Getting under the skin of clinical inertia in insulin initiation

The translating research into action for diabetes (TRIAD) insulin starts project

Neda Ratanawongsa, Jesse C. Crosson, Dean Schillinger, Andrew J. Karter, Chandan Saha, David Marrero

Research output: Contribution to journalArticle

39 Citations (Scopus)

Abstract

Purpose The purpose of this cross-sectional study is to explore primary care providers' (PCPs) perceptions about barriers to initiating insulin among patients. Studies suggest that many patients with poorly controlled type 2 diabetes do not receive insulin initiation by PCPs. Methods As part of the Translating Research Into Action for Diabetes study, the authors conducted structured interviews in health systems in Indiana, New Jersey, and California, asking PCPs about the importance of insulin initiation and factors affecting this decision. The authors calculated proportions choosing each multiple-choice response option and listed the most frequently offered open-ended response categories. Results Among 83 PCPs, 45% were women; 60% were white; and they averaged 13.4 years in practice. Four-fifths of PCPs endorsed guideline-concordant glycemic targets, but 54% individualized targets based on patient age, life expectancy, medical comorbidities, self-management capacity, and willingness. Most (64%) reported that many patients were resistant to new oral or insulin therapies due to fears about the therapy and what it meant about their disease progression. Two-thirds (64%) cited patient resistance as a barrier to insulin initiation, and 43% cited problems with patient self-management, including cognitive or mental health issues, dexterity, or ability to adhere. Eighty percent felt that patient nonadherence would dissuade them from initiating insulin at least some of the time. Conclusions PCPs perceived that patient resistance and poor self-management skills were significant barriers to initiating insulin. Future studies should investigate whether systems-level interventions to improve patient-provider communication about insulin and enhance providers' perceptions of patient self-management capacity can increase guideline-concordant, patient-centered insulin initiation.

Original languageEnglish (US)
Pages (from-to)94-100
Number of pages7
JournalDiabetes Educator
Volume38
Issue number1
DOIs
StatePublished - Jan 2012

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Insulin
Primary Health Care
Research
Self Care
Guidelines
Peptide Initiation Factors
Aptitude
Patient Compliance
Life Expectancy
Type 2 Diabetes Mellitus
Fear
Disease Progression
Comorbidity
Mental Health
Cross-Sectional Studies
Communication
Interviews
Health
Therapeutics

ASJC Scopus subject areas

  • Endocrinology, Diabetes and Metabolism
  • Health Professions (miscellaneous)

Cite this

Getting under the skin of clinical inertia in insulin initiation : The translating research into action for diabetes (TRIAD) insulin starts project. / Ratanawongsa, Neda; Crosson, Jesse C.; Schillinger, Dean; Karter, Andrew J.; Saha, Chandan; Marrero, David.

In: Diabetes Educator, Vol. 38, No. 1, 01.2012, p. 94-100.

Research output: Contribution to journalArticle

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