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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.

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Related in: MedlinePlus

Gap between considered and actual recommended level of HbA1c.HbA1c level at which insulin therapy would be recommended was compared to actual level at which insulin therapy was recommended (mean ± SD).
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pone-0036361-g002: Gap between considered and actual recommended level of HbA1c.HbA1c level at which insulin therapy would be recommended was compared to actual level at which insulin therapy was recommended (mean ± SD).

Mentions: In total, 134 physicians completed both Questionnaire A and Questionnaire B (Table 1). JDS-certified specialists treated more patients per month than the other physician groups. Only 3.7% of physicians had no experience providing insulin therapy. Staff who is capable of providing guidance on diabetes treatment (nurses, pharmacists, or other staff) is present in 76.1% of the participating institutions in total, but 70.4% of non-JDS-affiliated physicians had no access to this support. The mean HbA1c at which physicians responded they would recommend insulin to their patients was 8.7±0.7% although if they themselves required insulin, the physicians responded they would reduce this level to 8.2±0.7% (Figure 2).


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)

Gap between considered and actual recommended level of HbA1c.HbA1c level at which insulin therapy would be recommended was compared to actual level at which insulin therapy was recommended (mean ± SD).
© Copyright Policy
Related In: Results  -  Collection

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

pone-0036361-g002: Gap between considered and actual recommended level of HbA1c.HbA1c level at which insulin therapy would be recommended was compared to actual level at which insulin therapy was recommended (mean ± SD).
Mentions: In total, 134 physicians completed both Questionnaire A and Questionnaire B (Table 1). JDS-certified specialists treated more patients per month than the other physician groups. Only 3.7% of physicians had no experience providing insulin therapy. Staff who is capable of providing guidance on diabetes treatment (nurses, pharmacists, or other staff) is present in 76.1% of the participating institutions in total, but 70.4% of non-JDS-affiliated physicians had no access to this support. The mean HbA1c at which physicians responded they would recommend insulin to their patients was 8.7±0.7% although if they themselves required insulin, the physicians responded they would reduce this level to 8.2±0.7% (Figure 2).

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