School of Food Science and Nutrition, University of Leeds, Leeds, UK.
Multidisciplinary Cardiovascular Disease Research Group, University of Leeds, Leeds, UK.
Acta Diabetol. 2019 Sep;56(9):1045-1049. doi: 10.1007/s00592-019-01346-1. Epub 2019 Apr 16.
Little is known regarding initiation of insulin therapy in type 2 diabetes (T2D) in Central and South-Eastern European countries. Therefore, we conducted a survey to characterise the prescribing practices of specialist diabetes healthcare professionals in this region and assessed factors that influence clinical decision-making regarding insulin initiation in T2D.
A cross-sectional survey sampled 211 specialist diabetes healthcare prescribers from five Central and South-Eastern European countries (Bulgaria, Croatia, Greece, Hungary, and Slovenia). A structured questionnaire was developed which surveyed current clinical practices and influencing factors, barriers to insulin initiation, and combination therapy prescribing preferences.
Only 9.4% (20 of out of 211 respondents) of healthcare professionals would initiate insulin therapy in T2D patients at the recommended HbA1c threshold of 7-7.9% [53-63 mmol/mol]. Large regional differences were evident in insulin initiation thresholds (≥ 9.0% [≥ 75 mmol/mol]: Bulgaria 80.8% vs. Slovenia 13.3%). Psychological distress was recorded as the major barrier to insulin initiation. Health insurance regulations were ranked more important than personal clinical experience and clinical guidelines in clinical decision-making. Information from peers was more influential than manufacturer information, clinical experience, and continuous medical education, respectively, for insulin initiation.
Despite large regional variation, there is widespread delay of insulin initiation from specialist diabetes healthcare professionals in Central and South-Eastern Europe.
关于在中欧和东南欧国家 2 型糖尿病（T2D）中开始胰岛素治疗的情况知之甚少。因此，我们进行了一项调查，以描述该地区专科糖尿病医疗保健专业人员的处方实践，并评估影响 T2D 患者开始胰岛素治疗的临床决策的因素。
这项横断面调查从五个中欧和东南欧国家（保加利亚、克罗地亚、希腊、匈牙利和斯洛文尼亚）中抽取了 211 名专科糖尿病医疗保健开方者。制定了一份结构化问卷，调查了当前的临床实践和影响因素、胰岛素起始的障碍以及联合治疗处方的偏好。
只有 9.4%（211 名受访者中的 20 名）的医疗保健专业人员会在 T2D 患者的 HbA1c 推荐阈值为 7-7.9%[53-63mmol/mol]时开始胰岛素治疗。在胰岛素起始阈值方面存在明显的区域差异（≥9.0%[≥75mmol/mol]：保加利亚 80.8%，斯洛文尼亚 13.3%）。心理困扰被记录为胰岛素起始的主要障碍。在临床决策中，健康保险法规的重要性排名高于个人临床经验和临床指南。与制造商信息、临床经验和持续医学教育相比，来自同行的信息分别对胰岛素起始的影响更大。
尽管存在较大的区域差异，但在中欧和东南欧，专科糖尿病医疗保健专业人员普遍延迟开始胰岛素治疗。
