Overcome to the Barriers for Initiating Insulin in Type 2 Diabetes: Clinical Evidence Available to the Nurses
Article Type:
Research/Original Article (بدون رتبه معتبر)
Abstract:
Prevalence of diabetes has increased around the world, such that 4.5% in 1980 grew to 8.5% in 2014 (1). The aim of controlling diabetes is to achieve an HbA1C of lower than 7%. However, around 50% of the diabetic patients cannot achieve this target. Poor blood glucose control is a risk factor for the complications associated with diabetes (2,3).
To control this disease, typically oral hypoglycemic drugs are used. In case of failure in achieving normal blood glucose level, another oral drug or insulin may be required (4(. According to the research, only one fifth of patients are interested in insulin initiation. Further, insulin initiation in these patients is challenging for the health care providers as well (5).
The barriers related to the insulin initiation can be categorized into the health care providers and patient. According to the previous studies, the barriers related to the health care providers include fear of hypoglycemia, lack of sufficient time to educate the patients, low socioeconomic status of patients, lack of sufficient knowledge and experience, absence of a common language with the patients, and poor relationship. Furthermore, the barriers related to the patients include inconvenience and limitation in lifestyle, losing independence, social embarrassment, poor self-efficacy, needle phobia, depression, failure to receive convincing answers from the health care providers about the benefits and risk of insulin, incomplete understanding of diabetes, use of traditional herbal treatments and fear from weight gain due to use of insulin (3,4,6,7,8,9).
Based on the above mentioned reasons, delay in insulin initiation is common. Research has shown that around 50% of the patients with poor diabetes control, havent initiated insulin therapy timely, and even its initiation has been delayed by around 3 to 5 years after failure to receiving response from oral hypoglycemic drugs. Therefore, a special attention should be directed to this matter. From among the mentioned barriers, a few of them including low socioeconomic status cannot be modified, while in most cases, these barriers can be altered which should be resolved by the health care providers(8).
Nurses are among the most important members of the health care providers, who are in relation with patients and should provide their knowledge and specialized skills to educate and create motivation in diabetic patients to take insulin. In this way, they can contribute to fulfilling treatment objectives which include reducing the complications and achieving a suitable HbA1c level (10). Accordingly, along this way, evidence-based scientific documents are required, so that the essential education is given to the patients based on them. In order to achieve this evidence, electronic search in international database including web of science(ISI), Pubmed, Scopus, and Google Scholar was performed with the keywords of “initiate or starting”, type 2 diabetes”, and “insulin”. The search results indicated that the number of interventional articles in the field of nursing and “insulin initiation” is very limited. Among Persian electronic databases such as SID(Scientific Information Database) and Magiran, only one “descriptive- cross-sectional” study was found (11).
Indeed, across various studies, the barriers in insulin initiation have been listed and investigated. Only a few nursing interventions have been performed to overcome these barriers. It appears that considering the importance of insulin initiation and the significant role of nurses as facilitators of this process, a gap is felt regarding interventional studies to guide nurses in the clinical practice. Thus, it is suggested that researchers pay more attention to this dimension of treating diabetes and take more effective and practical steps to overcome the barriers insulin initiation in type 2 diabetic patients.
Language:
English
Published:
Journal Of Patient safety and quality improvement, Volume:6 Issue: 1, Winter 2018
Pages:
634 to 635
magiran.com/p1877782  
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