OBJECTIVE -To examine the correlates of patient and provider attitudes toward insulin therapy.RESEARCH DESIGN AND METHODS -Data are from surveys of patients with type 2 diabetes not taking insulin (n ϭ 2,061) and diabetes care providers (nurses ϭ 1,109; physicians ϭ 2,681) in 13 countries in Asia, Australia, Europe, and North America. Multiple regression analysis is used to identify correlates of attitudes toward insulin therapy among patients, physicians, and nurses.RESULTS -Patient and provider attitudes differ significantly across countries, controlling for individual characteristics. Patients rate the clinical efficacy of insulin as low and would blame themselves if they had to start insulin therapy. Self-blame is significantly lower among those who have better diet and exercise adherence and less diabetes-related distress. Patients who are not managing their diabetes well (poor perceived control, more complications, and diabetes-related distress) are significantly more likely to see insulin therapy as potentially beneficial. Most nurses and general practitioners (50 -55%) delay insulin therapy until absolutely necessary, but specialists and opinion leaders are less likely to do so. Delay of insulin therapy is significantly less likely when physicians and nurses see their patients as more adherent to medication or appointment regimens, view insulin as more efficacious, and when they are less likely to delay oral diabetes medications.CONCLUSIONS -Patient and provider resistance to insulin therapy is substantial, and for providers it is part of a larger pattern of reluctance to prescribe blood glucose-lowering medication. Interventions to facilitate timely initiation of insulin therapy will need to address factors associated with this resistance.

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ObjectiveSince 2014 Senegal has benefited from regular awareness-raising Short Message Service (SMS) campaigns (Be He@lthy, Be Mobile initiative) directed at people who have signed up, for free, to the ‘mDiabète’ programme. We report on an evaluation of its impact on diabetes control.DesignThe clinical trial was designed to send daily SMS during 3 months to people with type 2 diabetes. Due to centre randomisation, SMS were sent from inclusion (M0) to month 3 (M3) to people in centre S and from M3 to month 6 (M6) to people in centre P.SettingMedical centre S in the northwestern suburbs of Dakar; centre P in Popenguine, 70 km south of Dakar.ParticipantsIn February 2017, people with type 2 diabetes were consecutively recruited in the two centres. Complete data were available from 186 of these people.Main outcome measuresHbA1c was measured in the two centres with the same assay throughout the study. The primary end point was the difference between centres for the change in HbA1c from M0 to M3. Secondary end points were the evolution of HbA1c in centres S and P between M3 and M6.ResultsThe HbA1c change from M0 to M3 in centre S was better than in centre P, with a median difference of −0.4%, quartiles (−1.0; 0.3) versus 0.2% (-0.5; 0.8), respectively (p=0.0038). HbA1c decreased over the 3 months after having stopped SMS in centre S and was confirmed in centre P. The campaign cost was €2.5 (US$3.1) per person.ConclusionsIn Senegal, SMS sending was associated with an improved glycaemic control in people with type 2 diabetes. As SMS has a high penetration in low-income, middle-income countries where medical resources are scarce, health interventions using mobile telephones should be developed to facilitate exchanges between people with diabetes and medical teams; this may reduce diabetes-related complications.

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Diabetes mellitus is one of the major causes of morbidity and mortality in EU/EFTA countries. Monitoring risk factors for diabetes and its complications will offer the possibility to evaluate the development in time as well as the influence of possible interventions. In this investigation a list with core and secondary indicators is proposed. Availability of these indicators and their data sources is discussed. An important variability of data sources is used in EU/EFTA countries, interfering with the comparability of the outcome. Further harmonisation as well as continuous evaluation of data sources will be necessary to provide reliable tools to monitor diabetes mellitus and its outcome on a routine basis.

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