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
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.Summary of Results: We would like to sincerely thank all the individuals who took part in this study. Your willingness to share your experiences and perspectives has been essential in helping us better understand the challenges around starting insulin treatment. Your contributions will help inform improvements in diabetes care and support for people from ethnic minority populations. This research explored the challenges and support factors related to starting insulin treatment among people with type 2 diabetes from ethnic minority backgrounds. The study was carried out by Priscilla Katapa as part of a PhD at the University of Leicester and Leicester Diabetes Centre and was funded by the NIHR Applied Research Collaboration (ARC) East Midlands. The study took place in the United Kingdom as part of this research programme. 17 People living with type 2 diabetes from ethnic minority backgrounds, as well as 15 healthcare professionals directly involved in their diabetes care, took part in the study. Participants shared their lived experiences and views through one-to-one interviews, helping to identify real-world challenges regarding starting insulin therapy and support needs. Insulin is an effective treatment for managing type 2 diabetes, but some people find it difficult to start or continue using it. This study aimed to understand why this happens by exploring people’s experiences and perspectives. The study found that decisions about insulin are influenced by a range of factors rather than a single issue. Many people reported feeling worried or fearful about starting insulin, including concerns about injections, side effects, and what starting insulin might mean about the severity of their condition. Cultural beliefs and social influences also played an important role, with family views and concerns about stigma affecting how insulin was perceived. Some participants experienced challenges in communication with healthcare professionals, such as difficulty understanding information or feeling that they were not fully supported during appointments. In addition, pressures within the healthcare system, such as limited appointment time and resources, made it harder to provide ongoing support. Despite these challenges, the study also identified factors that helped people accept insulin. These included clear and supportive communication, care that takes account of cultural beliefs and values, and encouragement from family members and healthcare professionals. Overall, the findings show that improving insulin use requires more than just providing medical information. A more supportive and personalised approach is needed, including better communication, culturally sensitive care, and involvement of family and community where appropriate. The findings from this study will be used to develop a new intervention to support people starting insulin. This will involve community champions who can provide culturally relevant education and support, with the aim of helping people feel more confident and better supported in managing their diabetes.
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