Hayashino Yasuaki, Tsuboi Satoshi, Yamamoto Yuiko, Ishii Hitoshi
Department of Endocrinology, Tenri Hospital, Tenri, Japan.
Novo Nordisk Pharma Ltd, Tokyo, Japan.
Diabetes Ther. 2024 Dec;15(12):2537-2555. doi: 10.1007/s13300-024-01664-w. Epub 2024 Nov 1.
This survey assessed the perspectives of physicians, people with diabetes (PWD), and caregivers in Japan regarding initiation barriers and treatment burden associated with insulin therapy, and expectations for new insulin therapies.
An online survey, conducted May-June 2023, was completed by physicians (n = 411), PWD (type 1 diabetes, n = 108; type 2 diabetes [T2D]: insulin-naive, n = 114; insulin-treated, n = 108), and caregivers (family members, n = 107; nurses, n = 117; care workers, n = 104). Agreement with statements regarding initiation barriers, current feelings, and burden of insulin therapy was assessed. Physicians' views on ideal glycated hemoglobin (HbA) levels and actual levels in PWD at insulin initiation were captured.
Most PWD agreed with the statements "I don't want to be bothered with doing injections" (77.8-92.1%) and "I don't want to inject myself for the rest of my life" (78.7-91.2%). Physicians also considered these factors to be of high importance for PWD; however, physician and PWD (insulin-naive T2D) responses were significantly different for 11 statements. The greatest underestimation by physicians was for the statement "my family will be worried" (41.8% vs. 66.7%), whereas social factors (e.g., "my friendships may suffer," "if I take insulin I will be discriminated against") were overestimated by physicians (49.1% vs. 33.3% and 46.5% vs. 24.6%, respectively). Although > 70% of physicians considered HbA < 9.0% (< 75 mmol/mol) ideal for insulin initiation, only ~ 30% of PWD started insulin at HbA < 9.0% (< 75 mmol/mol). Nurses rated the burden of assisting with insulin injections significantly lower than family members or care workers. Respondents agreed the need for less frequent injections and improved glycemic control were important attributes expected from future insulin therapies.
Differences in perceptions between physicians and PWD in Japan regarding insulin therapy persist, but this gap may be narrowing. Both groups agreed that future insulin therapies should be simpler and provide better glycemic control.
本调查评估了日本医生、糖尿病患者（PWD）及护理人员对胰岛素治疗起始障碍、治疗负担以及对新型胰岛素疗法期望的看法。
2023年5月至6月进行了一项在线调查，医生（n = 411）、PWD（1型糖尿病，n = 108；2型糖尿病[T2D]：未使用胰岛素，n = 114；已使用胰岛素，n = 108）及护理人员（家庭成员，n = 107；护士，n = 117；护理人员，n = 104）完成了该调查。评估了对关于起始障碍、当前感受及胰岛素治疗负担的陈述的认同情况。收集了医生对PWD起始胰岛素时理想糖化血红蛋白（HbA）水平及实际水平的看法。
大多数PWD认同“我不想被注射困扰”（77.8 - 92.1%）和“我不想余生都自己注射”（78.7 - 91.2%）的陈述。医生也认为这些因素对PWD非常重要；然而，对于11条陈述，医生和PWD（未使用胰岛素的T2D）的回答存在显著差异。医生低估最严重的陈述是“我的家人会担心”（41.8%对66.7%），而社会因素（如“我的友谊可能会受影响”、“如果我使用胰岛素会受到歧视”）被医生高估（分别为49.1%对33.3%和46.5%对24.6%）。尽管超过70%的医生认为HbA < 9.0%（< 75 mmol/mol）是起始胰岛素的理想水平，但只有约30%的PWD在HbA < 9.0%（< 75 mmol/mol）时开始使用胰岛素。护士对协助胰岛素注射负担的评分显著低于家庭成员或护理人员。受访者一致认为未来胰岛素疗法需要注射频率更低和血糖控制更好是重要的期望特性。
日本医生和PWD对胰岛素治疗的认知差异仍然存在，但这种差距可能正在缩小。两组都认为未来胰岛素疗法应更简单且能提供更好的血糖控制。
