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Review
. 2018 May 22;19(1):70.
doi: 10.1186/s12875-018-0753-2.

Perceptions of insulin use in type 2 diabetes in primary care: a thematic synthesis

Kathy Ellis  1 , Henrietta Mulnier  2 , Angus Forbes  2
Affiliations
Review

Perceptions of insulin use in type 2 diabetes in primary care: a thematic synthesis

Kathy Ellis et al. BMC Fam Pract. .

Abstract

Background: Increasing numbers of patients with type 2 diabetes mellitus are progressing to insulin therapy, and despite its potency many such individuals still have suboptimal glycaemic control. Insulin initiation and intensification is now often conducted by Practice Nurses and General Practitioners in many parts of the UK. Therefore, gaining insight into perspectives of patients and primary care clinicians is important in determining self-management and engagement with insulin. A thematic synthesis of studies was conducted exploring the views and experiences of people with type 2 diabetes and of healthcare professionals on insulin use and management in the context of primary care.

Methods: Protocol based systematic searches of electronic databases (CINAHL, Cochrane Library, EMBASE, MEDLINE, PsycINFO, and Web of Science) were performed on 1 October 2014 and updated on 31 March 2015, to identify studies that identified the views and experiences of adults with type 2 diabetes or primary care clinicians on the use of insulin in the management of type 2 diabetes. Studies meeting the review inclusion criteria were critically appraised using the CASP qualitative research checklist or Barley's checklist for survey designs. A thematic synthesis was then conducted of the collected studies.

Results: Thirty-four studies were selected. Of these, 12 used qualitative interviews (nine with patients and three with healthcare professionals) and 22 were survey based (14 with patients, three with healthcare professionals, and five with both). Twelve key themes were identified and formed three domains, patient perceptions, healthcare professional perceptions, and health professional-patient relationships. The patient-centred themes were: insulin-related beliefs, social influences, psychological factors, hypoglycaemia, and therapy barriers. The clinician-related themes were: insulin skills of general practitioners, healthcare integration, healthcare professional-perceived barriers, hypoglycaemia, and explanations for adherence. Healthcare professional-patient relationship themes were drawn from the perspectives of patients and from clinicians.

Conclusions: This review reveals multiple barriers to optimal insulin use in primary care at both the patient and healthcare professional levels. These barriers indicate the need for multimodal interventions to: improve the knowledge and competencies of primary care professionals in insulin use; provide more effective patient education and self-management support; and introduce integrated insulin support systems.

Keywords: General practice; Insulin; Patients; Perceptions; Primary care; Type 2 diabetes.

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Conflict of interest statement

Authors’ information

KE is a PhD student at King’s College London.

HM is a lecturer at King’s College London.

AF is Chair of Clinical Diabetes Nursing at King’s College London

Ethics approval and consent to participate

This was not required as the data analysed were extracted from reports of previously published studies.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
PRISMA Flow Diagram Illustrating the Selection Process
Fig. 2
Fig. 2
Twelve Primary Themes formed from the Thematic Frameworks. Key: HCP = Healthcare Professional; T2DM = type 2 diabetes mellitus
Fig. 3
Fig. 3
Analytical Model and the Interrelated Themes. Key: HCP = Healthcare Professional
See this image and copyright information in PMC

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