Psychological Insulin Resistance Survey To General Practitioners In Shanghai

ObjectiveInsulin therapy is recommended for type2diabetic patients with poor glycemic control. However, the initiation of insulin therapy is often delayed in clinical practice. There are many reasons, an important one of them is psychological insulin resistance (PIR).we aims to investigate their views about insulin therapy and their familiarity with insulin therapy in general practitioners in Shanghai, and to analyze the situation of PIR in general practitioners in Shanghai, and its influencing factors. Met. We also aims to verify the PIR scale that we have quoted is suitable and effective in general practitioners in Shanghai.MethodsThe questionnaire consists of four parts, guide part, personal information, the PIR scale and insulin-related knowledge survey. Currently, there is no PIR scale for providers in our country. We reviewed a variety of diabetes-related literatures, finally, we adopted the Physicians Attitude to Insulin Therapy questionnaire(PAINT) of the DAWN JAPAN. We translated the scale, and pre-survey was eligible for reliability and validity of it. Ultimately the final PIR scale was adopted. We summarized the insulin-related knowledge survey through referenced2011China Diabetes Drug Injection Technology Guide and2010China Guideline for Type2Diabetes. We conducted the survey in mid-April2013with the general practitioners, who are working Community Health Center in Shanghai.Results1. Reliability and validity analysis of our questionnaire The PIR scale includes27items and three subscales, reliability measure a sum score of Cronbach’ Sa=0.896>0.7, Cronbach’S a of scale1is0.814, scale2is0.920and scale3is0.813. Results of the confirmatory factor analysis(CFA) also confirmed the structure of the questionnaire body part with an acceptable to good model fit with x2/df=3.422,RMSEA=0.093, RMR=0.077, CFI=0.775, IFI=0.770, GFI=0.787. Showing that it is appropriate to create a total score.2. Demographic and clinical characteristics of our survey Complete questionnaires were available from339general practitioners, of whom141were male,258were female;328were Western general,71were traditional Chinese Medicine;12were technical secondary school,68were junior college,296were undergraduate course,23were Master or above;58were resident physicians,294were attending physicians,47were associate senior physicians and chief physicians. The average of age is41.18+9.4years old. The an average of working life is18.07+9.64years. The number of general practitioners who have experience providing insulin therapy was210. The number of general practitioners who have experience providing guidance on diabetes treatment was319.3. Timing for starting insulin therapy The level of HbAlc that general practitioners will consider starting insulin therapy to patients was8.35%±0.99. But when the level of HbAlc was8.10%±0.96, the general practitioners with type2diabetes will consider insulin therapy in themselves. The differenced were both statistically significant(P=0.000<0.001).4. Situation of general practitioners with PIR in shanghai A total of127questionnaires had a sum score of81, which means they have PIR. PIR overall incidence rate was31.83%. The first three psychological factors of PIR were q9"If necessary, I can refer the patient to a specialist", q20"Patients would resist insulin therapy", q12" I do not have staff (nurses, pharmacists) who can assist with explanations".5. The situation of the knowledge of insulin therapy A Total of203questionnaires had a sum score over60, which means this part of general practitioners do know the knowledge of insulin therapy well. The average score is55.74±15.86. Of the10questions, q4"intermediate-acting insulin absorption peak after the injection a few hours", the correct rate was lowest;q1"What is the gold standard for evaluation of the level of blood sugar control", the correct rate was highest.Conclusion1. The PIR scale we used is reliable and valid, and can be used in general practitioners in shanghai Shanghai.2. The timing that general practitioners choose to start insulin therapy is too late. But if a general practitioner was a type2diabetes patient, he will initiate insulin therapy earlier.3. PIR incidence rate in general practitioners in shanghai is31.83%, compared to similar investigations abroad, the rate is lower than them.4. The main factors that lead to psychological insulin resistance in general practitioners in Shanghai are:lack of confidence on insulin therapy; worry about patients would not comply with the treatment; do not have enough time to explain how to use insulin properly to patients5. General practitioners do not know the knowledge of insulin therapy very well, especially the pharmacokinetics of insulin. They need further strengthen in insulin knowledge.