed factors that influence clinical decision-making regarding insulin initiation in T2D.

Methods: A cross-sectional survey sampled 211 specialist diabetes healthcare prescribers from five Central and South-Eastern European countries (Bulgaria, Croatia, Greece, Hungary, and Slovenia). A structured questionnaire was developed which surveyed current clinical practices and influencing factors, barriers to insulin initiation, and combination therapy prescribing preferences.

Result: Only 9.4% (20 of out of 211 respondents) of healthcare professionals would initiate insulin therapy in T2D patients at the recommended HbA1c threshold of 7-7.9% [53-63 mmol/mol]. Large regional differences were evident in insulin initiation thresholds (≥ 9.0% [≥ 75 mmol/mol]: Bulgaria 80.8% vs. Slovenia 13.3%). Psychological distress was recorded as the major barrier to insulin initiation. Health insurance regulations were ranked more important than personal clinical experience and clinical guidelines in clinical decision-making. Information from peers was more influential than manufacturer information, clinical experience, and continuous medical education, respectively, for insulin initiation.

Conclusions: Despite large regional variation, there is widespread delay of insulin initiation from specialist diabetes healthcare professionals in Central and South-Eastern Europe.

Download full-text PDF

Source
http://dx.doi.org/10.1007/s00592-019-01346-1DOI Listing
April 2019
1 Read

Publication Analysis

Top Keywords

insulin initiation
24
central south-eastern
16
diabetes healthcare
12
healthcare professionals
12
specialist diabetes
12
insulin
9
european countries
8
insulin therapy
8
clinical decision-making
8
clinical experience
8
south-eastern european
8
south-eastern europe
8
large regional
8
type diabetes
8
clinical
7
initiation
7
diabetes
5
peers influential
4
factors barriers
4
barriers insulin
4

References

(Supplied by CrossRef)
Article in Diabetes Res Clin Pract
K Ogurtsova et al.
Diabetes Res Clin Pract 2017
Article in Lancet Diabetes Endocrinol
S Zoungas et al.
Lancet Diabetes Endocrinol 2017
Article in N Engl J Med
RA Hayward et al.
N Engl J Med 2015
Article in Diabetes Care
SE Inzucchi et al.
Diabetes Care 2015
Article in Diabetes Obes Metab
K Khunti et al.
Diabetes Obes Metab 2018
Article in BMC Endocr Disord
G Goodall et al.
BMC Endocr Disord 2009
Article in Diabetes Care
WH Polonsky et al.
Diabetes Care 2005
Article in Aust Fam Physician
J Furler et al.
Aust Fam Physician 2011
Article in Int J Clin Pract
T Kunt et al.
Int J Clin Pract 2009
Article in J Diabetes Metab Disord
S Kalra et al.
J Diabetes Metab Disord 2015
Article in CMAJ
ANC Lau et al.
CMAJ 2012

Similar Publications