Barriers and enablers to self-titration of insulin in adults with type 2 diabetes: a qualitative study

McBain, H. B., Begum, S., Rahman, S. & Mulligan, K. (2016). Barriers and enablers to self-titration of insulin in adults with type 2 diabetes: a qualitative study. Diabetic Medicine, doi: 10.1111/dme.13196

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Abstract

Aims
The aim of this study was to identify the barriers and enablers to effective insulin selftitration in type 2 diabetes.

Methods
A qualitative semi-structured interview approach was employed. Questions were structured according to the Theoretical Domains Framework, which outlines 14 domains that can act as barriers and enablers to changing behaviour. Interviews were audio-recorded and transcribed verbatim. The data were coded according to the 14 domains, belief statements were created within each domain and a frequency count of the most reported barriers and enablers were then calculated. Analyses were conducted by two researchers, and discrepancies agreed with a third researcher.

Results
Eighteen adults with type 2 diabetes took part in an interview. A majority were South Asian (n=8), men (n=12), on average age 61 years old. Average duration of diabetes was 16 years and time on insulin 9 years. Inter-rater reliability for each of the domains varied (29%-100%). The most frequently reported domains were Social Influence and Beliefs about Consequences; the least frequently reported were Optimism and Reinforcement. Participants reported receiving support to self-titrate from a range of sources. Self-titrating was perceived to have a range of both positive and negative consequences, as was not titrating.

Conclusions
The findings highlight that participants experienced a range of barriers and enablers when attempting to self-titrate. Improved education and training when initiating insulin treatment among adults with type 2 diabetes, and throughout their journey on insulin therapy could help people identify and address these barriers in order to optimise self-titration.

Novelty statement

• This study is the first to comprehensively explore the reasons people with insulintreated type 2 diabetes struggle to self-titrate their insulin, using an established theoretical framework.
• Important factors in facilitating self-titration were support from healthcare professionals and family members, having a target blood glucose reading and strategies to achieve this.
• Barriers to self-titrating included difficulties experienced when at work or on holiday and concerns about the consequences of an increasing insulin dose. Holding strong but erroneous intentions to self-titrate, suggested a lack of knowledge about self-titration algorithms.
• Providing educational resources and training when initiating insulin treatment in type 2 diabetes and throughout treatment, in order to address these barriers and enhance these facilitators is vital.

Item Type: Article
Additional Information: This is the peer reviewed version of the following article: McBain, H. B., Begum, S., Rahman, S. & Mulligan, K. Barriers and enablers to self-titration of insulin in adults with type 2 diabetes: a qualitative study. Diabetic Medicine, which is to be published in final form at Diabetic Medicine. This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Self-Archiving.
Subjects: R Medicine > RC Internal medicine
Divisions: School of Health Sciences > Healthcare Research Unit
URI: http://openaccess.city.ac.uk/id/eprint/15010

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