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Insulin therapy attitudes and beliefs of physicians in Middle Eastern Arab countries.

BACKGROUND
Studies assessing attitudes and beliefs of physicians regarding insulin therapy in Arab countries are scant despite the high prevalence of type 2 diabetes mellitus (T2DM).


OBJECTIVE
This study examines family physicians' attitudes and beliefs towards insulin therapy in T2DM patients in the East Mediterranean Region of the World Organization of National Colleges, Academies and Academic Associations of General Practitioners/Family Physicians.


METHODS
This is a cross-sectional study conducted on 348 family physicians invited via email to fill an anonymous online questionnaire about their attitudes, beliefs and perceived barriers regarding insulin initiation in T2DM patients.


RESULTS
One hundred and twenty-two physicians completed the questionnaire. Of the 122 physicians, 73.6% preferred to delay insulin initiation until it is absolutely essential and 59.0% initiated it themselves. The majority agreed that T2DM patients benefit from insulin prior to the development of complications (85.7%) and that patient education is important (99.1%) and uncomplicated (74.7%). Sixty-three per cent expressed reluctance to start insulin mostly because of perceived patients' reluctance. Referral to endocrinologists to initiate insulin therapy was associated with inadequate experience and concern about risks, particularly in elderly patients (backward logistic regression, P < 0.05). Physicians' reluctance to initiate insulin therapy was associated with patients' perception of insulin initiation as a personal failure and threat to the quality of life (backward logistic regression, P < 0.05).


CONCLUSIONS
Although family physicians in the Arab world believe in the benefits of insulin therapy, many are reluctant to initiate it themselves. Further studies are needed per country, as well as multiple measures to minimize the physicians' barriers to insulin prescription.