High level of clinical inertia in insulin initiation in type 2 diabetes across Central and South-Eastern Europe: Insights from SITIP Study

Aims Little is known regarding initiation of insulin therapy in type 2 diabetes (T2D) in Central and South-Eastern European countries. Therefore, we conducted a survey to characterise the prescribing practices of specialist diabetes healthcare professionals in this region and assessed factors that infuence clinical decision-making regarding insulin initiation in T2D. Methods A cross-sectional survey sampled 211 specialist diabetes healthcare prescribers from fve Central and SouthEastern European countries (Bulgaria, Croatia, Greece, Hungary, and Slovenia). A structured questionnaire was developed which surveyed current clinical practices and infuencing factors, barriers to insulin initiation, and combination therapy prescribing preferences. Result Only 9.4% (20 of out of 211 respondents) of healthcare professionals would initiate insulin therapy in T2D patients at the recommended HbA1c threshold of 7–7.9% [53–63 mmol/mol]. Large regional differences were evident in insulin initiation thresholds (≥9.0% [≥75 mmol/mol]: Bulgaria 80.8% vs. Slovenia 13.3%). Psychological distress was recorded as the major barrier to insulin initiation. Health insurance regulations were ranked more important than personal clinical experience and clinical guidelines in clinical decision-making. Information from peers was more influential than manufacturer information, clinical experience, and continuous medical education, respectively, for insulin initiation. Conclusions Despite large regional variation, there is widespread delay of insulin initiation from specialist diabetes healthcare professionals in Central and South-Eastern Europe.