High level of clinical inertia in insulin initiation in type 2 diabetes across Central and South-Eastern Europe: insights from SITIP study

Campbell, Matthew, Babic, Drazen, Bolcina, Uros, Smirčić-Duvnjak, Lea, Tankova, Tsvetalina, Mitrakou, Asimina, Kempler, Peter and Janez, Andrej (2019) High level of clinical inertia in insulin initiation in type 2 diabetes across Central and South-Eastern Europe: insights from SITIP study. Acta Diabetologica, 56 (9). pp. 1045-1049. ISSN 0940-5429

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Abstract

Aims
Little 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.

Methods
A 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.

Result
Only 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.

Conclusions
Despite large regional variation, there is widespread delay of insulin initiation from specialist diabetes healthcare professionals in Central and South-Eastern Europe.

Item Type: Article
Divisions: Faculty of Health Sciences and Wellbeing > School of Nursing and Health Sciences
Depositing User: Leah Maughan
Date Deposited: 28 Jan 2021 10:53
Last Modified: 28 Jan 2021 10:53
URI: http://sure.sunderland.ac.uk/id/eprint/13013
ORCID for Matthew Campbell: ORCID iD orcid.org/0000-0001-5883-5041

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