J. Med. Internet Res. - Diabetes patients' experiences with the implementation of insulin therapy and their perceptions of computer-assisted self-management systems for insulin therapy.

Tópicos

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Resumo

CKGROUND: Computer-assisted decision support is an emerging modality to assist patients with type 2 diabetes mellitus (T2DM) in insulin self-titration (ie, self-adjusting insulin dose according to daily blood glucose levels). Computer-assisted insulin self-titration systems mainly focus on helping patients overcome barriers related to the cognitive components of insulin titration. Yet other (eg, psychological or physical) barriers could still impede effective use of such systems.OBJECTIVE: Our primary aim was to identify experiences with and barriers to self-monitoring of blood glucose, insulin injection, and insulin titration among patients with T2DM. Our research team developed a computer-assisted insulin self-titration system, called PANDIT. The secondary aim of this study was to evaluate patients' perceptions of computer-assisted insulin self-titration. We included patients who used PANDIT in a 4-week pilot study as well as patients who had never used such a system.METHODS: In-depth, semi-structured interviews were conducted individually with patients on insulin therapy who were randomly recruited from a university hospital and surrounding general practices in the Netherlands. The interviews were transcribed verbatim and analyzed qualitatively. To classify the textual remarks, we created a codebook during the analysis, in a bottom-up and iterative fashion. To support examination of the final coded data, we used three theories from the field of health psychology and the integrated model of user satisfaction and technology acceptance by Wixom and Todd.RESULTS: When starting insulin therapy, some patients feared a lifelong commitment to insulin therapy and disease progression. Also, many barriers arose when implementing insulin therapy (eg, some patients were embarrassed to inject insulin in public). Furthermore, patients had difficulties increasing the insulin dose because they fear hypoglycemia, they associate higher insulin doses with disease progression, and some were ignorant of treatment targets. Patients who never used a computer-assisted insulin self-titration system felt they had enough knowledge to know when their insulin should be adjusted, but still believed that the system advice would be useful to confirm their reasoning. Furthermore, the time and effort saved with automated insulin advice was considered an advantage. Patients who had used PANDIT found the system useful if their glycemic regulation improved. Nevertheless, for some patients, the absence of personal contact with their caregiver was a drawback. While guidelines state that adjustment of basal insulin dose based on fasting plasma glucose values is sufficient, both patients who had and those who had not used PANDIT felt that such a system should take more patient data into consideration, such as lifestyle and diet factors.CONCLUSIONS: Patients encounter multiple obstacles when implementing insulin therapy. Computer-assisted insulin self-titration can increase patient awareness of treatment targets and increase their confidence in self-adjusting the insulin dose. Nevertheless, some barriers may still exist when using computer-assisted titration systems and these systems could also introduce new barriers.

Resumo Limpo

ckground computerassist decis support emerg modal assist patient type diabet mellitus tdm insulin selftitr ie selfadjust insulin dose accord daili blood glucos level computerassist insulin selftitr system main focus help patient overcom barrier relat cognit compon insulin titrat yet eg psycholog physic barrier still imped effect use systemsobject primari aim identifi experi barrier selfmonitor blood glucos insulin inject insulin titrat among patient tdm research team develop computerassist insulin selftitr system call pandit secondari aim studi evalu patient percept computerassist insulin selftitr includ patient use pandit week pilot studi well patient never use systemmethod indepth semistructur interview conduct individu patient insulin therapi random recruit univers hospit surround general practic netherland interview transcrib verbatim analyz qualit classifi textual remark creat codebook analysi bottomup iter fashion support examin final code data use three theori field health psycholog integr model user satisfact technolog accept wixom toddresult start insulin therapi patient fear lifelong commit insulin therapi diseas progress also mani barrier aros implement insulin therapi eg patient embarrass inject insulin public furthermor patient difficulti increas insulin dose fear hypoglycemia associ higher insulin dose diseas progress ignor treatment target patient never use computerassist insulin selftitr system felt enough knowledg know insulin adjust still believ system advic use confirm reason furthermor time effort save autom insulin advic consid advantag patient use pandit found system use glycem regul improv nevertheless patient absenc person contact caregiv drawback guidelin state adjust basal insulin dose base fast plasma glucos valu suffici patient use pandit felt system take patient data consider lifestyl diet factorsconclus patient encount multipl obstacl implement insulin therapi computerassist insulin selftitr can increas patient awar treatment target increas confid selfadjust insulin dose nevertheless barrier may still exist use computerassist titrat system system also introduc new barrier

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