Free Health Dissertations - Literature Reviewed Cites A Number Of Barriers Responsible For The Slow
Literature reviewed cites a number of barriers responsible for the slow introduction of insulin regimens to Type 2 diabetic treatment. Barriers on the part of patients typically include fear of injections, feelings of failure, misconceptions regarding the effects of insulin, and concern that the disease is worsening. Cefalu (2004) found that fear of pain and inconvenience of having to inject insulin greatly increases patient anxiety regarding initiating insulin. He concludes a major limitation for advancing to intensive insulin therapy is that the only viable way to administer insulin is through injection (Cefalu 2004, 1149). Davies (2004, S18) similarly found that in Type 2 diabetics, needle phobia presents as a common additional barrier to good control.
Patients may also view moving to an insulin regimen as a indicator they have failed at other therapies, such as lifestyle management (Cefalu 2004). This can produce guilt over even minor incompliance in previous treatment, and cause the patient to want to try harder on their existing treatment plan rather than move to insulin (Cefalu 2004). In a recent survey, nearly forty percent of patients agreed that ‘Starting insulin would mean that I have not followed my treatment recommendations properly’ (Davies 2004, S16). Kuritzky and Nelson (2004, S11) additionally found that well-intended practitioners may have inadvertently set the stage for patient nonreceptivity by portraying insulin as appropriate therapy for patients who have "failed" with oral agents.
Davies (2004) goes further, offering anecdotal evidence of practitioners who attempt to coerce non-compliant Type 2 diabetics into lifestyle and oral medication compliance by the threat of beginning insulin therapy. This can result in strong patient resistance to insulin when it is eventually called for (Davies 2004). This can even lead to belief that insulin indicates inevitable complications or death to the patient. The perception is that use of insulin signifies progression to a more serious phase of their disease; some patients view insulin use as a ‘prelude to death’ (Cefalu 2004, 1152). Some patients also mistakenly believe that insulin intensifies insulin resistance (Kuritzky and Nelson 2004, S11). Others claim considerations of weight gain outweigh their desire for tight glucose control (Anon 2005).
Physicians and caregivers more often cite hypoglycemia, obesity, and patients lack of coping skills as reasons to delay insulin initiation. Davies (2004, S16) found concerns about causing hypoglycemic episodes or increasing patients’ obesity means that physicians may permit poor control to continue unduly by delaying the initiation or intensification of insulin therapy and regard insulin as treatment of last resort.Instead, Kuritzky and Nelson (2004, S11) recommend patients should be taught that insulin therapy is appropriate at any time during the course of diabetes to achieve glycemic goals.
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