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Friday, 10 May 2013

PCP Perceptions Influence Insulin Therapy !

PHOENIX -- Two-thirds of primary care physicians surveyed at one hospital said they delayed initiation of insulin therapy for type 2 diabetes because of concerns that their patients would find it too much of a burden, researchers reported here.
In a survey of 71 primary care physicians at York Hospital in York, Pa., 66% of doctors said they thought that putting a patient on insulin would be too burdensome, although 97% said that their patients would be willing to start insulin if it didn't involve needles, Yiyi Yan, MD, PhD, and colleagues reported at the annual meeting of the American Association of Clinical Endocrinologists.
Also, 69% said patients would perceive going on insulin as a failure to manage their disease, Yan said.
"We know that education helps patients in their use of insulin, but our study indicates that there needs to be more education of primary care physicians on type 2 diabetes management and insulin usage as well," Yan told MedPage Today.
"We think concern about how they think their patients will react is the biggest barrier to initiating insulin," she said.
Yan and colleagues conducted the in-house survey to determine their attitudes towards patient-related, insulin-related, resource-related, and physician-related questions involving insulin use.
They identified 1,226 patients, 273 of whom had a glycated hemoglobin (HbA1c) greater than 8.5%. Among these 273 patients, 119 were not on insulin.
The survey response rate from the 71 physicians was 45%.
A large majority of the responders (88%) agreed that "insulin therapy has a better effect on glycemic control than oral diabetes drugs." Three-fourths agreed that early initiation of insulin could prevent diabetes-related complications.
While 88% said they were comfortable initiating insulin therapy among their patients, 53% reported that the different types of insulin products created confusion in prescribing. Nearly 60% said they thought that insulin regimens were too complicated for most of their patients to understand.
Even so, only 6% of the primary care physicians agreed that insulin therapy should be managed solely by endocrinologists.
In other findings, 16% deemed insulin therapy too expensive while 38% said it was too time-consuming.
Overall, experienced primary care physicians were more aware of guidelines and were more comfortable with insulin initiation, the authors found.
"Those who were less comfortable with insulin therapy believed that education was needed, and many of them disagreed with the necessity of maintaining tight glycemic control," the authors explained.
"Our study suggests that education is the key to improving glycemic control and insulin usage among patients managed by their primary care physicians," they concluded.
In commenting on the study for MedPage Today, Jonathan Insel, MD, of Arizona Community Physicians in Tucson pointed out that "endocrinologists can get through that barrier of initiating insulin fairly readily, but the primary care doctors are a little gun shy because they worry about the risks of hypoglycemia and the injections and they don't want to take the time to teach the patients."
But some of those barriers may be addressed by the introduction of the new insulin pens and the smaller needles that are almost painless, he said.


Suzie_B said...

"They identified 1,226 patients, 273 of whom had a glycated hemoglobin (HbA1c) greater than 8.5%. Among these 273 patients, 119 were not on insulin."

Doesn't this also say that 154 of the 273 patients were on insulin and still had such poor control? Too bad medical doctors don't take diet more seriously - less medicine, less hypos to worry about amongst many other benefits.

Lowcarb team member said...

Hi Suzie,

Yes I suspect poor dietary advice (ADA) and lack of education is why they had A1c's >8.5% in the first place, I also wonder how many of those below 8.5% were at recommended A1c target level <6.5%!