Open AccessBarriers and facilitators to starting insulin in patients with type 2 diabetes: a systematic review
Author(s) -
Ng C. J.,
Lai P. S. M.,
Lee Y. K.,
Azmi S. A.,
Teo C. H.
Publication year - 2015
Publication title -
international journal of clinical practice
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.756
H-Index - 98
eISSN - 1742-1241
pISSN - 1368-5031
DOI - 10.1111/ijcp.12691
Subject(s) - medicine , cinahl , insulin , type 2 diabetes , psychological intervention , type 1 diabetes , medline , systematic review , diabetes mellitus , family medicine , nursing , endocrinology , political science , law
Summary Aim To identify the barriers and facilitators to start insulin in patients with type 2 diabetes. Method This was a systematic review. We conducted a systematic search using PubMed, EMBASE , CINAHL and Web of Science (up to 5 June 2014) for original English articles using the terms ‘type 2 diabetes’, ‘insulin’, and free texts: ‘barrier’ or ‘facilitate’ and ‘initiate’. Two pairs of reviewers independently assessed and extracted the data. Study quality was assessed with Qualsyst. Results A total of 9740 references were identified: 41 full‐text articles were assessed for eligibility. Twenty‐five articles (15 qualitative, 10 quantitative) were included in the review. Good inter‐rater reliability was observed for the Qualsyst score (weighted kappa 0.7). Three main themes identified were as follows: patient‐related, healthcare professional and system factors. The main patient‐related barriers were fear of pain and injection ( n = 18), concerns about side effects of insulin ( n = 12), perception that insulin indicated end stage of diabetes ( n = 11), inconvenience ( n = 10), difficulty in insulin administration ( n = 7), punishment ( n = 7) and stigma and discrimination ( n = 7). Healthcare professionals’ barriers were as follows: poor knowledge and skills ( n = 9), physician inertia ( n = 5) and language barriers ( n = 4). System barriers included lack of time ( n = 5). The most common facilitators were understanding the benefits of insulin ( n = 7), not being afraid of injections ( n = 5), and patient education and information ( n = 5). Conclusion Major barriers to insulin initiation persist despite availability of newer and safer insulin. Healthcare professionals should explore and address these barriers. Targeted interventions should be developed to overcome these barriers.