Data on insulin therapy refusal among type II diabetes mellitus patients in Mashhad, Iran

Reason for refusal of insulin therapy among type 2 diabetes mellitus patients in primary care clinic in Bangalore

Background

Early initiation of insulin therapy and thereby the better control of blood sugar levels has shown reduction in complications. Although insulin therapy has been demonstrated to be efficacious, its initiation is often delayed due to multiple factors including the refusal of insulin therapy by the patients. This study aims to explore the reasons for the refusal of insulin therapy in a resource-constrained primary care setting in an urban slum in India.

Materials and Methods

We included 148 patients who required insulin therapy but refused. A semi-structured questionnaire was administered by a primary care physician. Chi-square test was done to test the association between demographic factors and the reasons for refusal. P < 0.05 was considered as significant.

Results

The mean age of the patients was 49.53 (SD+/-9.8) years. Majority (40.5%) of the patients had diabetes for 6-10 years, and most of them were living with their families (89.9%) and 77% of them were dependent on their family for their financial and physical needs. Financial constraint was the most common reason for reason (74.3%) followed by afraid of pain (68.9%) and fear of dependency (57.4). Gender, occupation, and duration of diabetes and witnessing insulin administration were significantly associated with stigma related to insulin therapy.

Conclusion

Financial constraint is one of the key factors as patients have to buy insulin out of pocket and are not covered by insurance. Government initiatives to reduce and monitor the cost of the insulin would be of great benefit to the patients in this setting.

The barriers against initiating insulin therapy among patients with diabetes living in Yazd, Iran

INTRODUCTION

The decision to start insulin therapy is often difficult. Determining the barriers against insulin therapy initiation can facilitate care and treatment strategies. The aim of this study was to evaluate the barriers against initiating insulin therapy among patients with diabetes living in Yazd, Iran.

METHODS

This descriptive study was conducted on 214 patients referred to the Diabetes Center of Yazd University of Medical Sciences in 2015. Participants were randomly selected, and then they completed the insulin noncompliance questionnaire (20 questions). The percentage of adherence and the factors contributing to nonadherence to insulin therapy were analyzed using descriptive statistics, the Kruskal-Wallis test, and the Mann-Whitney test.

RESULTS

The most prevalent reason for insulin therapy refusal was expecting a new method of diabetes treatment (54.7%), followed by requiring someone else to administer the injection (19.2%), fear of needles, cost, traveling (18.7%), and stress/emotional problems (18.2%). Lack of trust in the physician was the least restrictive reason for nonadherence to insulin therapy.

CONCLUSION

The most common reason given for insulin therapy refusal was the lack of adequate education. Therefore, specialized educational interventions can help minimize barriers and improve patients' outcomes.