Factors that drive insulin-dosing decisions of diabetes care providers: a vignette-based study in the Netherlands
Aim To test how certain patient factors would influence the decision of Dutch care providers regarding insulin dose adjustments. We hypothesize that some of these decisions would diverge from recent evidence and consensus statements. Methods We developed narrative vignettes describing clinical scena...
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| Veröffentlicht in: | Diabetic medicine 2015-01, Vol.32 (1), p.69-77 |
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| creator | Simon, A. C. R. Schopman, J. E. Hoekstra, J. B. L. Abu-Hanna, A. Gerdes, V. E. A. Peek, N. Holleman, F. |
| description | Aim
To test how certain patient factors would influence the decision of Dutch care providers regarding insulin dose adjustments. We hypothesize that some of these decisions would diverge from recent evidence and consensus statements.
Methods
We developed narrative vignettes describing clinical scenarios of patients receiving basal insulin therapy. For each vignette, the respondents were asked to indicate whether they would advise a change in insulin dose. A total of 520 paper questionnaires were distributed among physicians and nurses in primary and secondary care in the Netherlands. Multivariate linear and logistic regression analyses were performed to identify factors associated with dosing decisions.
Results
A total of 190 (37%) questionnaires were returned. In cases of a severe rather than mild hypoglycaemic event, care providers were nearly five times more likely to decrease the dose (odds ratio 4.77, 95% CI 1.65–13.75). Care providers were six times more likely to increase the dose when the patient's current dose was low (30 units) rather than high (90 units) (odds ratio 6.38, 95% CI 3.04–13.37). The plasma glucose concentration during a hypoglycaemic event and a known history of cardiovascular disease did not influence the care providers' dosing decisions.
Conclusion
Evidence regarding the optimum insulin titration is not always translated into clinical practice. When formulating guidelines, misconceptions should be identified and addressed.
What's new?
Many guidelines and consensus statements have been developed to advise care providers on the implementation of insulin therapy in people with Type 2 diabetes, but little is known about the actual strategies that are followed by care providers in clinical practice.
Some of the decisions of care providers regarding insulin dose adjustments diverge from the available evidence and consensus statements. This study showed that pseudo‐hypoglycaemic events and high insulin doses are perceived as barriers to intensifying insulin dose. Based on our results, we recommend that misconceptions should be specifically identified and addressed when formulating and implementing guidelines. |
| doi_str_mv | 10.1111/dme.12586 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_1652766199</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>1652766199</sourcerecordid><originalsourceid>FETCH-LOGICAL-c4246-fd938e847b64e1eaeb808378ff8973bb9ddc647c2e7b7d0565a5c5c0d3543b5c3</originalsourceid><addsrcrecordid>eNp1kU1v1DAQhi0EokvhwB9AlrjAIa2_nXBDpV0QpRzaAjfLsSfFJZu0nmRh_30N2_aA1Dl4Ls88euWXkJec7fEy-3EFe1zo2jwiC66MqrRq-GOyYFaJSjLLd8gzxEvGuGhk85TsCC2YkkYsyPWRD9OYkU4__URjTmugacC5T0MVR0zDBY0QEqZxQDp2NCbfwgRIg89Ar_K4ThEyvqOertPFANMEVesRIsVpjpviKmagJ1De3Psh4nPypPM9wovbvUvOjw7PDj5Wx1-Xnw7eH1dBCWWqLjayhlrZ1ijg4KGtWS1t3XV1Y2XbNjEGo2wQYFsbmTba66ADi1Ir2eogd8mbrbeEvJ4BJ7dKGKAvIWCc0XGjhTWGN01BX_-HXo5zHkq6QknDtLZWFurtlgp5RMzQuaucVj5vHGfubw-u9OD-9VDYV7fGuV1BvCfvPr4A-1vgd-ph87DJffhyeKesthcJJ_hzf-HzL2estNp9P1k6u_zMv50tf7hTeQNhFqGi</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1636055773</pqid></control><display><type>article</type><title>Factors that drive insulin-dosing decisions of diabetes care providers: a vignette-based study in the Netherlands</title><source>Wiley-Blackwell Journals</source><source>MEDLINE</source><creator>Simon, A. C. R. ; Schopman, J. E. ; Hoekstra, J. B. L. ; Abu-Hanna, A. ; Gerdes, V. E. A. ; Peek, N. ; Holleman, F.</creator><creatorcontrib>Simon, A. C. R. ; Schopman, J. E. ; Hoekstra, J. B. L. ; Abu-Hanna, A. ; Gerdes, V. E. A. ; Peek, N. ; Holleman, F.</creatorcontrib><description>Aim
To test how certain patient factors would influence the decision of Dutch care providers regarding insulin dose adjustments. We hypothesize that some of these decisions would diverge from recent evidence and consensus statements.
Methods
We developed narrative vignettes describing clinical scenarios of patients receiving basal insulin therapy. For each vignette, the respondents were asked to indicate whether they would advise a change in insulin dose. A total of 520 paper questionnaires were distributed among physicians and nurses in primary and secondary care in the Netherlands. Multivariate linear and logistic regression analyses were performed to identify factors associated with dosing decisions.
Results
A total of 190 (37%) questionnaires were returned. In cases of a severe rather than mild hypoglycaemic event, care providers were nearly five times more likely to decrease the dose (odds ratio 4.77, 95% CI 1.65–13.75). Care providers were six times more likely to increase the dose when the patient's current dose was low (30 units) rather than high (90 units) (odds ratio 6.38, 95% CI 3.04–13.37). The plasma glucose concentration during a hypoglycaemic event and a known history of cardiovascular disease did not influence the care providers' dosing decisions.
Conclusion
Evidence regarding the optimum insulin titration is not always translated into clinical practice. When formulating guidelines, misconceptions should be identified and addressed.
What's new?
Many guidelines and consensus statements have been developed to advise care providers on the implementation of insulin therapy in people with Type 2 diabetes, but little is known about the actual strategies that are followed by care providers in clinical practice.
Some of the decisions of care providers regarding insulin dose adjustments diverge from the available evidence and consensus statements. This study showed that pseudo‐hypoglycaemic events and high insulin doses are perceived as barriers to intensifying insulin dose. Based on our results, we recommend that misconceptions should be specifically identified and addressed when formulating and implementing guidelines.</description><identifier>ISSN: 0742-3071</identifier><identifier>EISSN: 1464-5491</identifier><identifier>DOI: 10.1111/dme.12586</identifier><identifier>PMID: 25204362</identifier><identifier>CODEN: DIMEEV</identifier><language>eng</language><publisher>England: Blackwell Publishing Ltd</publisher><subject>Adult ; Algorithms ; Attitude of Health Personnel ; Clinical medicine ; Decision Making ; Diabetes ; Diabetes Mellitus, Type 1 - drug therapy ; Diabetes Mellitus, Type 1 - epidemiology ; Diabetes Mellitus, Type 2 - drug therapy ; Diabetes Mellitus, Type 2 - epidemiology ; Dose-Response Relationship, Drug ; Drug Administration Schedule ; Evidence-Based Practice ; Female ; Guideline Adherence ; Humans ; Hyperglycemia ; Hypoglycemia ; Hypoglycemia - prevention & control ; Hypoglycemic Agents - administration & dosage ; Insulin ; Insulin - administration & dosage ; Male ; Middle Aged ; Netherlands - epidemiology ; Practice Guidelines as Topic ; Practice Patterns, Physicians' - statistics & numerical data ; Surveys and Questionnaires</subject><ispartof>Diabetic medicine, 2015-01, Vol.32 (1), p.69-77</ispartof><rights>2014 The Authors. Diabetic Medicine © 2014 Diabetes UK</rights><rights>2014 The Authors. Diabetic Medicine © 2014 Diabetes UK.</rights><rights>Diabetic Medicine © 2014 Diabetes UK</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c4246-fd938e847b64e1eaeb808378ff8973bb9ddc647c2e7b7d0565a5c5c0d3543b5c3</citedby><cites>FETCH-LOGICAL-c4246-fd938e847b64e1eaeb808378ff8973bb9ddc647c2e7b7d0565a5c5c0d3543b5c3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1111%2Fdme.12586$$EPDF$$P50$$Gwiley$$H</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1111%2Fdme.12586$$EHTML$$P50$$Gwiley$$H</linktohtml><link.rule.ids>315,781,785,1418,27926,27927,45576,45577</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/25204362$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Simon, A. C. R.</creatorcontrib><creatorcontrib>Schopman, J. E.</creatorcontrib><creatorcontrib>Hoekstra, J. B. L.</creatorcontrib><creatorcontrib>Abu-Hanna, A.</creatorcontrib><creatorcontrib>Gerdes, V. E. A.</creatorcontrib><creatorcontrib>Peek, N.</creatorcontrib><creatorcontrib>Holleman, F.</creatorcontrib><title>Factors that drive insulin-dosing decisions of diabetes care providers: a vignette-based study in the Netherlands</title><title>Diabetic medicine</title><addtitle>Diabet. Med</addtitle><description>Aim
To test how certain patient factors would influence the decision of Dutch care providers regarding insulin dose adjustments. We hypothesize that some of these decisions would diverge from recent evidence and consensus statements.
Methods
We developed narrative vignettes describing clinical scenarios of patients receiving basal insulin therapy. For each vignette, the respondents were asked to indicate whether they would advise a change in insulin dose. A total of 520 paper questionnaires were distributed among physicians and nurses in primary and secondary care in the Netherlands. Multivariate linear and logistic regression analyses were performed to identify factors associated with dosing decisions.
Results
A total of 190 (37%) questionnaires were returned. In cases of a severe rather than mild hypoglycaemic event, care providers were nearly five times more likely to decrease the dose (odds ratio 4.77, 95% CI 1.65–13.75). Care providers were six times more likely to increase the dose when the patient's current dose was low (30 units) rather than high (90 units) (odds ratio 6.38, 95% CI 3.04–13.37). The plasma glucose concentration during a hypoglycaemic event and a known history of cardiovascular disease did not influence the care providers' dosing decisions.
Conclusion
Evidence regarding the optimum insulin titration is not always translated into clinical practice. When formulating guidelines, misconceptions should be identified and addressed.
What's new?
Many guidelines and consensus statements have been developed to advise care providers on the implementation of insulin therapy in people with Type 2 diabetes, but little is known about the actual strategies that are followed by care providers in clinical practice.
Some of the decisions of care providers regarding insulin dose adjustments diverge from the available evidence and consensus statements. This study showed that pseudo‐hypoglycaemic events and high insulin doses are perceived as barriers to intensifying insulin dose. Based on our results, we recommend that misconceptions should be specifically identified and addressed when formulating and implementing guidelines.</description><subject>Adult</subject><subject>Algorithms</subject><subject>Attitude of Health Personnel</subject><subject>Clinical medicine</subject><subject>Decision Making</subject><subject>Diabetes</subject><subject>Diabetes Mellitus, Type 1 - drug therapy</subject><subject>Diabetes Mellitus, Type 1 - epidemiology</subject><subject>Diabetes Mellitus, Type 2 - drug therapy</subject><subject>Diabetes Mellitus, Type 2 - epidemiology</subject><subject>Dose-Response Relationship, Drug</subject><subject>Drug Administration Schedule</subject><subject>Evidence-Based Practice</subject><subject>Female</subject><subject>Guideline Adherence</subject><subject>Humans</subject><subject>Hyperglycemia</subject><subject>Hypoglycemia</subject><subject>Hypoglycemia - prevention & control</subject><subject>Hypoglycemic Agents - administration & dosage</subject><subject>Insulin</subject><subject>Insulin - administration & dosage</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Netherlands - epidemiology</subject><subject>Practice Guidelines as Topic</subject><subject>Practice Patterns, Physicians' - statistics & numerical data</subject><subject>Surveys and Questionnaires</subject><issn>0742-3071</issn><issn>1464-5491</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2015</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp1kU1v1DAQhi0EokvhwB9AlrjAIa2_nXBDpV0QpRzaAjfLsSfFJZu0nmRh_30N2_aA1Dl4Ls88euWXkJec7fEy-3EFe1zo2jwiC66MqrRq-GOyYFaJSjLLd8gzxEvGuGhk85TsCC2YkkYsyPWRD9OYkU4__URjTmugacC5T0MVR0zDBY0QEqZxQDp2NCbfwgRIg89Ar_K4ThEyvqOertPFANMEVesRIsVpjpviKmagJ1De3Psh4nPypPM9wovbvUvOjw7PDj5Wx1-Xnw7eH1dBCWWqLjayhlrZ1ijg4KGtWS1t3XV1Y2XbNjEGo2wQYFsbmTba66ADi1Ir2eogd8mbrbeEvJ4BJ7dKGKAvIWCc0XGjhTWGN01BX_-HXo5zHkq6QknDtLZWFurtlgp5RMzQuaucVj5vHGfubw-u9OD-9VDYV7fGuV1BvCfvPr4A-1vgd-ph87DJffhyeKesthcJJ_hzf-HzL2estNp9P1k6u_zMv50tf7hTeQNhFqGi</recordid><startdate>201501</startdate><enddate>201501</enddate><creator>Simon, A. C. R.</creator><creator>Schopman, J. E.</creator><creator>Hoekstra, J. B. L.</creator><creator>Abu-Hanna, A.</creator><creator>Gerdes, V. E. A.</creator><creator>Peek, N.</creator><creator>Holleman, F.</creator><general>Blackwell Publishing Ltd</general><general>Wiley Subscription Services, Inc</general><scope>BSCLL</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7T5</scope><scope>8FD</scope><scope>FR3</scope><scope>H94</scope><scope>K9.</scope><scope>P64</scope><scope>RC3</scope><scope>ASE</scope><scope>FPQ</scope><scope>K6X</scope></search><sort><creationdate>201501</creationdate><title>Factors that drive insulin-dosing decisions of diabetes care providers: a vignette-based study in the Netherlands</title><author>Simon, A. C. R. ; Schopman, J. E. ; Hoekstra, J. B. L. ; Abu-Hanna, A. ; Gerdes, V. E. A. ; Peek, N. ; Holleman, F.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c4246-fd938e847b64e1eaeb808378ff8973bb9ddc647c2e7b7d0565a5c5c0d3543b5c3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2015</creationdate><topic>Adult</topic><topic>Algorithms</topic><topic>Attitude of Health Personnel</topic><topic>Clinical medicine</topic><topic>Decision Making</topic><topic>Diabetes</topic><topic>Diabetes Mellitus, Type 1 - drug therapy</topic><topic>Diabetes Mellitus, Type 1 - epidemiology</topic><topic>Diabetes Mellitus, Type 2 - drug therapy</topic><topic>Diabetes Mellitus, Type 2 - epidemiology</topic><topic>Dose-Response Relationship, Drug</topic><topic>Drug Administration Schedule</topic><topic>Evidence-Based Practice</topic><topic>Female</topic><topic>Guideline Adherence</topic><topic>Humans</topic><topic>Hyperglycemia</topic><topic>Hypoglycemia</topic><topic>Hypoglycemia - prevention & control</topic><topic>Hypoglycemic Agents - administration & dosage</topic><topic>Insulin</topic><topic>Insulin - administration & dosage</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Netherlands - epidemiology</topic><topic>Practice Guidelines as Topic</topic><topic>Practice Patterns, Physicians' - statistics & numerical data</topic><topic>Surveys and Questionnaires</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Simon, A. C. R.</creatorcontrib><creatorcontrib>Schopman, J. E.</creatorcontrib><creatorcontrib>Hoekstra, J. B. L.</creatorcontrib><creatorcontrib>Abu-Hanna, A.</creatorcontrib><creatorcontrib>Gerdes, V. E. A.</creatorcontrib><creatorcontrib>Peek, N.</creatorcontrib><creatorcontrib>Holleman, F.</creatorcontrib><collection>Istex</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Immunology Abstracts</collection><collection>Technology Research Database</collection><collection>Engineering Research Database</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Biotechnology and BioEngineering Abstracts</collection><collection>Genetics Abstracts</collection><collection>British Nursing Index</collection><collection>British Nursing Index (BNI) (1985 to Present)</collection><collection>British Nursing Index</collection><jtitle>Diabetic medicine</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Simon, A. C. R.</au><au>Schopman, J. E.</au><au>Hoekstra, J. B. L.</au><au>Abu-Hanna, A.</au><au>Gerdes, V. E. A.</au><au>Peek, N.</au><au>Holleman, F.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Factors that drive insulin-dosing decisions of diabetes care providers: a vignette-based study in the Netherlands</atitle><jtitle>Diabetic medicine</jtitle><addtitle>Diabet. Med</addtitle><date>2015-01</date><risdate>2015</risdate><volume>32</volume><issue>1</issue><spage>69</spage><epage>77</epage><pages>69-77</pages><issn>0742-3071</issn><eissn>1464-5491</eissn><coden>DIMEEV</coden><abstract>Aim
To test how certain patient factors would influence the decision of Dutch care providers regarding insulin dose adjustments. We hypothesize that some of these decisions would diverge from recent evidence and consensus statements.
Methods
We developed narrative vignettes describing clinical scenarios of patients receiving basal insulin therapy. For each vignette, the respondents were asked to indicate whether they would advise a change in insulin dose. A total of 520 paper questionnaires were distributed among physicians and nurses in primary and secondary care in the Netherlands. Multivariate linear and logistic regression analyses were performed to identify factors associated with dosing decisions.
Results
A total of 190 (37%) questionnaires were returned. In cases of a severe rather than mild hypoglycaemic event, care providers were nearly five times more likely to decrease the dose (odds ratio 4.77, 95% CI 1.65–13.75). Care providers were six times more likely to increase the dose when the patient's current dose was low (30 units) rather than high (90 units) (odds ratio 6.38, 95% CI 3.04–13.37). The plasma glucose concentration during a hypoglycaemic event and a known history of cardiovascular disease did not influence the care providers' dosing decisions.
Conclusion
Evidence regarding the optimum insulin titration is not always translated into clinical practice. When formulating guidelines, misconceptions should be identified and addressed.
What's new?
Many guidelines and consensus statements have been developed to advise care providers on the implementation of insulin therapy in people with Type 2 diabetes, but little is known about the actual strategies that are followed by care providers in clinical practice.
Some of the decisions of care providers regarding insulin dose adjustments diverge from the available evidence and consensus statements. This study showed that pseudo‐hypoglycaemic events and high insulin doses are perceived as barriers to intensifying insulin dose. Based on our results, we recommend that misconceptions should be specifically identified and addressed when formulating and implementing guidelines.</abstract><cop>England</cop><pub>Blackwell Publishing Ltd</pub><pmid>25204362</pmid><doi>10.1111/dme.12586</doi><tpages>9</tpages></addata></record> |
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| ispartof | Diabetic medicine, 2015-01, Vol.32 (1), p.69-77 |
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| source | Wiley-Blackwell Journals; MEDLINE |
| subjects | Adult Algorithms Attitude of Health Personnel Clinical medicine Decision Making Diabetes Diabetes Mellitus, Type 1 - drug therapy Diabetes Mellitus, Type 1 - epidemiology Diabetes Mellitus, Type 2 - drug therapy Diabetes Mellitus, Type 2 - epidemiology Dose-Response Relationship, Drug Drug Administration Schedule Evidence-Based Practice Female Guideline Adherence Humans Hyperglycemia Hypoglycemia Hypoglycemia - prevention & control Hypoglycemic Agents - administration & dosage Insulin Insulin - administration & dosage Male Middle Aged Netherlands - epidemiology Practice Guidelines as Topic Practice Patterns, Physicians' - statistics & numerical data Surveys and Questionnaires |
| title | Factors that drive insulin-dosing decisions of diabetes care providers: a vignette-based study in the Netherlands |
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