Clinical inertia to initiation of insulin therapy among patients with Type 2 Diabetes in Moi Teaching and Referral Hospital, Kenya: A mixed methods study

Abstract

Background: The prevalence of diabetes among Kenyan adults currently stands at 4%, with Type 2 Diabetes (T2D) contributing to over 90% of cases. Clinical inertia in diabetology is defined as the lack of antidiabetic therapy escalation despite patients failing to achieve glycemic targets.
Objectives: To determine the prevalence of clinical inertia to insulin therapy among patients with T2D in Eldoret, identify associated patient factors, and to explore clinicians’ view on the use of routine insulin therapy among patients with T2D.
Methods: This was a mixed methods study conducted in Moi Teaching and Referral Hospital, Eldoret in the Diabetes Out Patient Clinic (MTRH DOPC), where the quantitative stage involved a cross sectional study to determine the prevalence of clinical inertia and its associated factors with a patient sample size of 480. Questionnaires record patient biodata, HbA1c levels, patients’ attitudes
towards insulin using the Insulin Treatment Appraisal Scale (ITAS), clinical depression using Patient Health Questionnaire-9 (PHQ-9), and patient T2D self-care knowledge using Spoken Knowledge in Low Literacy in Diabetes (SKILLD) tool. Statistical analysis was performed using R software at a 95% confidence. The qualitative stage involved conducting key informant interviews among 15 clinicians, exploring their perceptions on routine insulin therapy among T2D patients. Qualitative data was analyzed using NVivo 12.
Results: The prevalence of clinical inertia was 54%. Single marital status increased the risk (OR 2.1; CI 95%; p=0.047), while male gender was protective (OR 0.65; CI 95%; p=0.041). Clinicians acknowledged the importance of insulin in T2D management but hesitated to prescribe it due to various patient and clinician related factors.
Conclusion and Recommendations: The study revealed a high prevalence of clinical inertia among T2D patients. Several patient and clinician related factors were identified as barriers to prescribing insulin therapy for T2D patients. Future research should include longitudinal studies to assess the evolving prevalence of clinical inertia to insulin therapy among T2D patients.