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Table 1 Multifaceted support program addressing known barriers to insulin initiation

From: Engaging GPs in insulin therapy initiation: a qualitative study evaluating a support program in the Belgian context

Addressing patient barriers: misconceptions about insulin therapy, fear of injections, fear of hypoglycaemia, fear that insulin therapy will interfere with daily living, social stigma
Structured education program: patient education checklist addressing potential barriers and misconceptions, familiarising with what insulin is, guiding on when and who to call for problems, .…
Educational tools for patients: information sheets regarding SMBG, insulin administration, managing hypoglycemia; patient booklet; website [http://www.diabetesprojectaalst.be]
SMBG-material for free; devices corresponding with patient’s needs and capabilities.
Addressing physician barriers: doubts about the benefit of insulin therapy, lack of knowledge, lack of familiarity, concerns about the risk of hypoglycaemia, concerns about patient compliance, time constraints, lack of staff support
Simplified treatment protocol starting with a once-daily insulin regime.
Provider education: interactive workshops (main topics: indications for insulin therapy in T2DM, starting up a once daily basal insulin regimen, insulin titration algorithm and collaboration modalities, website (http://www.diabetesprojectaalst.be), continuous feedback by DNE.
Coaching of GPs by specialists from the 2 hospital diabetes centres (e-mail, phone).
Team-working approach: interdisciplinary protocol with clear job descriptions.
Appointment of a well-trained diabetes nurse educator (DNE).
Formal mentoring of DNE by one of the specialists from the region.
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