Choice of insulins, pen devices and blood glucose meters: factors influencing decision making by DSNs in the UK

Abstract

AbstractChoices of insulin type and associated equipment largely result from discussions between patients and diabetes specialist nurses (DSNs), although we clearly do not fully understand the process leading to decision making. To establish a greater understanding of prescribing issues, we developed a UK questionnaire designed to identify factors influencing choice and the importance of the DSN's role. Furthermore, trends in responses according to experience of the DSN and geographical location of the practice were also examined. A Likert scale was employed where 1 = strongly disagree, 2 = disagree, 3 = agree and 4 = strongly agree.Insulin therapy was independently initiated by 96 per cent of DSNs. DSNs were likely to choose the insulin type (mean score 2.84) whereas patients were likely to choose pen devices (mean score 2.81). The DSN and patient were equally involved in choosing blood glucose meters (BGMs) (mean scores both 2.41). Key influential factors (mean score >3) when choosing insulin types were previous experience of the DSN and literature product availability. Influential factors when choosing pen devices (mean score >3) were accuracy, cartridge loading and reliability (pen features) and poor learning ability, poor memory and impaired sight (patient characteristics). Principle factors influencing choice of BGMs (mean score >3) were display size, accuracy and reliability (meter features) and impaired sight, poor dexterity and poor memory (patient characteristics).We conclude that both DSN and patient were integrally involved in decision making and there are heterogeneous complex factors influencing these choices. There were no trends in choice with regard to geographical location of the diabetes service or duration of DSN experience. Copyright © 2003 John Wiley & Sons, Ltd.