Barriers and facilitators to insulin therapy
Research type
Research Study
Full title
Phase 1:Exploring barriers and facilitators to the initiation of insulin therapy in people with type 2 diabetes from ethnic minority populations Phase 2:Development and piloting of an intervention delivered by community champions to address the barriers to insulin initiation.
IRAS ID
314077
Contact name
Pratik Choudhary
Contact email
Sponsor organisation
University of Leicester
Duration of Study in the UK
1 years, 0 months, 1 days
Research summary
Type 2 diabetes mellitus (T2D) is commonly characterized by persistently high levels of glucose in the blood due to the failure of the pancreas to produce sufficient insulin to maintain normal glucose levels. Uncontrolled glucose levels are associated with complications, such as blindness, lower limb amputation, kidney disease, stroke, and heart disease.
The population of ethnic minorities in the UK has been growing steadily from 4.5 million in 2001 to 6.4 million in 2011. T2D is undiagnosed more frequently in people from black ethnic minority populations than in individuals from white backgrounds, and they have a four-fold increased risk of developing diabetes.
In addition, research on this topic suggests a delay in insulin initiation among non-white populations compared with white populations. Even with clear treatment guidelines, ethnic minorities continue to take oral antihyperglycemic drugs for a mean duration of 7.7years with suboptimal glycaemic control. Ethnic minorities also develop T2D 10 years earlier due to beta cell dysfunction and may therefore require insulin earlier. Despite ethnic minorities initiating oral diabetes treatment earlier than white populations, there were delays in treatment intensification to insulin therapy, which led to poorer health outcomes. Various factors are thought to contribute to this, including the fear of side effects and clinical inertia. Other contributing factors found in the literature specific to ethnic minorities include negative attitudes toward insulin therapy language barriers, lack of health knowledge, social stigma, conflicting religious beliefs about insulin, healthcare professionals’ time constraints associated with language barriers, and concerns about patients’ negative cultural and social influences on insulin therapy.
A review of the literature revealed themes regarding barriers to insulin therapy: psychological insulin resistance, therapeutic inertia, and beliefs. However, we are not aware of specific barriers in ethnic minority populations.
Therefore, this research aimed to identify specific barriers through in-depth semi-structured interviews with people with T2D from ethnic minority populations and focus group discussions with healthcare practitioners. By exploring the barriers associated with insulin therapy from this specific ethnic group and healthcare professionals, we aim to use data collected to inform intervention mapping for training community champions to promote the initiation of insulin therapy.REC name
West Midlands - South Birmingham Research Ethics Committee
REC reference
23/WM/0193
Date of REC Opinion
27 Sep 2023
REC opinion
Further Information Favourable Opinion