Table 1 Multifaceted support program addressing known barriers to insulin initiation
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. |