SingHealth Polyclinics-Head Office, 167 Jalan Bukit Merah, #15-10 Connection One (Tower 5), Singapore 150167.
Singapore Med J. 2011 Nov;52(11):801-9.
Type 2 diabetes mellitus is a progressive condition in which the pancreatic beta-cell function deteriorates with increasing duration of the disease. When good glycaemic control is not achieved despite adherence to oral hypoglycaemic drugs, healthy diet and lifestyle, insulin should be initiated. However, this is often delayed due to various reasons. We aimed to determine the issues relating to insulin initiation for diabetic patients managed in primary care polyclinics in Singapore.
Qualitative data was obtained during four focus group discussions, with participation from healthcare professionals (HCPs), including physicians and nurses, and type 2 diabetes mellitus patients. The data was transcribed into text, coded and grouped into themes.
Launching the topic and doctor-patient communication on insulin therapy were key issues in insulin initiation. Patient barriers to insulin commencement included: refusal to acknowledge the need for insulin therapy; its perception as a social stigma, an inconvenient mode of treatment or punishment for failure; and fear of needles, side-effects and complications. The HCP's attitude and experience with insulin therapy were also possible barriers.
Our findings highlight that insulin initiation is affected by the complex interaction between the patients and HCPs, and other system factors. Patients may harbour misconceptions about insulin due to the late introduction of insulin therapy by HCPs or the way the therapy is being communicated to them. The key issues to address are the disparity in perceptions of diabetic control between HCPs and patients, and education regarding the need for insulin therapy.
2 型糖尿病是一种进行性疾病，随着疾病持续时间的延长，胰腺β细胞功能逐渐恶化。当尽管坚持使用口服降糖药、健康饮食和生活方式，但仍无法达到良好的血糖控制时，应开始使用胰岛素。然而，由于各种原因，这通常会被延迟。我们旨在确定在新加坡基层医疗诊所管理的糖尿病患者中启动胰岛素治疗的相关问题。
在四个焦点小组讨论中获得了定性数据，参与者包括医疗保健专业人员（HCPs），包括医生和护士，以及 2 型糖尿病患者。将数据转录为文本，进行编码并分为主题。
启动胰岛素治疗的话题和医患沟通是胰岛素起始的关键问题。患者开始胰岛素治疗的障碍包括：拒绝承认需要胰岛素治疗；将其视为社会耻辱、不方便的治疗方式或对失败的惩罚；以及对针头、副作用和并发症的恐惧。HCP 对胰岛素治疗的态度和经验也可能是障碍。
我们的研究结果表明，胰岛素的起始受到患者和 HCP 之间复杂相互作用以及其他系统因素的影响。患者可能由于 HCP 延迟引入胰岛素治疗或向他们传达治疗的方式而对胰岛素产生误解。需要解决的关键问题是 HCP 和患者对糖尿病控制的看法存在差异，以及关于胰岛素治疗必要性的教育。
