Misconceptions about Insulin and Barriers to Insulin Initiation in Type 2 Diabetes among General Physicians in Southeast Nigeria

Abstract

Aims: The aim of this study was to evaluate the perceptions of general physicians (GPs) regarding insulin and determine the barriers to its initiation in patients with type 2 diabetes mellitus (T2DM). Study Design: A cross-sectional, quantitative research. Place and Duration: Enugu metropolis, Southeast Nigeria, between March and November 2018. Methodology: We used structured self administered questionnaire to evaluate the perceptions of 64 GPs (45 males and 19 females) regarding insulin, and to elicit barriers to insulin initiation in subjects with T2DM. Results: The mean (SD) age of the participants was 45.5 (11.7) years and their duration of general practice ranged from 3 – 38 years. Majority were private practitioners predominantly in the rural areas. Only 15 (23.4%) respondents had ever initiated insulin for outpatient with T2DM. Fear of hypoglycemia, anticipated patients’ refusal of insulin, physician’s lack of confidence, and concerns about needle pains were among the commonly reported barriers to insulin initiation. Others were socio-economic factors including concerns about affordability of insulin and frequent glycemic monitoring, and availability of insulin storage facilities. There was a general consensus among the GPs on a number of misconceptions including that patients’ adherence to oral glucose lowering drugs eliminates the need for insulin; that insulin should be reserved as a last resort; and that once initiated, insulin therapy is lifelong. Conclusion: This study revealed that there are several physician-related barriers and misconceptions regarding insulin therapy for T2DM among GPs in Southeast Nigeria. Periodic training to improve GPs’ attitude to insulin and optimize insulin utilization in T2DM is required.