Journal article
Barriers and facilitators to the initiation of injectable therapies for type 2 diabetes mellitus: a mixed methods study
- Abstract:
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Introduction
Initiation of injectable therapies in type 2 diabetes (T2D) is often delayed, however the reasons why are not fully understood.Methods
A mixed methods study performed in sequential phases. Phase 1: focus groups with people with T2D (injectable naïve [n = 12] and experienced [n = 5]) and healthcare professionals (HCPs; nurses [n = 5] and general practitioners (GPs) [n = 7]) to understand their perceptions of factors affecting initiation of injectables. Phase 2: video-captured GP consultations (n = 18) with actor-portrayed patient scenarios requiring T2D treatment escalation to observe the initiation in the clinical setting. Phase 3: HCP surveys (n = 87) to explore external validity of the themes identified in a larger sample.Results
Focus groups identified patients’ barriers to initiation; fear, lack of knowledge and misconceptions about diabetes and treatment aims, concerns regarding lifestyle restrictions and social stigma, and feelings of failure. Facilitators included education, good communication, clinician support and competence. HCP barriers included concerns about weight gain and hypoglycaemia, and limited consultation time. In simulated consultations, GPs performed high-quality consultations and recognised the need for injectable initiation in 9/12 consultations where this was the expert recommended option but did not provide support for initiation themselves. Survey results demonstrated HCPs believe injectable initiation should be performed in primary care, although many practitioners reported inability to do so or difficulty in maintaining skills.Conclusion
People with T2D have varied concerns and educational needs regarding injectables. GPs recognise the need to initiate injectables but lack practical skills and time to address patient concerns and provide education. Primary care nurses also report difficulties in maintaining these skills. Primary care HCPs initiating injectables require additional training to provide practical demonstrations, patient education and how to identify and address concerns. These skills should be concentrated in the hands of a small number of primary care providers to ensure they can maintain their skills.
- Publication status:
- Published
- Peer review status:
- Peer reviewed
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(Preview, Supplementary materials, pdf, 3.8MB, Terms of use)
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(Preview, Version of record, pdf, 364.6KB, Terms of use)
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- Publisher copy:
- 10.1007/s13300-022-01306-z
Authors
- Publisher:
- Springer Nature
- Journal:
- Diabetes Therapy More from this journal
- Volume:
- 13
- Issue:
- 10
- Pages:
- 1789-1809
- Place of publication:
- United States
- Publication date:
- 2022-09-02
- Acceptance date:
- 2022-07-25
- DOI:
- EISSN:
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1869-6961
- ISSN:
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1869-6953
- Pmid:
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36050586
- Language:
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English
- Keywords:
- Pubs id:
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1277335
- Local pid:
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pubs:1277335
- Deposit date:
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2024-07-09
- ARK identifier:
Terms of use
- Copyright holder:
- de Lusignan et al
- Copyright date:
- 2022
- Rights statement:
- © 2022, The Author(s). This article is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License, which permits any non-commercial use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder.
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