Attitudes of primary care physicians towards insulin initiation in people with type 2 diabetes in Bahrain

Objective: The aim of this study is to explore the beliefs and attitudes of primary care physicians (PCP) regarding insulin initiation in people with type 2 diabetes. Methods: A structured, adapted questionnaire was distributed to all primary care physicians. The questionnaire consisted of 2 parts: the first part collected information on physicians’ demographic characteristics; the second part contained 30 items measuring the beliefs and attitudes of physicians regarding insulin initiation. Results: A total of 171 physicians out of 245 completed the questionnaire with a response rate of 70%. Most of the physicians were between 30 and 59 years of age. The majority were females (79.4%), had been in practice for >10 years and were certified family physicians seeing more than 25 diabetic patients a week. About 75% of the physicians found initiation of insulin as one of the most difficult aspects of managing patients with type 2 diabetes. The main obstacles reported by physicians were: route of administration by injection, the risk of hypoglycemia, and the patients’ level of education. However, they agreed that the benefits of insulin outweighed the risks of hypoglycemia and weight gain. Only 45% of them agreed that patients will eventually need to go on insulin regardless of how well they adhere to treatment. Moreover, 31.8% of physicians stated that increased levels of plasma insulin will increase the risk of cardiovascular events. Conclusion: Physicians’ concerns and lack of knowledge regarding insulin use may act as barriers to insulin initiation. This may increase the risk for a higher rate of uncontrolled diabetes and its subsequent complications.