Öz
Amaç: Diabetes mellitus hastalarında gerekmesine rağmen insülin başlatılmasıyla ilgili birçok sorun vardır. Bu çalışmanın amacı hastaların niçin zamanında insülin tedavilerini alamadıklarını saptamak ve bu sorunlara değinmektir.
Yöntemler: Tek merkezde kesitsel yapılan bu çalışma için etik kurul’dan izin ve gönüllülerden onam alındı. 18 yaşından büyük, tip 2 diyabetes mellituslu hastalar çalışmaya dahil edildi. Hamileler, 18 yaşından küçükler, dekompanse karaciğer hastalığı olanlar, psikiyatrik bozukluğu olanlar, Tip 1 diyabeti olanlar çalışmaya alınmadı. Veri toplanması için anket kullanıldı. İstatistiksel analiz SPSS 18.0'da yapıldı.
Bulgular: Toplam 1062 hasta çalışmaya alındı. Hastaların %34’ü regüle idi. İnsülin kullanması gerektiği halde kullanmayan hasta sayısı 105’di. 105 hastadan 34 hastaya hekimler hiç insülin tedavisi önermemişken 33 hasta enjeksiyon korkusu nedeniyle insülin istememiş ve 32 hasta ise insülin hakkında yanlış bilgileri olduğu için insülin kullanmaya başlamamıştı. İnsülin kullanırken insülin tedavisine son veren 36 hasta sorgulandığında 8 hastanın insülin tedavisi hekimleri tarafından durdurulmuştu. Kalan 28 hasta ise insülin tedavilerini en sık enjeksiyon zorluğu ve insülin hakkında duyduğu yanlış bilgiler nedeni ile kendileri bırakmıştı.
Sonuçlar: Hasta hekim diyalogunu artıran poliklinik şartlarının sağlanması, enjeksiyon kaleminin ve iğnesinin bizzat hasta tarafından görülüp denenmesi, yanlış bilgi edinilmesinden kaçınmak için hastalara ve doktorlara yönelik konferanslar diyabetes mellitus’ta insülinin geç başlanmasına çözüm olabilir.
Anahtar Kelimeler
Kaynakça
- 1. King P, Peacock J, Donnelly R. The UK Prospective Diabetes Study (UKPDS): clinical and therapeutic implications for type 2 diabetes. Br J Clin Pharmacol. 1999;48:643–8.
- 2. ORIGIN Trial Investigators. Cardiovascular and Other Outcomes Postintervention With Insulin Glargine and Omega-3 Fatty Acids (ORIGINALE). Diabetes Care 2016;39:709-16.
- 3. Del Prato S. Role of glucotoxicity and lipotoxicity in the pathophysiology of Type 2 diabetes mellitus and emerging treatment strategies. Diabet Med. 2009;26:1185–92.
- 4. Raz I, Mosenzon O. Early insulinization to prevent diabetes progression. Diabetes Care. 2013;36:190-7.
- 5. Chon S, Oh S, Kim SW, Kim JW, Kim YS, Woo JT. The effect of early insulin therapy on pancreatic beta-cell function and long-term glycemic control in newly diagnosed type 2 diabetic patients. Korean J Intern Med. 2010;25:273–81.
- 6. Lagunes-Córdoba R, Galindo-Guevara I, Reyes AC, Romero-Aparicio C, Rosas-Santiago FJ. Why don't doctors use early insulinization therapy in patients with diabetes mellitus type 2? A qualitative approach in a Mexican city. Salud Colect. 2017;13(4):693-712.
- 7. Sonmez A, Haymana C, Bayram F, Salman S, Dizdar O.S, Gurkan E et al. Turkish nationwide survEy of glycemic and other Metabolic parameters of patients with Diabetes mellitus (TEMD study). Diabetes Research and Clinical Practice 2018;146:138-47.
- 8. Ilkova H, Damcı T, Karşıdağ K, Cömlekçi A, Ayvaz G. The international diabetes management practices study (IDMPS) - Turkey’s 5th wave results. Turk J Endocrineol Metab 2016;20:88–96.
- 9. Satman I, Imamoglu S, Yilmaz C. ADMIRE Study Group. A patient-based study on the adherence of physicians to guidelines for the management of type 2 diabetes in Turkey. Diab Res Clin Pract 2012;98:75–82.
- 10. Damci T, Kultursay H, Oguz A, Pehlivanoglu S, Tokgozoglu L. Vascular Risk Study Group. Sub-optimal drug treatment of diabetes and cardiovascular risk in diabetic patients in Turkey. A countrywide survey. Diabetes Metab 2004;30:327–33.
- 11. Heller SR. A Summary of the ADVANCE Trial. Diabetes Care. 2009; 32:357–61.
- 12. Patel A, MacMahon S, Chalmers J, Neal B, Billot L, Woodward M et al. Intensive blood glucose control and vascular outcomes in patients with type 2 diabetes. N Engl J Med. 2008;358:2560–72.
- 13. Hanefeld M, Bramlage P. Insulin use early in the course of type 2 diabetes mellitus: the ORIGIN trial. Current Diabetes Reports. 2013;13:342-9.
- 14. Pennartz C, Schenker N, Menge BA, Schmidt WE, Nauck MA, Meier JJ. Chronic reduction of fasting glycemia with insulin glargine improves first- and second-phase insulin secretion in patients with type 2 diabetes. Diabetes Care. 2011;34:2048–53.
- 15. Lee YK, Lee PY, Ng CJ. A qualitative study on healthcare professionals’ perceived barriers to insulin initiation in a multi-ethnic population. BMC Family Practice. 2012;13:28.
- 16. Karter AJ, Parker MM, Swain BE, Moffet HH, Subramanian U, Saha C. Barriers to Insulin Initiation. The Translating Research Into Action for Diabetes Insulin Starts Project. Diabetes Care. 2010;33:733-5.
- 17. Oliveria SA, Menditto LA, Yood MU, Koo YH, Wells KE, McCarthy BD. Barriers to the initiation of, and persistence with, insulin therapy. Current Medical Research and Opinion. 2008;23:3105-12.
- 18. Khunti K, Nikolajsen A, Thorsted BL, Andersen M, Davies MJ, Paul SK. Clinical inertia with regard to intensifying therapy in people with type 2 diabetes treated with basal insulin. Diabetes Obes Metab. 2016;18:401–9.
- 19. Yavuz DG, Ozcan S, Deyneli O. Adherence to insulin treatment in insulin-naïve type 2 diabetic patients initiated on different insulin regimens. Patient Prefer Adherence. 2015;9:1225–31.
Öz
Aim: There are many problems with insulin initiation though required in diabetes mellitus patients. This study aims to determine why patients are unable to receive insulin treatments on time.
Methods: Approval from the ethics committee and consent from the volunteers was obtained for this cross sectional, single center study, in which patients with type 2 diabetes mellitus over the age of 18 years were included. Pregnant women, patients with cirrhosis, and psychiatric disorders were excluded. A questionnaire was used for data collection. Statistical analysis was performed with SPSS 18.0.
Results: A total of 1062 patients were included in this study. Diabetes mellitus was regulated in 34% of the patients. The number of patients who did not use insulin even though they should was 105. While physicians did not recommend any insulin treatment to 34 patients, 33 patients did not want insulin treatment due to fear of injection and 32 patients did not start insulin treatment because they had incorrect information regarding insulin. When 36 patients who stopped insulin treatment while they were using were questioned for the reason, it was learnt that 8 patients' insulin treatment was stopped by their physicians. The remaining 28 patients, on the other hand, stopped their insulin treatments most frequently because of the difficulty of injection and incorrect information they heard about insulin.
Conclusions: Providing outpatient conditions that increase patient-physician dialogue, ensuring that the injection pen and needle are seen and tested by the patient in person, and conferences for the patients and medical doctors to prevent getting the incorrect information would be the solution of the delay in starting insulin in diabetes mellitus.
Anahtar Kelimeler
Kaynakça
- 1. King P, Peacock J, Donnelly R. The UK Prospective Diabetes Study (UKPDS): clinical and therapeutic implications for type 2 diabetes. Br J Clin Pharmacol. 1999;48:643–8.
- 2. ORIGIN Trial Investigators. Cardiovascular and Other Outcomes Postintervention With Insulin Glargine and Omega-3 Fatty Acids (ORIGINALE). Diabetes Care 2016;39:709-16.
- 3. Del Prato S. Role of glucotoxicity and lipotoxicity in the pathophysiology of Type 2 diabetes mellitus and emerging treatment strategies. Diabet Med. 2009;26:1185–92.
- 4. Raz I, Mosenzon O. Early insulinization to prevent diabetes progression. Diabetes Care. 2013;36:190-7.
- 5. Chon S, Oh S, Kim SW, Kim JW, Kim YS, Woo JT. The effect of early insulin therapy on pancreatic beta-cell function and long-term glycemic control in newly diagnosed type 2 diabetic patients. Korean J Intern Med. 2010;25:273–81.
- 6. Lagunes-Córdoba R, Galindo-Guevara I, Reyes AC, Romero-Aparicio C, Rosas-Santiago FJ. Why don't doctors use early insulinization therapy in patients with diabetes mellitus type 2? A qualitative approach in a Mexican city. Salud Colect. 2017;13(4):693-712.
- 7. Sonmez A, Haymana C, Bayram F, Salman S, Dizdar O.S, Gurkan E et al. Turkish nationwide survEy of glycemic and other Metabolic parameters of patients with Diabetes mellitus (TEMD study). Diabetes Research and Clinical Practice 2018;146:138-47.
- 8. Ilkova H, Damcı T, Karşıdağ K, Cömlekçi A, Ayvaz G. The international diabetes management practices study (IDMPS) - Turkey’s 5th wave results. Turk J Endocrineol Metab 2016;20:88–96.
- 9. Satman I, Imamoglu S, Yilmaz C. ADMIRE Study Group. A patient-based study on the adherence of physicians to guidelines for the management of type 2 diabetes in Turkey. Diab Res Clin Pract 2012;98:75–82.
- 10. Damci T, Kultursay H, Oguz A, Pehlivanoglu S, Tokgozoglu L. Vascular Risk Study Group. Sub-optimal drug treatment of diabetes and cardiovascular risk in diabetic patients in Turkey. A countrywide survey. Diabetes Metab 2004;30:327–33.
- 11. Heller SR. A Summary of the ADVANCE Trial. Diabetes Care. 2009; 32:357–61.
- 12. Patel A, MacMahon S, Chalmers J, Neal B, Billot L, Woodward M et al. Intensive blood glucose control and vascular outcomes in patients with type 2 diabetes. N Engl J Med. 2008;358:2560–72.
- 13. Hanefeld M, Bramlage P. Insulin use early in the course of type 2 diabetes mellitus: the ORIGIN trial. Current Diabetes Reports. 2013;13:342-9.
- 14. Pennartz C, Schenker N, Menge BA, Schmidt WE, Nauck MA, Meier JJ. Chronic reduction of fasting glycemia with insulin glargine improves first- and second-phase insulin secretion in patients with type 2 diabetes. Diabetes Care. 2011;34:2048–53.
- 15. Lee YK, Lee PY, Ng CJ. A qualitative study on healthcare professionals’ perceived barriers to insulin initiation in a multi-ethnic population. BMC Family Practice. 2012;13:28.
- 16. Karter AJ, Parker MM, Swain BE, Moffet HH, Subramanian U, Saha C. Barriers to Insulin Initiation. The Translating Research Into Action for Diabetes Insulin Starts Project. Diabetes Care. 2010;33:733-5.
- 17. Oliveria SA, Menditto LA, Yood MU, Koo YH, Wells KE, McCarthy BD. Barriers to the initiation of, and persistence with, insulin therapy. Current Medical Research and Opinion. 2008;23:3105-12.
- 18. Khunti K, Nikolajsen A, Thorsted BL, Andersen M, Davies MJ, Paul SK. Clinical inertia with regard to intensifying therapy in people with type 2 diabetes treated with basal insulin. Diabetes Obes Metab. 2016;18:401–9.
- 19. Yavuz DG, Ozcan S, Deyneli O. Adherence to insulin treatment in insulin-naïve type 2 diabetic patients initiated on different insulin regimens. Patient Prefer Adherence. 2015;9:1225–31.
Ayrıntılar
| Birincil Dil | İngilizce |
|---|---|
| Konular | Klinik Tıp Bilimleri |
| Bölüm | Araştırma makalesi |
| Yazarlar | |
| Yayımlanma Tarihi | 1 Ağustos 2020 |
| Yayımlandığı Sayı | Yıl 2020 Cilt: 4 Sayı: 8 |
