Barriers for Insulin Therapy Initiation among Type 2 Diabetic Patients Attending the Specialized Center for Endocrinology and Diabetes / Baghdad 2019
Iraqi Postgraduate Medical Journal,
2021, Volume 20, Issue 2, Pages 186-192
The beginning of insulin therapy is a mutual decision between the health care provider and the patient. People with type 2 diabetes mellitus often have strongly negative attitudes toward insulin therapy. This refusal is often based on a range of patient concerns and misconceptions.
To determine the barriers for insulin therapy refusal among type 2 diabetic patient, and to find the association between socio-demographic characteristic and the barriers of refusal.
PATIENTS AND METHODS:
A cross sectional study was conducted during the period from first of March to 30th of June 2019 in the Specialized Center for Endocrinology and Diabetes in Al-Kindy Teaching Hospital in Baghdad/Al-Rusafa. .The study was conducted by using a convenient sampling method of 400 patients’ withT2DM. A questionnaire form was used to collect demographic data, and appraisal of insulin therapy measured by Insulin Treatment Appraisal Scale (ITAS).
Perceived loss of control/ life style adaptation and restriction were the first barrier to initiation of insulin therapy (70.6%), and the least barrier to start insulin was perceived lack of positive gain (43. 1%), also there is statistically less negative appraisal scores in patients aged 45-60 years, males, higher educational levels and ‘10-12 years’ duration of illness, but no statistical difference in regards whether a family member or a friend used, or did not use insulin.
Many misconceptions about the use of insulin therapy can be corrected by working to increase patient education.
- DeFronzo RA, Ferrannini E, Groop L, Henry RR, Herman WH, Holst JJ, et al. Type 2 diabetes mellitus. Nature Reviews Disease Primers. 2015;1:15019.
- Defronzo RA. Banting Lecture. From the triumvirate to the ominous octet: a new paradigm for the treatment of type 2 diabetes mellitus. Diabetes. 2009;58:773-95.
- DeFronzo RA, Eldor R, Abdul-Ghani M. Pathophysiologic approach to therapy in patients with newly diagnosed type 2 diabetes. Diabetes care. 2013;36(Supplement 2):S127-S38.
- Abdul Ghani MA, Puckett C, Triplitt C, Maggs D, Adams J, Cersosimo E, et al. Initial combination therapy with metformin, pioglitazone and exenatide is more effective than sequential add‐on therapy in subjects with new‐onset diabetes. Results from the Efficacy and Durability of Initial Combination Therapy for Type 2 Diabetes (EDICT): a randomized trial. Diabetes, Obesity and Metabolism. 2015;17:268-75.
- Hu Y, Li L, Xu Y, Yu T, Tong G, Huang H, et al. Short-term intensive therapy in newly diagnosed type 2 diabetes partially restores both insulin sensitivity and β-cell function in subjects with long-term remission. Diabetes care. 2011;34:1848-53.
- Gram J, Henriksen JE, Grodum E, Juhl H, Hansen TB, Christiansen C, et al. Pharmacological treatment of the pathogenetic defects in type 2 diabetes: the randomized multicenter South Danish Diabetes Study. Diabetes Care. 2011;34:27-33.
- American College of Physicians, Burns C. MKSAP® 18 Endocrinology and Metabolism. United States. 2018: 14-15.
- Khan AR, Al-Abdul Lateef ZN, Al Aithan MA, Bu-Khamseen MA, Al Ibrahim I, Khan SA. Factors contributing to non-compliance among diabetics attending primary health centers in the Al Hasa district of Saudi Arabia. Journal of family & community medicine. 2012;19:26-32.
- Al‑Haddad HM, Al‑Ali SA, Al‑Drees AM, Mahdi A. Practice and Attitude of Insulin Therapy Initiation for Type 2 Diabetes Mellitus Patients among General Practitioners and Family Physicians in Primary Health‑Care Setting in Al‑Ahsa. International J. of Scientific Study. 2018;6:15-23.
- Rubino A., McQuay L.J., Gough S.C., Kvasz M., Tennis P. Delayed initiation of subcutaneous insulin therapy after failure of oral glucose-lowering agents in patients with Type 2 diabetes: a population-based analysis in the UK. Diabet Med. 2007;24:1412–18.
- Wong S., Lee J., Ko Y., Chong M.F., Lam C.K., Tang W.E. Perceptions of insulin therapy amongst Asian patients with diabetes in Singapore. Diabet Med. 2011;28:206–211.
- Snoek FJ, Skovlund SE, Pouwer F. Development and validation of the insulin treatment appraisal scale (ITAS) in patients with type 2 g
- Yiu MP, Cheung KL, Chan KW. A questionnaire study to analyze the reasons of insulin refusal of DM patients on maximum dose of oral hypoglycemic agents (OHA) among 3 GOPC in Kowloon West Cluster. Hospital Authority. 2010;5:38.
- Ali M.H. Psychological Resistance to Insulin Therapy among Type 2 Diabetes Patients in a Specialized Center in Baghdad. Thesis submitted as a Partial Fulfillment of the second part of the Arab Board in Community Medicine.2015
- Taylor S, Thompson F, McDermott R. Barriers to insulin treatment among Australian Torres Strait Islanders with poorly controlled diabetes. Australian Journal of Rural Health. 2016;24:363-70.
- Saleem A, Masood I, Khan TM. Insulin perception among insulin-naïve type-2 diabetes mellitus patients in Pakistan. Cogent Medicine. 2016;3:1229374.
- Polonsky WH, Fisher L, Guzman S, Villa-Caballero L, Edelman SV. Psychological insulin resistance in patients with type 2 diabetes: the scope of the problem. Diabetes care. 2005 Oct 1;28:2543-5.
- Ali MH, AbdulRaheem Y. Psychological Resistance to Insulin Therapy among Type 2 Diabetes Patients in a Specialized Center in Baghdad. Thesis submitted as a Partial Fulfillment of the second part of the Arab Board in Community Medicine. [Thesis]. In press 2015.
- Abdulkader MA. Resistance to insulin among patients with type 2 diabetes at Duhok diabetes center. Muthanna Medical Journal. 2017;4:97-107.
- Mostafavian Z, Ghareh S, Torabian F, Yazdi MS, Khazaei MR. Data on insulin therapy refusal among type II diabetes mellitus patients in Mashhad, Iran. Data in brief. 2018;18:2047-50.
- Batais MA, Schantter P. Prevalence of unwillingness to use insulin therapy and its associated attitudes amongst patients with Type 2 diabetes in Saudi Arabia. Primary care diabetes. 2016;10:415-24.
- Bayoumy IE, Dawood W. Identifying and Addressing the Barriers of Insulin Use in Type II Diabetes Patients. EC Diabetes and Metabolic Research. October 30, 2018;2.2:38-46.
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