Abstract
AimsLittle 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.MethodsA 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.ResultOnly 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.ConclusionsDespite large regional variation, there is widespread delay of insulin initiation from specialist diabetes healthcare professionals in Central and South-Eastern Europe.
Highlights
Type 2 diabetes (T2D) is one of the greatest global health emergencies of today with almost a half a billion people living with the disease [1]
A cross-sectional survey was performed between September 2017 to January 2018, on 233 actively prescribing specialist diabetes healthcare professionals residing across five Central and South-Eastern European countries (Bulgaria, Croatia, Greece, Hungary, and Slovenia)
Almost half of the healthcare professionals (47.4%) would initiate insulin therapy at an HbA1c threshold of ≥ 9.0% (≥ 75 mmol/ mol), and 8.0% would not initiate insulin until a threshold of ≥ 10.0% (≥ 86 mmol/mol) was reached (Table 1)
Summary
Type 2 diabetes (T2D) is one of the greatest global health emergencies of today with almost a half a billion people living with the disease [1]. It is understood that insulin initiation is often inappropriately delayed [5], resulting in an unnecessary increased risk of complications and needlessly reduced life expectancy and quality of life [6] This has been termed ‘clinical inertia,’ and can be due to a number of factors including clinical concerns (i.e. risk of weight gain, hypoglycaemia, or patient distress), professional concerns (e.g. lack of clinical experience, skills, or confidence in insulin titration), or health system concerns (competing priorities, regulatory or financial constraints, or a lack of impartial continued medical education [CME]) [7,8,9,10,11,12,13]. We aimed to comprehensively characterise the prescribing practices of specialist diabetes healthcare professionals across Central and South-Eastern European countries and assess the factors that influence their clinical decision-making regarding insulin initiation in T2D
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