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December 2021 -
Volume 19, Issue 12


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From the Editor

Editorial
A. Abyad (Chief Editor)
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Original Contribution

Patients' Attendance to The Virtual Compared to The In-person Complimentary Outpatient Clinics at a Tertiary Care Hospital in Western Saudi Arabia: A Comparative Cross-sectional Study
[Abstract]
[pdf]
Mohammed Z. Altaf, Lina Z. Altaf, (2) Fayssal M Farahat, Abdulhakeem O. AlThaqafi
DOI: 10.5742/MEWFM.2021.94170

Knowledge around back pain and spinal disorders among Aseer patients: A cross sectional study
[Abstract]
[pdf]
Ibrahim Alburaidi, Saleh Saeed AlQahtani, Fahad mohammed saran, Zuhair Abshan Alshehri,
Rayan Dulaym Dashnan, Sultan Abdullah Al Mansour, Faisal al-Jahami, Shaker Alshehri,
Hani Fayez Ahmed Alasmari, Jamal Saad Saeed Alqahtani, Meshari Shar Alshehri
DOI: 10.5742/MEWFM.2021.94171

Environmental Triggers in Migraine patients in Riyadh: A Cross-Sectional Study
[Abstract]
[pdf]
Awad Al Harbi, Nada Hussain Alzahrani, Hanan Abdulkarim Alsuhibany, Manal Abdullah Al-Dosari, Reeman Salman Alsalman, Alanoud Abdulaziz Alkhalifah (2)
DOI: 10.5742/MEWFM.2021.94172

Job Satisfaction among Primary Health Care Workers in Buraidah, Qassim, Saudi Arabia
[Abstract]
[pdf]
Entisar AlJumail, Unaib Rabbani
DOI: 10.5742/MEWFM.2021.94173

Barriers to Compliance of Hypertensive Patients in Abha City, Saudi Arabia
[Abstract]
[pdf]
Alhussein Ali Almonawar, Ali Saeed Alasmary, Mohammed Mabkhoot Mogbel,
Hassan Mussa Almojamad
DOI: 10.5742/MEWFM.2021.94177

Disappearance of hepatitis C virus antibodies with hydroxyurea therapy in sickle cell diseases
[Abstract]
[pdf]
Mehmet Rami Helvaci, Engin Altintas, Atilla Yalcin, Orhan Ekrem Muftuoglu, Abdulrazak Abyad, Lesley Pocock
DOI: 10.5742/MEWFM.2021.94177

School Teachers' Knowledge and Attitude toward School Students with Epilepsy
[Abstract]
[pdf]
Rawan S. AlSuqair,Mohrah A. Alyabis,Marwa A. Algadi, Asmaa Attieh, Labani A. Juha,
Rama G. Alawa, Sarah G. Alghannam, Noora Z. Alsaadoon, Nervana A. Elsayed, Mona A. Alfadeel
DOI: 10.5742/MEWFM.2021.94183

Regional Covid

Increased Psychological Disorders among Pediatric Population during Covid
[Abstract]
[pdf]
Hamda Ahmed J H AlQaatri
DOI: 10.5742/MEWFM.2021.94174

Letter to the Editor
[pdf]
Mark Spigelman
DOI: 10.5742/MEWFM.2021.94192

Population and Community Studies

Patterns and determinants of Z score of Height for Age, Weight for Age and Weight for Height among Preschool children in Jeddah city, Saudi Arabia
[Abstract]
[pdf]
Fathi M. El-Gamal, Nuha Alsubhi, Shahd Badr, Nada Althaqafi, Fatima Al-Qadasi, Mariyam Hammed DOI: 10.5742/MEWFM.2021.94179

Effectiveness of Community Mental Health Service in Oman: A Pilot Study
[Abstract]
[pdf]
Saleha Al-Jadidi, Ahmed. S. Aboalatta, Iman Al-Rahbi, Maryiam Al-Harrasi,
Hamood AlRauzaiqi, Musa Abu Sabeih, Thuraiya AlGammari, Ahmed Al-Shammakhi
DOI: 10.5742/MEWFM.2021.94180

Proton Pump Inhibitors Awareness among Physicians and Pharmacists in Primary Healthcare Centres in Abha, Saudi Arabia
[Abstract]
[pdf]
Ibrahim Hasan Alasmari, Majed Mohammed AL Saleh, Majed Ali Alahmari, Sawsan Mohammad Asiri, Aljawhara Yahya Asiri
DOI: 10.5742/MEWFM.2021.94184

Knowledge, Attitude and Practice of Non-Psychiatric Physicians about Addiction
[Abstract]
[pdf]
Saeed M. Al-Ahmari, Ali A. Almusa, Ali A. Alshomrani, Waleed S.H. Al Ahmary,
Zahra S.A. Assiry, Suad M.S. Alqahtany, Ahmed Yahya Asiri, Turki Hassan Alqahtani,
Nasser Saeed Alassiri, Ossama A. Mostafa
DOI: 10.5742/MEWFM.2021.94185

Risk Factors for Diabetic Ketoacidosis among Type 1 Diabetic Children Registered at "Heraa Diabetes Center" in Makkah Al-Mokarramah City, Saudi Arabia
[Abstract]
[pdf]
Waleed K. Ballaji, Hassan M. Hadadi
DOI: 10.5742/MEWFM.2021.94186

Physicians’ Perspectives of Barriers to Insulin Initiation for Adults with Type 2 Diabetes Mellitus in Primary Health Care Centers (PHCCs), Tabouk Province - Kingdom of Saudi Arabia (KSA)
[Abstract]
[pdf]
Sameh F. Ahmed, Ghurmallah A. Alghamdi, Amerah A. Albalawi, Majed S. Alqahtani, Ibrahim M. Ghonim, Hoda M. Elhady, Shimaa A. Abdelhamid, Abderahman A. Eldesouky
DOI: 10.5742/MEWFM.2021.94189

Review

Role of SGLT2 Inhibitors and GLP-1 Analogs in Cardiovascular Risk Reduction in Type 2 Diabetes
[Abstract]
[pdf]
Mostafa Hamdy Rashed, Tonbra Deborah Dauyoumor, Sarah Corney,
Kimberly Konono, Nadia Joubert, Marwa Mohamed, Michon Sukhoo-Pertab,
Mobowa Makhomisane, Irene Njeri, Julius Mwita, Mariam Sefen,
Khadija Mohamed, Nicolette Whiley
DOI: 10.5742/MEWFM.2021.94188

Diagnostic approach to eosinophilia in children
[Abstract]
[pdf]
Raghba Shasho
DOI: 10.5742/MEWFM.2021.94190

Original Clinical Research

Machine Learning in Otorhinolaryngology, Head and Neck Surgery and its applications in diagnosis and management: Undergraduates Perception toward New Era
[Abstract]
[pdf]
Saleh Abdulmoneim Alomary, Belal Abdullah Alorainy , Naif Saleh Albargan, Fahad Z. Alotaibi
Feras Alkholaiwi
DOI: 10.5742/MEWFM.2021.94191


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Middle East Quality Improvement Program
(MEQUIP QI&CPD)

Chief Editor -
Abdulrazak Abyad MD, MPH, MBA, AGSF, AFCHSE
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Editorial Office -
Abyad Medical Center & Middle East Longevity Institute
Azmi Street, Abdo Center,
PO BOX 618
Tripoli, Lebanon
Phone: (961) 6-443684
Fax:     (961) 6-443685
Email: aabyad@cyberia.net.lb
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Publisher -
Lesley Pocock
medi+WORLD International
AUSTRALIA
Email: lesleypocock@mediworld.com.au
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Editorial Enquiries -
abyad@cyberia.net.lb
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Advertising Enquiries -
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December 2021 - Volume 11, Issue 12

Physicians’ Perspectives of Barriers to Insulin Initiation for Adults with Type 2 Diabetes Mellitus in Primary Health Care Centers (PHCCs), Tabouk Province - Kingdom of Saudi Arabia (KSA)


Sameh F. Ahmed, MSc, MD(1),
Ghurmallah A. Alghamdi, SBFM(2),
Amerah A. Albalawi, SBFM(1),
Majed S. Alqahtani SBFM(3),
Ibrahim M. Ghonim, EBFM, MRCGP(1),
Hoda M. Elhady, EBFM, MRCGP(1)
Shimaa A. Abdelhamid, MRCGP, EBFM(1)
Abderahman A. Eldesouky, M.B.Bch(1)

(1) Department of Public Health, MOH, Tabouk Health Region, KSA.
(2) General Health Affair, Tabouk Health Region, KSA.
(3) Diabetes Center, King Fahd Specialized Hospital, Tabouk, KSA.

Corresponding author:
Sameh Fawzi Ahmed, MBBS, MSc, MD, Consultant Family Physician, Department of Family Medicine, MOH, Tabouk, Saudi ArabiaDepartment of Family Medicine, Suez Canal University, EgyptCell phone: +966-581803197
Email: sfmahdi3691@gmail.com

Received: October 2021; Accepted: November 2021; Published: December 1, 2021.
Citation: Sameh F. Ahmed et al. Physicians’ Perspectives of Barriers to Insulin Initiation for Adults with Type 2 Diabetes Mellitus in Primary Health Care Centers (PHCCs), Tabouk Province - Kingdom of Saudi Arabia (KSA). World Family Medicine. 2021; 19(12): 105-117 DOI: 10.5742/MEWFM.2021.94189

Abstract


Aim: The goal of this study is to explore the family physicians’ perspectives of the barriers in initiating insulin for adult patients with Type 2 diabetes mellitus (T2DM) in their primary health care settings.

Background: Insulin therapy often becomes necessary when oral anti-hyperglycemic agents are not enough, no longer effective or even as an initial choice. Timely insulin initiation was noticed to be a clinical problem among people with type 2 diabetes mellitus (T2DM) registered in primary health care centers (PHCCs) of Tabouk Province, KSA. Tackling this inertia or insulinophobia is a challenge in order to delay or prevent serious complications of uncontrolled diabetes. Our study and many other studies indicated that this therapeutic inertia is inappropriately due to many patient, system and physician-related factors. The present study aimed to investigate physicians’ perspectives of barriers to insulin initiation for adults with T2DM registered in PHCCs, Tabouk Province - KSA and to identify opportunities for better outcomes.

Materials and Methods: This is a cross sectional study where 102 primary health care physicians (PHCPs) (58 females and 44 males) from multi PHCCs in Tabouk Health Province – Kingdom of Saudi Arabia (KSA), responded correctly to online reliable self-administered questionnaire (Cronbach alpha of 0.77344) to address their perspectives of barriers to insulin initiation for adult patients with T2DM. All participants were physicians attending PHCCs with well-equipped diabetes care clinics. Data were collected during a period from 6th – 17th June 2021. Participants included 11 (10.8%) family medicine consultants, 14 (13.7%) family medicine specialists and 77 (75.5%) general physicians.

Results: 68.6 of the study participants had barriers in initiating insulin for their patients with T2DM. A significant statistical disproportional correlation was found between the level of specialty and the rate of reporting barriers to insulin initiation (P<0.001). The top 10 listed barriers included the following: patients’ refusal to initiate insulin (71.4%), physicians’ fear of hypoglycemia (51.4%), inability of patients to perform home blood glucose monitoring (HMGM) (50%), physicians have no access to second opinion (44.3%), insufficient educational courses for physicians (37.1%), no family support for patients (34.3%), no clear MOH circular to support physicians’ initiation of insulin at PHCCs (28.6%) , insufficient hypoglycemic medications at PHCCs (25,7%), inability of patients to manage hypoglycemia (24.3%), and patients’ noncompliance to insulin regimen (24.3%).

Conclusion: Despite the free of cost availability of all types of insulin, including the safest and peak less ultra-long (degludec) and long (Glargine), the availability of free of cost glucometers for all people with diabetes, the presence of a well-equipped diabetes clinic at every PHCC, the long list of guidelines and educational courses as well as an appointment system with electronic health information system (HIS), insulin inertia is a common problem among PHCPs working in Tabouk Health Region.

Key words: Barriers, insulin initiation, insulin, primary health care, type 2 diabetes mellitus.







 


 
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