Abstract
Objective:
This study aimed to assess the barriers to initiating insulin therapy among family physicians managing patients with type 2 diabetes mellitus (T2DM) in primary healthcare centers within Saudi Arabia and to identify physician and practice characteristics associated with these barriers and confidence in insulin initiation.

Methods:
A quantitative cross-sectional observational study was conducted using a structured questionnaire among the family medicine physicians working in accredited PHCs. The questionnaire evaluated physician characteristics, available treatment resources, provider attitude, perceived barriers to insulin initiation, and criteria for insulin intensification.

Results:
A total of 208 physicians participated in the study. The mean total barrier score was 2.31 ± 0.33, with the highest domain score observed for provider reluctance attributable to patient factors (2.45 ± 0.41) and the lowest for provider reluctance attributable to self/system factors (2.09 ± 0.44). The most frequently reported patient barriers were inadequate diabetes and insulin education (72.1%), fear of injection (67.8%), and fear of hypoglycemia (63.5%). Only 46.2% of physicians reported confidence in initiating insulin therapy. Physicians managing a higher volume of diabetic patients demonstrated significantly greater confidence in insulin initiation (adjusted OR = 1.96, 95% CI 1.33–2.89, p=0.001). Female physicians reported slightly higher overall barrier scores than male physicians (β = 0.092, p=0.044), while education level and weekly patient volume were significantly associated with selected barrier domains.

Conclusion:
Patient-related concerns, particularly inadequate diabetes education, fear of injections, fear of hypoglycemia, and concerns regarding treatment adherence, remain the predominant barriers to insulin initiation among primary healthcare physicians.

Key words: Insulin, therapy, barriers, family physicians, diabetes mellitus, Saudi Arabia