Limits...
An exploration of barriers to insulin initiation for physicians in Japan: findings from the Diabetes Attitudes, Wishes And Needs (DAWN) JAPAN study.

Ishii H, Iwamoto Y, Tajima N - PLoS ONE (2012)

Bottom Line: With regard to physician barriers to insulin initiation, the biggest differences in concerns expressed by JDS-certified specialists and non-JDS-affiliated physicians were observed in the following items with statistical significance: "I do not have staff (nurse, pharmacists) who can assist with explanations" (1.3% vs 55.5%, respectively), "I have concerns about the use of insulin therapy in elderly patients" (38.1% vs 81.5%), and "It is difficult to provide guidance and education on insulin injection to patients" (16.9% vs 55.5%).The mean HbA1c at which physicians responded they would recommend insulin to their patients was 8.7%; however, they would reduce this level to 8.2% if they themselves required insulin.Our results demonstrated that physicians have concerns about insulin use, and suggested that their concerns can lead to delay of insulin initiation.

View Article: PubMed Central - PubMed

Affiliation: Department of Endocrinology, Tenri Hospital, Tenri, Nara, Japan. hit@tenriyorozu.jp

ABSTRACT

Objective: Insulin is recommended as an appropriate treatment in type 2 diabetes patients with suboptimal glycemic control; however, its initiation is often delayed. We therefore conducted the DAWN (Diabetes Attitudes, Wishes and Needs) JAPAN study in an attempt to identify specific patient- and physician-related factors which contribute to delay of insulin initiation among Japanese patients with diabetes. In this report, we explored barriers for physicians which prevent timely insulin initiation.

Methods: The DAWN JAPAN study is a multicenter, questionnaire-based survey, conducted between 2004 and 2005. Participating physicians were categorized as follows based on their expertise: Japan Diabetes Society (JDS) certified specialists (n = 77), JDS-affiliated physicians (n = 30), and non-JDS-affiliated physicians (n = 27). To assess physician barriers to insulin initiation, we have used a newly developed 27- item questionnaire.

Results: The mean age of patients (n = 11,656) treated by participating physicians was 64.1 years. The mean duration of diabetes was 121.6 months, and their mean HbA1c was 7.5%. Insulin was used in 27.4% of total patients. With regard to physician barriers to insulin initiation, the biggest differences in concerns expressed by JDS-certified specialists and non-JDS-affiliated physicians were observed in the following items with statistical significance: "I do not have staff (nurse, pharmacists) who can assist with explanations" (1.3% vs 55.5%, respectively), "I have concerns about the use of insulin therapy in elderly patients" (38.1% vs 81.5%), and "It is difficult to provide guidance and education on insulin injection to patients" (16.9% vs 55.5%). The mean HbA1c at which physicians responded they would recommend insulin to their patients was 8.7%; however, they would reduce this level to 8.2% if they themselves required insulin.

Conclusions: Our results demonstrated that physicians have concerns about insulin use, and suggested that their concerns can lead to delay of insulin initiation.

Show MeSH

Related in: MedlinePlus

The survey process of DAWN JAPAN study.
© Copyright Policy
Related In: Results  -  Collection


getmorefigures.php?uid=PMC3375282&req=5

pone-0036361-g001: The survey process of DAWN JAPAN study.

Mentions: The survey process of the DAWN JAPAN study is shown in Figure 1. Participating physicians first completed Questionnaire A, assessing their attitudes towards insulin as a treatment for T2D. The same physicians then completed Questionnaire B to obtain treatment status of the patients with T2D they treated during a 1-month period, up to a maximum of 100 patients. Of the patients whose treatment status was collected in Questionnaire B, those who were recommended to start insulin in the participating sites were asked to complete Questionnaire C, which examined their perceptions of insulin treatment. Of these patients, those who subsequently chose to start insulin treatment answered Questionnaire D a month after the start of insulin treatment to examine whether their attitudes toward to insulin would change after insulin had been initiated. Also, those who chose not to start insulin filled out Questionnaire E, 4 months after the end of Questionnaire B completion period to examine a change of their attitudes toward insulin treatment. The attending physicians filled out Question D1 or E1 to assess treatment status of their patients who completed either Questionnaire D or E a month after the completion of each questionnaire.


An exploration of barriers to insulin initiation for physicians in Japan: findings from the Diabetes Attitudes, Wishes And Needs (DAWN) JAPAN study.

Ishii H, Iwamoto Y, Tajima N - PLoS ONE (2012)

The survey process of DAWN JAPAN study.
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC3375282&req=5

pone-0036361-g001: The survey process of DAWN JAPAN study.
Mentions: The survey process of the DAWN JAPAN study is shown in Figure 1. Participating physicians first completed Questionnaire A, assessing their attitudes towards insulin as a treatment for T2D. The same physicians then completed Questionnaire B to obtain treatment status of the patients with T2D they treated during a 1-month period, up to a maximum of 100 patients. Of the patients whose treatment status was collected in Questionnaire B, those who were recommended to start insulin in the participating sites were asked to complete Questionnaire C, which examined their perceptions of insulin treatment. Of these patients, those who subsequently chose to start insulin treatment answered Questionnaire D a month after the start of insulin treatment to examine whether their attitudes toward to insulin would change after insulin had been initiated. Also, those who chose not to start insulin filled out Questionnaire E, 4 months after the end of Questionnaire B completion period to examine a change of their attitudes toward insulin treatment. The attending physicians filled out Question D1 or E1 to assess treatment status of their patients who completed either Questionnaire D or E a month after the completion of each questionnaire.

Bottom Line: With regard to physician barriers to insulin initiation, the biggest differences in concerns expressed by JDS-certified specialists and non-JDS-affiliated physicians were observed in the following items with statistical significance: "I do not have staff (nurse, pharmacists) who can assist with explanations" (1.3% vs 55.5%, respectively), "I have concerns about the use of insulin therapy in elderly patients" (38.1% vs 81.5%), and "It is difficult to provide guidance and education on insulin injection to patients" (16.9% vs 55.5%).The mean HbA1c at which physicians responded they would recommend insulin to their patients was 8.7%; however, they would reduce this level to 8.2% if they themselves required insulin.Our results demonstrated that physicians have concerns about insulin use, and suggested that their concerns can lead to delay of insulin initiation.

View Article: PubMed Central - PubMed

Affiliation: Department of Endocrinology, Tenri Hospital, Tenri, Nara, Japan. hit@tenriyorozu.jp

ABSTRACT

Objective: Insulin is recommended as an appropriate treatment in type 2 diabetes patients with suboptimal glycemic control; however, its initiation is often delayed. We therefore conducted the DAWN (Diabetes Attitudes, Wishes and Needs) JAPAN study in an attempt to identify specific patient- and physician-related factors which contribute to delay of insulin initiation among Japanese patients with diabetes. In this report, we explored barriers for physicians which prevent timely insulin initiation.

Methods: The DAWN JAPAN study is a multicenter, questionnaire-based survey, conducted between 2004 and 2005. Participating physicians were categorized as follows based on their expertise: Japan Diabetes Society (JDS) certified specialists (n = 77), JDS-affiliated physicians (n = 30), and non-JDS-affiliated physicians (n = 27). To assess physician barriers to insulin initiation, we have used a newly developed 27- item questionnaire.

Results: The mean age of patients (n = 11,656) treated by participating physicians was 64.1 years. The mean duration of diabetes was 121.6 months, and their mean HbA1c was 7.5%. Insulin was used in 27.4% of total patients. With regard to physician barriers to insulin initiation, the biggest differences in concerns expressed by JDS-certified specialists and non-JDS-affiliated physicians were observed in the following items with statistical significance: "I do not have staff (nurse, pharmacists) who can assist with explanations" (1.3% vs 55.5%, respectively), "I have concerns about the use of insulin therapy in elderly patients" (38.1% vs 81.5%), and "It is difficult to provide guidance and education on insulin injection to patients" (16.9% vs 55.5%). The mean HbA1c at which physicians responded they would recommend insulin to their patients was 8.7%; however, they would reduce this level to 8.2% if they themselves required insulin.

Conclusions: Our results demonstrated that physicians have concerns about insulin use, and suggested that their concerns can lead to delay of insulin initiation.

Show MeSH
Related in: MedlinePlus