ABSTRACT
Aims: The morbidities and mortalities associated with diabetes are disproportionately high in low and middle income countries. This study aimed to explore important barriers and facilitators to diabetes care in Nigeria from the perspectives of diabetes healthcare providers (DHPs).Study Design:A nationwide descriptive survey Place and Duration:Onsite (Calabar, Nigeria) and online surveys conducted between September 2016 and March 2017. Methodology:A validated self-administered questionnaire was used to assess barriers to diabetes care and strategies to improve care among DHPs in Nigeria.Results:A total of 129 subjects with mean ± SD age and mean ± SD duration of practice of 42.4 ± 7.6 years and 8.5 ± 5.4 years respectively were surveyed. About 84.5% of the respondents perceived diabetes care in Nigeria as being remarkably challenging. The most common barriers identified include: poverty, low diabetes awareness, shortage of trained diabetes care specialists, poor diabetes care knowledge among primary care doctors, and poor knowledge of diabetes self care among patients and other institutional, cultural and religious barriers. To improve care, respondents recommended, among other strategies, increasing healthcare funding, expansion of national health insurance coverage, introduction of government subsidy on diabetes medications, encouraging local production of diabetes medicines and supplies, increasing public diabetes awareness, periodic training of general practitioners and strict regulation of alternative medicine practitioners and faith healing centers.Conclusion:This survey identified several barriers to diabetes care in Nigeria and proffered some useful and implementable strategies to improve care. In order to reduce the burden of diabetes in Nigeria and perhaps other countries in SSA, these expert opinions should form the basis for a blue print by major diabetes stakeholders and health policy makers
ABSTRACT
Aims: The aim of this study was to evaluate the perceptions of general physicians (GPs) regarding insulin and determine the barriers to its initiation in patients with type 2 diabetes mellitus (T2DM).Study Design:A cross-sectional, quantitative research.Place and Duration:Enugu metropolis, Southeast Nigeria, between March and November 2018.Methodology:We used structured self administered questionnaire to evaluate the perceptions of 64 GPs (45 males and 19 females) regarding insulin, and to elicit barriers to insulin initiation in subjects with T2DM.Results:The mean (SD) age of the participants was 45.5 (11.7) years and their duration of general practice ranged from 3 –38 years. Majority were private practitioners predominantly in the rural areas. Only 15 (23.4%) respondents had ever initiated insulin for outpatient with T2DM Fear of hypoglycemia, anticipated patients’ refusal of insulin, physician’s lack of confidence, and concerns about needle pains were among the commonly reported barriers to insulin initiation. Others were socio-economic factors including concerns about affordability of insulin and frequent glycemic monitoring, and availability of insulin storage facilities.There was a general consensus among the GPs on a number of misconceptions including that patients’ adherence to oral glucose lowering drugs eliminates the need for insulin; that insulin should be reserved as a last resort; and that once initiated, insulin therapy is lifelong.Conclusion:This study revealed that there are several physician-related barriers and misconceptions regarding insulin therapy for T2DM among GPs in Southeast Nigeria. Periodic training to improve GPs’ attitude to insulin and optimize insulin utilization in T2DM is required